Browsing by Author "Commerford, Patrick"

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    Balloon mitral valvuloplasty at Groote Schuur Hospital : results, complications and short-term follow-up
    (1995) Lawrenson, John Bernard; Commerford, Patrick
    Balloon dilatation of the stenosed mitral valve, in an attempt to relieve symptoms, was developed to replace the surgical procedure of closed mitral valvotomy. This procedure, whereby a balloon tipped catheter is introduced from the femoral vein and directed across the mitral valve after an atrial septal puncture, was developed in 1982. The procedure was first performed at Groote Schuur Hospital in 1988. Two types of dilating balloon (Inoue and Bifoil types) have been used. The aim of this retrospective study was to analyze the results of balloon mitral valvuloplasty procedures performed from 1988 until November 1992. In addition a detailed analysis was made of all complications of the procedure. 118 patients (mean age 30.7 years) underwent 124 attempted procedures. 93 % of attempts were successfully completed and an optimal result was achieved in 76% of patients. Mitral valve area increased from 0.9cm² to 2.0cm². Equivalent results have been achieved with both balloon types. Death occurred in 1.6 % of patients. 2.4 % of patients had severe mitral regurgitation as a complication. 4% of procedures resulted in cardiac chamber perforation. The experience at Groote Schuur has been similar to other centres treating young patients with rheumatic mitral stenosis.
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    A sequential evaluation of left ventricular function in asymptomatic and symptomatic patients with chronic severe aortic regurgitation
    (1987) Sarembock, Ian J; Beck, Walter; Commerford, Patrick
    The optimal timing of valve replacement surgery in chronic severe aortic regurgitation (AR) has remained a major clinical problem in the management of these patients. Although the onset of symptoms is the generally accepted indication for aortic valve replacement (AVR), the unpredictable development of pre-symptomatic left ventricular (LV) dysfunction as a result of prolonged volume overload has resulted in numerous reports attempting to formulate a risk profile for these patients. Although aortic root and LV cineangiography have been the "gold standard" for defining the severity of AR and its effect on LV performance, serial follow-up by these means is impractical. More recently numerous non-invasive measures of LV size (echocardiogram) and function both at rest and on exercise (echocardiogram and equilibrium radionuclide angiocardiography., ERNA) have been serially utilised~ In these endeavours, the thinking has been clouded by a tendency to equate these two measures and failing to appreciate that apparent preoperative LV dysfunction (particularly on exercise) may be rapidly reversible by AVR and the consequent changes in LV loading conditions. This study was a prospective, sequential evaluation of left ventricular function using both non-invasive and invasive techniques in symptomatic and asymptomatic patients with isolated chronic, severe (4+) AR at cardiac catheterisation. The aims of the study were to (I) Identify differences in the clinical, echocardiographic, resting and exercise haemodynamic and I radionuclide measures of left ventricular function in symptomatic and asymptomatic patients with chronic severe A.R. with particular reference to the incidence of presymptomatic development of left ventricular dysfunction. (II) Critically evaluate the role of exercise stress (both isotonic and isometric) in the assessment of patients with chronic severe A.R. (III) Evaluate the influence of time (sequential studies) on the haemodynamic burden in asymptomatic patients. (IV) Study the impact of successful aortic valve replacement on the reversibility of abnormal pre-operative LV function in an attempt to predict which patients would benefit from this therapeutic intervention and whether operation for symptoms alone is the correct clinical practice.
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    The Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa
    (2006) Mayosi, Bongani; Robertson, Kate; Volmink, Jimmy; Adebo, Wole; Akinyore, Kingsley; Amoah, Albert; Bannerman, Charles; Biesman-Simons, Shan; Jonathan, Carapetis; Cilliers, Antoinette; Commerford, Patrick; Croasdale, Anne; Damasceno, Albertino; Dean, Jenny; Dean, Michael; de Souza, Robert; Filipe, Antonio; Hugo-Hamman, Chris; JurgensClur, Sally-Ann; Kombila-Koumba, Pierre; Kotzenberg, Christelle; Lawrenson, John; Manga, Pravin; Matenga, Jonathan; Mathivha, Tshimbi; Mntla, Phindile; Mocumbi, Ana; Mokone, Tiny; Ogola, Elijah; Omokhodion, Samuel; Palweni, Chapman; Pearce, Adrian; Salo, Avril; Thomas, Baby; Walker, Kathie; Wiysonge, Charles; Zaher, Salah
    This paper reviews some research studies on tillage methods influencing soil and moisture conservation in the eastern African countries of Kenya, Tanzania, Malawi and Ethiopia during the past four decades. Most of these studies were conducted in marginal rainfall (semi arid ) areas and on shallow soils of various textures (sandy clay loam, sandy clay, clay and loam). The studies were meant to establish the effects of tillage and residue management practices on physico-chemical soil properties (i.e. structure, bulk density, soil moisture and organic matter contents), runoff and infiltration. This review emphasizes the importance of appropriate tillage and residue management methods (contour bunds and terraces, minimum tillage, tied ridging, mulching and conventional tillage) in providing soil conditions favourable for soil moisture conservation and subsequent crop performance and yield on smallholder farms