Philippine Heart Research Articles

Pulmonary tuberculosis in Filipino children with congenital heart disease at Philippine Heart Center

Pulmonary tuberculosis in Filipino children with congenital heart disease at Philippine Heart Center

Philippine Heart Association-Council on Hypertension Report on Survey of Hypertension (PRESYON 3): A Report on Prevalence of Hypertension, Awareness and Treatment Profile

BACKGROUND: The Council on Hypertension (COH) has observed a progressive rise in the prevalence of hypertension in the Philippines based on the series of nationwide surveys it conducted from 1992 up to 2007. The increasing prevalence was associated with low rates of blood pressure (BP) control and treatment compliance; an increasing prevalence of co-morbidities; and evidence of target organ damage. With cardiovascular and cerebrovascular diseases being the most common causes of morbidity and mortality in the country, the COH conducted the present study as an update to determine the latest prevalence of hypertension, awareness, treatment profile and control rate, as well as the prevalence of co-morbidities and target organ damage. METHODOLOGY: This is a randomized, prospective, multi-stage, stratified, nationwide survey on hypertension. The study surveyed 300 Filipinos per region (aged 12 years and above) for a total target population of 3,900. Prevalence of hypertension from this base population was analyzed. History, anthropometric measurements, risk factor and co-morbidity assessment were included in the survey. RESULTS: This nationwide survey on hypertension conducted from December 2012 to May 2013 included 626 adolescent Filipinos (12-18 years old); 3,334 adults (≥18 years old); and 570 elderly Filipinos (≥ 60 years old). Of the total adult population (male: 48%, female: 52%), hypertension prevalence was 28%. The age- and gender- corrected prevalence of hypertension was 23%. The rate of increase started at age 30 years with male patients having a greater prevalence at age 30 to 39 years. Hypertension was more frequent among those aged at least 60 years. The prevalence of pre-hypertension was 48%; stage 1 hypertension was 48%; and stage 2 was 43%. The prevalence of hypertension was highest in Region 7 (Central Visayas) (35%), National Capital Region (33%) and Region 10 (North Mindanao) (32%). Prevalence was lowest in region 6 (Western Visayas) (13%). Prevalence was higher in urban (31%) than rural (25%) areas; and was highest in socio-economic class (SEC) Broad C (31%) and lowest in SEC-E patients (24%). Treatment rate was 56%, and was higher in urban areas and among SEC-AB/C+ (79%) and broad C (66%). Treatment compliance was 57%. The rate of BP control was 20%. Among those on medication, only 27% were controlled. The most commonly used antihypertensive medications were beta-blockers (36%); calcium channel blockers (CCB) (33%); angiotensin receptor blockers (ARB) (28%); angiotensin-converting enzyme (ACE) inhibitors (5%); and centrally acting agents (4%). Majority were on monotherapy (86%). KEYWORDS: Hypertension, Philippine prevalence, blood pressure awareness, compliance and control.

Early and Late Outcome of Surgery for Ebstein Anomaly: A 20-year Experience in Philippine Tertiary Centers

BACKGROUND: Ebstein Anomaly (EA) is a rare congenital heart disease. Clinical presentation depends on the severity of tricuspid valve displacement and associated intracardiac congenital anomalies. Surgical indications have been described on recent guidelines, resulting in favorable outcomes in well-selected patients. There is no published experience in tricuspid valve surgery for EA in the Philippines. OBJECTIVES: To describe the clinical profile of patients who underwent cardiac surgery for EA from 1992 to 2012 in the Philippines, and to compare the clinical characteristics of survivors and immediate non-survivors of tricuspid valve surgery for EA. METHODOLOGY: This was a retrospective cohort study on patients who underwent cardiac surgery from 1992 to 2012, at the Philippine Heart Center and Philippine General Hospital. Characteristics between survivors and non-survivors were compared. RESULTS: Twenty-eight patients underwent cardiac procedures for EA from 1992 to 2012 in the Philippines. The mean age at operation was 12 years. Majority of the patients were males (57%) and were at least 18 years old (75%). Among the 28 patients, 21 were identified to have undergone a definitive treatment (i.e., either tricuspid valve (TV) repair or replacement. Mean total bypass time was 148.71 minutes ± 133.31. Mean total cross-clamp time was 89.89 minutes ± 46.65. The most common surgical complications were prolonged intubation (32%) and atrial arrhythmias (21%). The average length of hospital stay was 20.67 days ± 11.64. Follow-up was possible in 20 out of the 21 patients (95%). There were three early deaths (< 30 days), all of whom had TV repair. Of the 18 survivors, 15 underwent TV repair while three underwent TV replacement. Non-survivors had significantly lower arterial oxygen saturation (p=0.045), more post-operative bleeding (p=0.014), and greater post-operative need for hemodialysis (p=0.014). Exact logistic regression did not reveal any significant predictor of mortality among the various characteristics analyzed, probably due to the small number of patients in this study.

Burden of Smoking in Acute Coronary Syndrome

The purpose of this study was to evaluate the burden of smoking among patients who had acute coronary syndrome seen at Philippine Heart Center in terms of its outcomes and expenditures. 199 patients (138 males and 61 females) participated in the study. Smoking habits were recorded including their co-morbidities, GRACE and TIMI scores. Financial data were gathered, tabulated and evaluated. Outcomes of ACS were tabulated in relation to patients9 smoking history and were evaluated. In this study, it shows that among those patients who have acute coronary syndromes, predominantly were smokers, both direct and passive smokers comprising 72% of the patients. In a developing country like ours, the mean amount expended for each person admitted for acute coronary syndrome who smokes (direct and passive) was two hundred forty-seven thousand two hundred sixty pesos (PhP 247, 260.00 ± 276,428.00 excluding physician9s professional fee) which is already a sumptuous that drains one9s finances. And of these, for every smoker patients who had acute coronary syndrome, the mean expenses for each person with each admission were PhP 217,160.00 ± 226,791.09 for those who survived and were discharged and PhP 517,960.00 ± 448,085.23 for those who died. Therefore, smoking is still prevalent among patients who have acute coronary syndrome and with each admission, each patient expend a sumptuous amount of money for the health resources.

Predictors of Postoperative Pulmonary Complications in Children Undergoing Cardiothoracic Surgery at the Philippine Heart Center (PREdICt Phase I)

Predictors of Postoperative Pulmonary Complications in Children Undergoing Cardiothoracic Surgery at the Philippine Heart Center (PREdICt Phase I)

Pericardial Abscess: A Rare Complication of Pyogenic Liver Abscess

Massive pericardial effusion from rupture of a hepatic abscess is rare. We report an unusual case of a pericardial abscess caused by a poorly treated hepatic abscess. This is the case of a 60-year old male with exertional dyspnea, intermittent low back pain, occasional low-grade fever; and progressive malaise, anorexia and weight loss. One month prior to admission, an abdominal ultrasound showed a left hepatic abscess. The patient was treated with metronidazole, but had poor compliance. A later two dimensional echocardiogram with doppler showed a massive pericardial effusion with no signs of tamponade. The patient was then referred to the Philippine Heart Center. On physical examination, heart sounds were muffled. Hematology revealed leukocytosis. Electrocardiography showed sinus tachycardia, isolated premature ventricular depolarization, and low-voltage chest leads. Subxiphoid tube pericardiostomy drained one liter of purulent non-foul smelling pericardial fluid. Cytology and chemistry showed an inflammatory process. Gram staining showed pus cells and gram-positive cocci in pairs. The patient was given intravenous (IV) metronidazole 500 mg every 8 hours, and IV ampicillin 1.5 mg every 8 hours. Computerized tomography of the upper abdomen revealed a large abscess at the lateral segment of the left lobe of the liver; hepatic cortical cysts; and minimal pericardial effusion. On the 20th hospital day, the subxiphoid catheter was removed and the patient was discharged. Home medications included oral metronidazole and ampicillin-sulbactam for 2 weeks. The hepatic catheter was then subsequently removed after another 2 weeks.

Tetralogy of Fallot: A Philippine Heart Center Review

INTRODUCTION: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease (CHD) in the adult. The Philippine Heart Center (PHC) performs surgery on most TOF patients, averaging 50 patients per year. This study aimed to provide a comprehensive review of literature regarding TOF post operative outcomes in the Philippines. METHOD: Studies conducted at PHC that included 20 or more patients were included and reviewed independently by two investigators for validity. RESULTS: Five published and 22 unpublished studies were retrieved, with 12 studies meeting the inclusion criteria and validity standards. The mean mortality rate with TOF correction at the PHC from 1975 to 2011 was 6.7%. From 2000-2011, the mortality rate was 5.50%. Complications included myocardial failure, arrhythmias, infective endocarditis, and growth retardation. Electrocardiography and two dimensional echocardiography were indispensable tools in the follow-up of TOF patients post correction. Most patients had New York Heart Association Functional Class I, and had normal exercise tolerance, intelligence, and fertility. CONCLUSION: Although surgical outcome has been good in the Philippines, there should be emphasis on earlier intervention to avoid complications. With the growing number of TOF patients who survive into adulthood, it is important to have consistent follow-up with an expert cardiologist keen on CHD.

Correlation of physiologic functional variable with hemodynamic variables among Filipino children with pulmonary arterial hypertension: Philippine Heart Center experience

Correlation of physiologic functional variable with hemodynamic variables among Filipino children with pulmonary arterial hypertension: Philippine Heart Center experience

Multinomial logistic regression modelling of cardiologists' awareness of the impact of air pollution on cardiovascular disease in Vietnam and the Philippines

The Air Pollution (AP) situation in Vietnam and the Philippines has deteriorated in recent years. During this time period, mortality rates from Cardiovascular Diseases (CVDs) have remained in the top ten of all causes of deaths. The aim of this paper is to understand and model the awareness of cardiologists of the potential impact of AP on CVD in both nations. A full-scale survey covering 321 cardiologists was conducted in Vietnam (27 hospitals across the country) and the Philippines (members of the Philippine Heart Association with a subset from Davao Province). The paper reports on extensive results obtained through descriptive analysis and logistic regression modelling.

Pediatric Risk Stratification Method (PediaRiSM) for Postoperative Pulmonary Complications for Cardiothoracic Surgery: A Validity Study at the Philippine Heart Center

Pediatric Risk Stratification Method (PediaRiSM) for Postoperative Pulmonary Complications for Cardiothoracic Surgery: A Validity Study at the Philippine Heart Center

Determination of the Utility of the Spo2/Fio2 Ratio in the Diagnosis of Patients Admitted at the Philippine Heart Center With Acute Lung Injury or Acute Respiratory Distress Syndrome: A Cross-sectional Study

Determination of the Utility of the Spo2/Fio2 Ratio in the Diagnosis of Patients Admitted at the Philippine Heart Center With Acute Lung Injury or Acute Respiratory Distress Syndrome: A Cross-sectional Study

Abstract A136: Immunohistologic and clinicopathologic profile of thymic epithelial tumors: A 30-year experience in the Philippine Heart Center

Abstract The thymus, said to be the “organ of mystery” throughout the 2000-year history of medicine, demonstrates a variety of clinical and pathologic manifestations that require comprehensive understanding of its entity. In this study, we discuss the profile of patients with thymic epithelial tumors seen in the Philippine Heart Center, including the variable clinical, pathologic, immunohistochemical and prognostic features. For the last 30 years, surgically resected cases of thymic epithelial tumors were reviewed. We used descriptive statistics and quanititative variables are expressed as mean, range and standard deviation whereas qualitative variables are expressed as proportion. A comprehensive review of the tumor registry in our center revealed majority of mediastinal masses, 75% occured at the anterior compartment, 4% in the posterior compartment and 1% from the superior compartment. Thymomas are most common among the adult age group with an average mean age of 42 years. Other thymic tumors encountered were thymic carcinoma, lymphoma, cysts, and carcinoid. In recent years, several variants of thymic epithelial tumors have been observed, some with unique biological behavior, high malignant potential, frequent metastases, and tumor recurrence. Such cases as primary neuroendocrine carcinoma with oncocytic differentiation, composite Hodgkins and Non-Hodgkins lymphoma arising from the thymus and thymic carcinoma arising from a thymoma has definitely challenged the Pathologist. In such cases, several battery of immunohistochemical studies were done, such as Cytokeratin 7 and 20, Chromogranin, Synaptophysin, Neuron Specific Enolase, CD 3, CD 15, CD 20, CD 30, CD 68, and LCA. The series of neoplasm presented varies in clinical and histopathologic presentation. Its histologic variants and spectrum of differentiation are necessary to be defined, the soonest possible time. This will eventually lead the pathway towards treatment options. The World Health Organization histologic classification for thymic tumors paved the way to a better phase in the prognostication of thymic epithelial tumors. A greater challenge for the Pathologist is to prove the existence of synchronous, concurrent and composite tumors in the thymus. Most of these tumors are far advanced upon diagnosis, and therefore requires more aggressive treatment. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A136.

Risk factors of pleuro-pericardial effusion among pediatric patients with initial presentation of pleural effusion alone and pericardial effusion alone at Philippine Heart Center

Risk factors of pleuro-pericardial effusion among pediatric patients with initial presentation of pleural effusion alone and pericardial effusion alone at Philippine Heart Center

Effect of Ascorbic Acid on Dyslipidemia [A Study Among Philippine Heart Center Employees

Effect of Ascorbic Acid on Dyslipidemia [A Study Among Philippine Heart Center Employees

P-296 Prevalence of Carotid Artery Stenosis in Patients with Coronary Artery Disease A Philippine Heart Center (PHC) Experience

P-296 Prevalence of Carotid Artery Stenosis in Patients with Coronary Artery Disease A Philippine Heart Center (PHC) Experience

30 years of experience in the Philippine Heart Center: P1-158: Thoracocardiovascular surgery and pathology of 255 patients with cardiac tumors

30 years of experience in the Philippine Heart Center: P1-158: Thoracocardiovascular surgery and pathology of 255 patients with cardiac tumors

First National Meeting on Quality Assurance in Healthcare in the Philippines

Quality assurance activities have been undertaken for a number of years in the Philippines, such as those by the Nutrition Service of the Department of Health; HAMIS, a GTZ-DOH project; the QAP Committee of the Task Force on Health Systems Research; Clinical Epidemiology Unit of the PGH-UP College of Medicine; Social Development and Research Center, De La Salle University; Philippine Heart Center and Lung Center of the Philippines (DOH); major tertiary private hospitals (Makati Medical Center, St. Luke's Medical Center and Medical City General Hospital), and others. However, many of these activities and others which may not have been labeled as such, were being undertaken in isolation with no interaction with the other institutions. When some of the QA proponents learned about the programs in other institutions, they asked: Why don't we get together and share our ideas and experiences? Furthermore, the National Health Insurance Act (RA 7875), enacted the previous year, provides for universal compulsory health insurance for all citizens and residents in the country. The law stipulates that to be accredited to participate in the National Health Insurance Program, health care providers, including hospitals, arc required to establish quality assurance programs. Thus, on 14 May 1996, a group of health professionals and representatives of hospitals, academic institutions, government agencies, and professional organizations met to discuss the proposal to hold the First National Meeting on Quality Assurance in Health. It was decided to hold the meeting on 8-9 November 1996 at the Makati Medical Center, Makati City, Metro Manila.

Atrioventricular Conduction in Sick Sinus Syndrome

With the increasing recognition of the pacemaker syndrome and with the availability of newer methods of pacing therapy, the status of the atrioventricular (AV) conduction in patients with Sick Sinus Syndrome (SSS) becomes crucial in the choice of mode of pacing. At the Philippine Heart Center, from April 1983 to November 1986, the sinus and AV node function studies of 46 patients who, by electrophysiological studies had sinus node dysfunction (SND)-SN recovery time (SNRT) greater than 1400 msec, were reviewed. These were arbitrarily classified according to duration of SNRT into: Group A--borderline SND, SNRT from 1,401 to 1,499 msec (n = 4); Group B--mild SND, SNRT from 1,500 to 2,499 msec (n = 25); Group C--moderate SND, SNRT from 2,500 to 3499 msec (n = 6); Group D--severe SND, SNRT of 3,500 m and above (n = 11). Out of the 46, 14 (30%) had concomittant AVN dysfunction (AVND)--antegrade block rate less than 130 beats per minute (BPM). The percentage occurrence of AVND was noted as follows: Group A--25% (1/4); Group B--28% (7/25); Group C--50% (3/6); Group D--27% (3/11). Out of the 14 patients with concomittant AVND, 5(35%) had antegrade block rate less than 100 BPM, 3 in Group B and 2 in Group D. The study shows that AVND occurs in only 30% of SSS patients. Its occurrence and severity has no bearing on the degree of SND. In these, antegrade block was at a rate higher than 100 BPM in the majority of patients.(ABSTRACT TRUNCATED AT 250 WORDS)