Nigel Wilson

Auckland District Health Board, Окленд, Auckland, New Zealand

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Publications (34)56.69 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To estimate the echocardiography confirmed prevalence of rheumatic heart disease (RHD) in school children in Fiji. Cross-sectional observational study. Ten primary schools in Fiji. School children aged 5-14years. Each child had an echocardiogram performed by an echocardiographic technician subsequently read by a paediatric cardiologist not involved with field screening, and auscultation performed by a paediatrician. Echocardiographic criteria for RHD diagnosis were based on those previously published by the National Institutes of Health (NIH) and World Health Organization (WHO), and data were also analyzed using the new World Heart Federation (WHF) criteria. Prevalence figures were calculated with binomial 95% confidence intervals. Using the modified NIH/WHO criteria the prevalence of definite RHD prevalence was 7.2 cases per 1000 (95% CI 3.7-12.5), and the prevalence of probable RHD 28.2 cases per 1000 (95% CI 20.8-37.3). By applying the WHF criteria the prevalence of definite and borderline RHD was 8.4 cases per 1000 (95% CI 4.6-14.1) and 10.8 cases per 1000 (95% CI 6.4-17.0) respectively. Definite RHD was more common in females (OR 5.1, 95% CI 1.1-48.3) and in children who attended school in a rural location (OR 2.3, 95% CI 0.6-13.50). Auscultation was poorly sensitive compared to echocardiography (30%). There is a high burden of undiagnosed RHD in Fiji. Auscultation is poorly sensitive when compared to echocardiography in the detection of asymptomatic RHD. The results of this study highlight the importance of the use of highly sensitive and specific diagnostic criteria for echocardiography diagnosis of RHD.
    International journal of cardiology 03/2014; · 6.18 Impact Factor
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    ABSTRACT: This study identified tracheobronchial cartilage calcification in children with congenital heart disease. Calcification of the tracheobronchial airways has been found previously in adults receiving warfarin and in children receiving warfarin after mitral valve replacement. A 9-year-old girl who had received a Fontan repair 6 years previously underwent a cardiac computed tomography (CT) scan to evaluate pulmonary artery size. The result was an incidental finding of extensive tracheobronchial cartilage calcification. A retrospective review of all pediatric Fontan patients who had undergone cardiac CT was conducted to search for calcification of the tracheobronchial cartilage. The study investigated ten pediatric Fontan patients who had undergone cardiac CT scanning. Two patients with extensive calcification of the tracheobronchial airways were identified. The index case had hypoplastic left heart syndrome, and the patient had undergone a staged repair with the Fontan at the age of 3 years. A 16-year-old boy with tricuspid atresia had undergone staged repair and Fontan at the age of 3.5 years. These two patients had received continuous warfarin therapy for 6 and 13 years, respectively. Other common causes of airway calcification were excluded from the study. This report describes warfarin-induced tracheobronchial calcification in patients after the Fontan procedure. This finding has possible implications for airway growth and vascular calcification.
    Pediatric Cardiology 03/2014; · 1.20 Impact Factor
  • Nicole J Moreland, Nigel J Wilson
    Pediatric Cardiology 01/2014; · 1.20 Impact Factor
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    ABSTRACT: Mitral valve (MV) repair offers potential advantages over replacement in patients with rheumatic heart disease (RHD). We present the first long-term study that compares MV repair with replacement in children with RHD. Single institute retrospective review of patients with RHD under 20 years of age, who underwent their first isolated MV surgery between 1990 and 2006. Of the 81 patients, 98% were Māori or Pacific Islander. The median age was 12.7 (3-19) years. The MV was repaired in 59%, a mechanical valve replacement (MVR) took place in 35% and bioprosthetic valve replacement in 6% of the patients. Follow-up data were available for 91.4% of the patients with mean follow-up of 7.6 years (range 0-19.4 years), a total of 620 patient years. Actuarial survival at 10 and 14 years for patients with MVR was 79% and 44%, compared to 90% and 90% for patients who underwent repair (P = .06). Actuarial freedom from late reoperation at 10 and 14 years for patients with MVR was 88% and 73%, compared to 76% and 76% for patients with repair (P = .52). Actuarial freedom from thrombotic, embolic, and hemorrhagic events at 10 and 14 years for patients with MVR was 63% and 45%, compared to 100% and 100% for patients with repair P < .01). This study shows that MV repair is superior to replacement for RHD in the young with follow-up to 19 years. Repair offers a survival advantage, greater freedom from valve-related morbidity, and long-term durability that equals that of MVR.
    World journal for pediatric & congenital heart surgery. 04/2013; 4(2):155-164.
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    ABSTRACT: The aim of the study was to compare utilisation of the New Zealand guidelines for the diagnosis of acute rheumatic fever (ARF) compared to the American Heart Association Jones criteria in a cohort of children Retrospective review of 79 consecutive hospital diagnosed cases of ARF referred for secondary penicillin prophylaxis. The 2006 New Zealand guidelines for ARF were applied to the cohort and the diagnostic classification compared to classification using the American Heart Association 1992 Jones criteria. Cases were defined as definite, probable, possible or not ARF. The New Zealand guidelines use subclinical (echocardiographic) carditis as a major criterion of ARF. Monoarthritis, if associated with anti-inflammatory medicine usage likely preventing polyarthritis, is also accepted as a major criterion. Sixty-six cases were considered to be possible, probable or definite first episode of occurrence ARF. Utilisation of the New Zealand guidelines resulted in 16% (CL 7a29%) more cases defined as definite ARF than using American Heart Association 1992 Jones criteria (59/66 cases vs 51/66 cases). Polyathritis was the most frequent presenting symptom. Of those classified as definite ARF, 11% had monoarthritis with anti-inflammatory usage. Clinical carditis was present in 55% and subclinical carditis in 30%. The utilisation of subclinical carditis as a major criterion influenced the diagnosis to become definite ARF in 8% of the cohort only, as the remainder had polyarthritis or Sydenham's chorea as a major criterion. Utilisation of New Zealand guidelines for the diagnosis of ARF result in a modest increase (16%) in cases classified as definite ARF compared to the 1992 Jones criteria.
    The New Zealand medical journal 01/2013; 126(1379):50-9.
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    Anita Saxena, Liesl Zühlke, Nigel Wilson
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    ABSTRACT: The advent of portable echocardiography has led to screening for rheumatic heart disease (RHD) with high disease prevalence found in many countries. Data are presented from studies from India, Africa, and New Zealand. The natural history of subclinical echocardiographically detected RHD is the most important research question to be answered before more widespread screening is endorsed. The 2012 World Heart Federation (WHF) criteria for the echocardiographic diagnosis of RHD provide standardization of RHD diagnosis, increasing the specificity for definite RHD and raising the threshold for borderline RHD. Use of the criteria should reduce the false positive rate for minor echocardiographic changes due to physiological valvular regurgitation. This review highlights issues of screening for RHD that are of relevance to the cardiology community.
    Global Heart. 01/2013; 8(3):197–202.
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    Kirsten Finucane, Nigel Wilson
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    ABSTRACT: This review outlines a philosophy of surgical cardiac care for rheumatic heart disease, which has evolved over the past 2 decades, in the young in the Oceania region. Topics covered include the optimal timing of surgery, recommended strategies for mitral and aortic valve disease, and the importance of the team approach to these patients. There is a global priority for more cardiac surgeons to become skilled in repair of the rheumatic mitral valve. Surgeons operating on patients from remote regions with RHD are encouraged to audit outcomes and help these communities develop their health services to optimize continued RHD care.
    Global Heart. 01/2013; 8(3):213–220.
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    ABSTRACT: We designed a pilot study of a training module for nurses to perform rheumatic heart disease echocardiography screening in a resource-poor setting. The aim was to determine whether nurses given brief, focused, basic training in echocardiography could follow an algorithm to potentially identify cases of rheumatic heart disease requiring clinical referral, by undertaking basic two-dimensional and colour Doppler scans. Training consisted of a week-long workshop, followed by 2 weeks of supervised field experience. The nurses' skills were tested on a blinded cohort of 50 children, and the results were compared for sensitivity and specificity against echocardiography undertaken by an expert, using standardised echocardiography definitions for definite and probable rheumatic heart disease. Analysis of the two nurses' results revealed that when a mitral regurgitant jet length of 1.5 cm was used as the trigger for rheumatic heart disease identification, they had a sensitivity of 100% and 83%, respectively, and a specificity of 67.4% and 79%, respectively. This pilot supports the principle that nurses, given brief focused training and supervised field experience, can follow an algorithm to undertake rheumatic heart disease echocardiography in a developing country setting to facilitate clinical referral with reasonable accuracy. These results warrant further research, with a view to developing a module to guide rheumatic heart disease echocardiographic screening by nurses within the existing public health infrastructure in high-prevalence, resource-poor regions.
    Cardiology in the Young 10/2012; · 0.95 Impact Factor
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    ABSTRACT: Pre-operative end-systolic volume (ESV) is predictive of outcome after surgery for severe aortic regurgitation. ESV is influenced by body size and reflects function and afterload, but not pre-load. Left ventricular (LV) chamber size and function were measured in 40 patients (ages 10 to 64 years) by echocardiography before and 7 months after operation and expressed as z-scores in addition to simple indexing. A functional pre-load index, a marker of pre-load reserve, was calculated. Independent risk factors for post-operative LV dysfunction included higher post-operative ESV z-score (odds ratio [OR]: 3.3, p = 0.006) and lower functional pre-load index (OR: 0.3, p = 0.03). ESV per square meter had similar power to the ESV z-score. The ESV uncorrected for body size underestimated risk in smaller patients and overestimated risk in larger patients (p < 0.002). Pre-load reserve is an independent risk factor for LV dysfunction after aortic valve surgery in patients with severe aortic regurgitation. Failure to correct ESV for body size introduces systematic bias to risk assessment.
    JACC. Cardiovascular imaging 06/2012; 5(6):626-33. · 14.29 Impact Factor
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    ABSTRACT: Over the past 5 years, the advent of echocardiographic screening for rheumatic heart disease (RHD) has revealed a higher RHD burden than previously thought. In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune. Systematic differences in the reporting of and diagnostic approach to RHD exist, reflecting differences in local experience and disease patterns. The World Heart Federation echocardiographic criteria for RHD have, therefore, been developed and are formulated on the basis of the best available evidence. Three categories are defined on the basis of assessment by 2D, continuous-wave, and color-Doppler echocardiography: 'definite RHD', 'borderline RHD', and 'normal'. Four subcategories of 'definite RHD' and three subcategories of 'borderline RHD' exist, to reflect the various disease patterns. The morphological features of RHD and the criteria for pathological mitral and aortic regurgitation are also defined. The criteria are modified for those aged over 20 years on the basis of the available evidence. The standardized criteria aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs. However, important unanswered questions remain about the importance of subclinical disease (borderline or definite RHD on echocardiography without a clinical pathological murmur), and about the practicalities of implementing screening programs. These standardized criteria will help enable new studies to be designed to evaluate the role of echocardiographic screening in RHD control.
    Nature Reviews Cardiology 02/2012; 9(5):297-309. · 10.40 Impact Factor
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    ABSTRACT: The aim of this programme was to find undetected rheumatic heart disease (RHD) in students from selected schools in the Tairawhiti region (eastern part of the North Island) of New Zealand. Portable echocardiography was used to scan students in 5 urban and rural schools in Tairawhiti where the population is predominantly Maori. The age range of students in the urban schools was 10-13 years and in the rural schools 5-17 years. Those with abnormal echocardiograms were referred for a paediatric consultation, with hospital-based echocardiography if required for the clarification of diagnoses and further management. A total of 685 students, representing over 95% of the schools' students, consented to having echocardiographic scanning. After repeat hospital based echocardiography for 11 students, a total of 52 scans were regarded as abnormal. In this population definite (n=4) or probable (n=7) RHD was found in 11 students a prevalence of 1.61% (95%CIs 0.80-2.85). Possible RHD was found in 19 students. Previously undetected confirmed (n=1) or probable (n=7) RHD was found in 8 students a prevalence of 1.17% (95%CIs 0.51-2.29). Congenital heart defects (CHD) were found in 22 students a prevalence of 3.21% (95%CIs 2.02-4.83). Echocardiography was a popular modality and detected a significant burden of previously unknown RHD in this young Maori population who are now receiving penicillin. However, echocardiography detected a greater prevalence of possible RHD for which optimum management is at present uncertain. Echocardiography also detected students with a range of severity of CHD. Screening with echocardiography for RHD would involve a significant use of public health, paediatric and cardiac resources with 7.6% of students and their families requiring clinical consultations and ongoing management of the abnormal echocardiographic results.
    The New Zealand medical journal 01/2012; 125(1363):53-64.
  • Rachel Webb, Nigel Wilson
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    ABSTRACT: Acute rheumatic fever and its sequel rheumatic heart disease remain major unsolved problems in New Zealand, causing significant morbidity and premature death. The disease burden affects predominantly indigenous Māori and Pacific Island children and young adults. In the past decade these ethnic disparities are even widening. Secondary prophylaxis using 28-day intramuscular penicillin has been the mainstay of disease control. In the greater Auckland region, audit shows community nurse-led penicillin delivery rates of 95% and recurrence rates of less than 5%. The true penicillin failure rate of 0.07 per 100 patient years supports 4 weekly penicillin rather than more frequent dose regimens. Landmark primary prevention research has been undertaken supporting sore throat primary prevention programmes in regions with very high rheumatic fever rates. Echocardiographic screening found 2.4% previously undiagnosed rheumatic heart disease in socially disadvantaged children. Combined with secondary prevention, echocardiography screening has the potential to reduce the prevalence of severe rheumatic heart disease.
    Journal of Paediatrics and Child Health 11/2011; · 1.25 Impact Factor
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    ABSTRACT: The aim of this study was to review the severity and morbidity of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) for children with the most significant cardiac disease in the current era in New Zealand. Retrospective 2-year review of children with ARF and RHD admitted to Starship Children's cardiology ward. Medical and surgical admissions were classified. Echocardiographic severity of cardiac disease and cardiac surgical data were analyzed. Using length of stay data and 2009 District Health Board costings, admission costs were calculated. 36 children had 49 admissions. Mean age 11.8 plus or minus 2.4 years. All but one child was of Māori or Pacific Island ethnicity. 10 children had symptoms and signs of congestive cardiac failure on admission. The average length of stay was 23 days, but the subset of children with ARF requiring cardiac surgery at the same admission had an average of 54 days (range 36-78 days) in hospital. The total hospital costs over the 2-year period was $1,918,600. Failure to prevent rheumatic fever in New Zealand means that there is significant cardiac sequelae for those children who develop severe RHD. The early morbidity includes heart failure, need for cardiac surgery, and prolonged hospital stay.
    The New Zealand medical journal 01/2011; 124(1343):57-64.
  • Heart Lung and Circulation - HEART LUNG CIRC. 01/2011; 20(6):405-406.
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    ABSTRACT: For patients with an atrial septal defect and pulmonary hypertension it can be difficult to determine whether it is safe to intervene. With newer treatments for pulmonary hypertension and transcatheter techniques avoiding surgical stressors, it has been hoped that we can occlude previously inoperable defects safely. We undertook a subgroup analysis of outcomes for patients with mean pulmonary artery pressure (PAp) ≥30mmHg from within our database of patients undergoing transcatheter ASD closure from 1997 to 2004. Data for 11 patients were reviewed. Mean age of the patients at intervention was 38 years (5-69 years). Eight patients have had symptomatic improvement with no evidence of progressive pulmonary hypertension. There was one death due to unrelated causes. Two patients have developed progressive pulmonary vascular disease with one death. Despite early symptomatic improvement, adverse outcomes may occur in patients with elevated pulmonary vascular resistance undergoing transcatheter ASD closure. Careful haemodynamic evaluation is vital. Modest elevation of pulmonary vascular resistance and the presence of left to right shunt (Qp:Qs>1.5:1) are reassuring.
    Heart Lung &amp Circulation 12/2010; 19(12):713-6. · 1.25 Impact Factor
  • Nigel Wilson
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    ABSTRACT: Rheumatic fever continues unabated among the indigenous Māori and Pacific Island New Zealanders. Ethnic disparities have increased in the past decade. The major success story for disease control has been secondary penicillin prophylaxis with 28-day intramuscular benzathine penicillin with high penicillin delivery rates and low recurrence rates. A landmark study for primary prevention of acute rheumatic fever for group A streptococcal pharyngitis was published in 2009. New Zealand has helped establish the role of echocardiography in acute rheumatic fever, with subclinical carditis incorporated into guidelines as a major criterion of rheumatic fever in high prevalence regions. The rates of mitral valve repair for rheumatic heart disease (RHD) are currently greater than 90% in the children's cardiac unit but remain low in adult cardiac units in New Zealand. This is particularly relevant to women of child bearing age where New Zealand data has shown that pregnancy outcomes for mothers with prosthetic valves on warfarin are poor. There are new initiatives to prevent severe RHD using portable echocardiography by screening school aged children. The prevalence of definite RHD was 2.4% in a large cohort of socially disadvantaged children in South Auckland studied in 2007-2008. Cost benefit models of screening need to be developed. Ongoing research involves international consensus standardisation of RHD patterns, and the need to define the natural history of subclinical RHD.
    Heart Lung &amp Circulation 01/2010; 19(5-6):282-8. · 1.25 Impact Factor
  • Heart Lung and Circulation - HEART LUNG CIRC. 01/2010; 19.
  • Heart Lung and Circulation - HEART LUNG CIRC. 01/2010; 19.
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    ABSTRACT: Rheumatic heart disease (RHD) is an important cause of morbidity and mortality in young people in developing countries. Many cases of RHD are first detected when they progress to cardiac failure. Screening for RHD represents a means of detecting cases early so that preventative measures to halt the disease progression can be put into place. A cross-sectional screening survey of RHD in 3,462 children aged 5 to 15 years in Fiji was performed in 2006. A three-stage screening method was used: stage 1 involved auscultatory screening; stage 2 was a limited echocardiography of children identified as having a suspicious murmur in stage 1; and stage 3 involved a full echocardiography of children identified as having pathology in stage 2. Among the 3,462 children screened, 359 (10.4%) had a significant murmur; subsequent echocardiography was performed on 331 of these children, with RHD being detected in 29 cases. The prevalence of definite RHD was 4.1 per 1,000 (95% CI 2.2-6.8), and the overall prevalence (definite or probable RHD) was 8.4 cases per 1,000 (95% CI 5.6-12). The study results suggest that there is a significant burden of undetected RHD in Fiji. The three-stage approach described here represents a practical means of screening for clinical RHD in developing countries, although it does not allow detection of the subclinical disease.
    The Journal of heart valve disease 06/2009; 18(3):327-35; discussion 336. · 1.07 Impact Factor

Publication Stats

152 Citations
56.69 Total Impact Points

Institutions

  • 2014
    • Auckland District Health Board
      Окленд, Auckland, New Zealand
  • 2006–2014
    • Starship Children's Hospital
      Окленд, Auckland, New Zealand
  • 2012
    • Gisborne Hospital
      Gisborne, Gisborne Region, New Zealand
  • 2008
    • Waikato District Health Board
      Hamilton City, Waikato, New Zealand
  • 2002
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom