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Double-outlet right ventricle (DORV) is a complex and rare congenital heart disease (CHD), which is usually symptomatic early in childhood and thus diagnosed early. Dextrocardia is another rare CHD that can occur either as an isolated cardiac abnormality or may be associated with other complex cardiac defects. However, the co-occurrence of DORV and dextrocardia is rare, especially in adult life. We present a 35-year-old Nigerian lady with situs inversus totalis and complex CHD, which included dextrocardia with multiple congenital intracardiac shunts, DORV occurring with L-malpositioning of the great vessels, atrial septal defect, and ventricular septal defect with partial anomalous pulmonary venous drainage, persistent left superior vena cava as well as severe pulmonary stenosis.

The choice and regimen of anticoagulation therapy in pregnant women with mechanical valve prostheses have always been a daunting task. It is a delicate balance that takes into consideration the risk of thromboembolic complications in the mother and the risk of potential Warfarin embryopathy to the foetus. Medical practice in a low socioeconomic setting also has the peculiar challenge of financial constraints on the part of the patients and difficulties in monitoring the efficacy of anticoagulation therapy. We report our experience in managing two pregnant women with mechanical valve prostheses and review the existing literature on this complex but interesting subject.

Background: Elderly hypertensive patients have been reported to be particularly at the risk of cognitive dysfunction because of several factors. The previous studies in both rats and humans suggest that some classes of antihypertensive drugs could ameliorate the cognitive decline in elderly hypertensive patients. Most of these studies were among Caucasians in the Western world. This study was aimed at evaluating the oxidative stress and cognitive function status of elderly hypertensive Nigerians on regular antihypertensive drugs. Methods: One hundred and eight elderly hypertensive Nigerians of both gender who were 60 years old and above, were controlled with different antihypertensive drugs, and were enrolled into the study. All had cognitive function status evaluation using the Mini-Mental State Examination (MMSE) score. Totally 98 of the elderly hypertensive patients also had their oxidative stress status evaluated by measurement of their serum antioxidant levels. 33 elderly normotensive Nigerians were used as controls. Results: The elderly hypertensives had a significantly higher mean MMSE cognitive score of 27.97 ± 1.70 compared to the elderly normotensives with score of 26.97 ± 2.44 (P = 0.001). The elderly hypertensive patients had significantly higher mean level of serum antioxidants – catalase, superoxide dismutase, reduced glutathione, and glutathione peroxidase, compared to the elderly normotensive individuals (P < 0.01). Patients on calcium channel blockers had higher mean serum antioxidants level than patients on other classes of antihypertensive drugs. Conclusion: The present study suggests that elderly hypertensive Nigerians who were controlled with regular antihypertensive drugs, had better cognitive function and lower oxidative stress status than their normotensive counterparts.