[Congenital heart disease in adolescents and adults: Management in a general cardiology department in Senegal]

[Anaesthesia in on-pump cardiac surgery for congenital heart diseases at the Cuomo Pediatric Cardiology Center (Senegal)]

Les cardiopathies congénitales surviennent dans 0,5 - 1% des naissances. La prise en charge d´enfants souffrant de malformation cardiaque nécessite un centre adapté, un matériel médical adéquat et des connaissances particulières tant sur le plan anesthésique que chirurgical. L´objectif de ce travail était d´évaluer la prise en charge anesthésique de ces cardiopathies dans notre centre après une première année d´activité et de comparer les résultats obtenus aux données de la littérature. Nous avons mené une étude rétrospective, descriptive sur une année allant de janvier à décembre 2017. Ont été inclus tous les patients opérés au cours de cette période pour une cure de cardiopathie congénitale sous circulation extracorporelle. Nous avons colligé 80 dossiers de patients opérés pour une cardiopathie congénitale. Parmi ces 80 patients, 60 ont été opéré sous circulation extra corporelle (CEC) soit un taux de 75%. L´âge moyen de nos patients était de 7,41 ans avec un sex- ratio de 1,22. La durée de la CEC était en moyenne de 82,82 mn et la durée moyenne du clampage aortique était de 58,31 mn. Soixante-dix pourcent (70%) des patients ont eu des catécholamines en fin d´intervention. La complication la plus fréquente en post opératoire était la défaillance cardiaque droite (69%). La durée moyenne de séjour en réanimation était de 4,33 jours. Nous avons noté le décès d´un patient portant la mortalité à 1,6%. Les cardiopathies congénitales sont complexes et très variables. Avec l´amélioration des techniques de prise en charge, leur morbi-mortalité a fortement diminué.

Pulmonary vascular disease in Africa: Lessons from registries

The epidemiology of pulmonary vascular disease (PVD) remains unclear in Africa, where health systems do not reach the majority of the population and heath information systems are poorly developed. In this context, registries are particularly important in gathering crucial information on PVD, aiming at improving knowledge of the epidemiology and/or quality of care. While population-based registries are the main tool to identify incident cases, and be a better indicator of pulmonary vascular disease burden, hospital-based registries can give an indication of the demand for specific care services, which is useful for health policy and planning. The only registry for pulmonary hypertension in Africa - the Pan African Pulmonary Hypertension Cohort (PAPUCO) - involved four countries, and was a pragmatic study that revealed a unique pattern of environmental risks, issues related to low access to health care, and ill-equipped health facilities for diagnosis and management of pulmonary hypertension. In addition, disease specific registries for conditions such as congenital heart disease and rheumatic heart disease uncovered high occurrence of PVD that can be managed and/or prevented with improvements in community awareness, surveillance, management and prevention. It is suggested that existing networks of experts and researchers develop regional registries to determine the epidemiology of PVD in Africa, assess geographic, environmental and seasonal differentials, as well as inform policy and care provision in the continent.

Heart catheterization in adults in a sub-Saharan tertiary centre: 8 years' experience

Background

The goal of the investigation was to analyze the results of heart catheterization in the Cardiac centre Shisong from December 2010 till December 2017.

Methods

This retrospective study done in the Cardiac centre Shisong in adult patients that underwent a procedure in the catheterization laboratory from December 2010 till December 2017.

Results

Three hundred and sixty-five adult underwent a cardiac catheterization procedure during the study period. Among the patients, 126 were female while 239 were male. The mean age at presentation was 52.6±12.9 years old. Patients were coming from neighboring countries: Nigeria n=5 (1.3%), Tchad n=3 (0.8%), Equatorial Guinea n=4 (1%), Democratic republic of Congo n=2 (0.5%). Patients were also coming from all the ten regions of Cameroon: Littoral n=122 (33.2%), Centre n=127 (34.8%), North west n=47 (12.9%), South west n=17 (4.5%), West n=26 (7.1%), North n=7 (1.8%), Adamaoua n=8 (2.1%), Far North n=5 (1.3%), South n=2 (0.5%), East n=4 (1%). Depending on the type of procedures diagnostic coronarography in case with suspicion of coronary artery disease and presurgical coronarography were the main procedures done in 171 patients (46.8%) and in 146 patients (40%) respectively. Diagnostic coronarography was positive in 31 cases (8.4%). In patients with ischemic heart disease (IHD), percutaneous intervention with dilatation of the coronary arteries and implantation of stents was done in 19 cases (5.2%). The remaining 12 cases (3.2%) were having many lesions that could be managed only by coronary artery grafting surgery, done with success in all the cases. In grown up congenital heart disease patients, diagnostic catheterization was done in 48 cases meanwhile interventional catheterization: pulmonary artery valvuloplasty, patent ductus arteriosus (PDA) closure, atrial septal defect closure and decoarctation of the aorta were done in n=11 (3.4%), n=9 (2.4%), n=12 (3.2%), n=6 (1.6%) cases respectively.

Conclusions

Coronary heart disease was confirmed by angiography in 8.4% cases, and among grown up congenital heart disease 'patients, atrial septal defect was the pathology the most managed. Heart catheterization is done in the Cardiac centre Shisong with good results.