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Kalezi ZE, Simbila AN, Mongella S, Nkya D, Sharau G, Shonyela F, Mlawi V, Majani N. Outcomes post Ozaki procedure among children with aortic valve disease at Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania: a retrospective descriptive study. BMC Cardiovasc Disord 2024; 24:163. [PMID: 38504187 PMCID: PMC10949633 DOI: 10.1186/s12872-024-03829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Aortic valve reconstruction using glutaraldehyde-treated autologous pericardium, also called Ozaki procedure, is a surgical procedure for patients with aortic valve disease. Gratifying results have been reported in adult patients, however, limited published data is available in paediatric population. This study looked at clinical characteristics and early outcomes of children who underwent Ozaki procedure at our Institute. METHODS This was a retrospective descriptive study conducted on children who underwent aortic valve reconstruction at Jakaya Kikwete Cardiac Institute (JKCI) from January 2019 through December 2022. Medical records of these children were reviewed to extract data on demographics, clinical characteristics, redo surgical interventions and survival. RESULTS A total of 10 children underwent Ozaki procedure during the study period. Eight children had severe aortic regurgitation while 2 had severe aortic stenosis preoperatively. All children had either none or trivial aortic regurgitation immediately after surgery. None of them had redone operations throughout the follow-up period. There was no in-hospital mortality, however, one child died one-year after surgery. The mean follow-up period was 1.6 years with the longest follow-up time of 4 years. CONCLUSION Ozaki procedure showed encouraging early results among children with aortic valve disease who underwent surgical repair by this technique. Future studies with larger sample sizes and longer follow up periods to evaluate long-term results in this population are recommended.
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Affiliation(s)
- Zawadi Edward Kalezi
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
| | - Alphonce Nsabi Simbila
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stella Mongella
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Deogratias Nkya
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Godwin Sharau
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Felix Shonyela
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Vivienne Mlawi
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Naizihijwa Majani
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Kalezi ZE, Majani N, Simbila AN, Mongella S, Sharau GG, Nkya D, Kubhoja S. Late surgical ventricular septal defect closure in a low middle-income country setting: a case series. J Med Case Rep 2023; 17:235. [PMID: 37259096 DOI: 10.1186/s13256-023-03972-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/04/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Ventricular septal defect (VSD) is the commonest type of congenital heart lesion accounting for up to 40% of congenital heart defects. Well timed VSD closures are reported to yield excellent long-term outcomes. Late surgical VSD closures, particularly from the developing countries, are infrequently reported. CASE PRESENTATION We report three cases of African children aged between 13 and 14 years who had late VSD presentations. They reported complaints of growth failure and recurrent respiratory infections since early infancy which necessitated frequent visits to primary health care facilities. They were found to have large ventricular septal defects by thoracic echocardiography. Diagnostic cardiac catheterization was done to all three patients to rule out irreversible pulmonary hypertension. After promising cardiac catheterization findings, they all underwent successful surgical VSD repair with good early outcomes. CONCLUSION VSD surgical closure is ideal in children below 2 years, however, it can be done in children who present at advanced age despite being considered high risk patients. All three of our patients who presented late had successful surgical VSD repairs with promising immediate outcome. The role of genetics in the protection against developing irreversible pulmonary vascular disease in these patients is a possible area for future studies.
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Affiliation(s)
| | - Naizihijwa Majani
- Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | | | - Stella Mongella
- Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | | | - Deogratias Nkya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sulende Kubhoja
- Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Chillo P, Mlay J, Akanyirige PW, Majani N, Janabi M, Kaaya S, Hawkins C, Hirschhorn LR. Adapting and usability testing of the Kansas city cardiomyopathy questionnaire (KCCQ) in a heart failure clinic in Tanzania: the Swahili KCCQ. BMC Cardiovasc Disord 2023; 23:242. [PMID: 37149565 PMCID: PMC10163850 DOI: 10.1186/s12872-023-03265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/26/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The integration of patient-reported outcome measures (PROMS) into health care delivery systems is being increasingly recognized as an important component of quality, person-centered care, especially for chronic illnesses like congestive heart failure (CHF). However, while PROMS are increasingly being used to follow up CHF patients in high income countries, their use in sub-Saharan Africa is still limited. We adapted the Kansas City Cardiomyopathy Questionnaire (KCCQ-23), an internationally validated, CHF-specific PROM and tested its use in measuring outcomes in an outpatient CHF clinic at a cardiac referral hospital in Tanzania. METHODS Adaptation of the KCCQ-23 included translation into Swahili by linguistic experts, in-depth cognitive debriefing in native Swahili-speaking CHF patients, and input from Tanzanian Cardiologists, PROMS experts, and the tool developer. Using a cross-sectional design, we tested the usability and observed the results of the translated KCCQ-23 in a convenience sample of 60 CHF patients attending outpatient clinic at the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam. RESULTS The survey was successfully completed by 59 (98.3%) of 60 enrolled participants. The mean (SD) age of participants was 54.9 (14.8) years (range 22-83), 30.5% were women and 72.2% had class 3 or 4 New York Heart Association (NYHA) symptoms at enrollment. The overall KCCQ-23 score was low, with a mean (SD) score of 21.7 (20.4) indicating generally very poor to poor patient reported outcomes in this population. The mean (SD) scores for the specific KCCQ-23 domains were 15.25 (24.2) for social limitation, 23.8 (27.4) for physical limitation, 27.1 (24.1) for quality of life and 40.7 (17.0) for self-efficacy. No socio-demographic or clinical characteristics were associated with their overall KCCQ-23 scores. Comparing the short version (KCCQ-12) with the full KCCQ-23 revealed excellent correlation between the two (r = 0.95; p < 0.0001). CONCLUSIONS We successfully translated a validated tool, the Swahili KCCQ, for use in improving the care of patients with CHF in Tanzania and a broader population of Swahili-speaking patients. Both the Swahili KCCQ-12 and KCCQ-23 can be used, with similar outcomes. Work to expand the use of the tool in the clinic and other settings is planned.
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Affiliation(s)
- Pilly Chillo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.
| | - Jackson Mlay
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Mohamed Janabi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claudia Hawkins
- Feinberg School of Medicine, Northwestern University, Evanston, USA
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Dopke C, Connor J, Zheleva B, Gauvreau K, Bakalcheva B, Bina N, Calvimontes G, Cerovic I, Majani N, Oketcho M, Pechilkov D, Shidhika F, Shiryaev T, Jenkins K. Effects of COVID-19 on paediatric cardiac centres in low-income and middle-income countries: a mixed-methods study. BMJ Open 2022; 12:e065031. [PMID: 36418128 PMCID: PMC9684279 DOI: 10.1136/bmjopen-2022-065031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to understand the effects of the COVID-19 pandemic on paediatric cardiac services in critical access centres in low-income and middle-income countries. DESIGN A mixed-methods approach was used. SETTING Critical access sites that participate in the International Quality Improvement Collaborative (IQIC) for congenital heart disease (CHD) were identified. PARTICIPANTS Eight IQIC sites in low-income and middle-income countries agreed to participate. OUTCOME MEASURES Differences in volume and casemix before and during the pandemic were identified, and semistructured interviews were conducted with programme representatives and analysed by two individuals using NVivo software. The qualitative component of this study contributed to a better understanding of the centres' experiences and to identify themes that were common across centres. RESULTS In aggregate, among the seven critical access sites that reported data in both 2019 and 2020, there was a 20% reduction in case volume, though the reduction varied among programmes. Qualitative analysis identified a universal impact for all programmes related to Access to Care/Clinical Services, Financial Stability and Professional/Personal Issues for healthcare providers. CONCLUSIONS Our study identified and quantified a significant impact of the COVID-19 pandemic on critical access to CHD surgery in low-income and middle-income countries, as well as a significant adverse impact on both the skilled workforce needed to treat CHD and on the institutions in which care is delivered. These findings suggest that the COVID-19 pandemic has been a major threat to access to care for children with CHD in resource-constrained environments and that this effect may be long-lasting beyond the global emergency. Efforts are needed to preserve vulnerable CHD programmes even during unprecedented pandemic situations.
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Affiliation(s)
- Campbell Dopke
- Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA
- Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Jean Connor
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Najeebullah Bina
- Department of Cardiology, French Medical Institute for Children (FMIC), Kabul, Afghanistan
| | - Gonzalo Calvimontes
- Department of Cardiology, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala
| | - Ivana Cerovic
- Department of Cardiology, Mother and Child Health Institute of Serbia, Belgrade, Serbia
| | - Naizihijwa Majani
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, Dar Es Salaam, Tanzania, United Republic of
| | - Michael Oketcho
- Department of Paediatric Cardiac Surgery, Uganda Heart Institute, Kampala, Uganda
| | - Dimitar Pechilkov
- Department of Paediatric Cardiology, National Heart Hospital, Sofia, Bulgaria
| | - Fenny Shidhika
- Department of Paediatric Cardiology, Windhoek Central Hospital, Windhoek, Namibia
| | - Tengiz Shiryaev
- Congenital Cardiac Surgery Department, JoAnn McGowan Paediatric Cardiac Surgery Center, Tbilisi, Georgia
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Paediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Kazahura PT, Mushi TL, Pallangyo P, Janabi M, Kisenge R, Albaghdadi M, Majani N, Kija E. Prevalence and risk factors for Subclinical Rheumatic Heart Disease among primary school children in Dar es Salaam, Tanzania: a community based cross-sectional study. BMC Cardiovasc Disord 2021; 21:610. [PMID: 34930122 PMCID: PMC8686380 DOI: 10.1186/s12872-021-02377-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is the most common acquired heart disease occurring in children and adolescents. RHD is associated with significant morbidity and mortality particularly in low and middle- income countries (LMICs) where the burden is estimated to be higher compared to high income countries. Subclinical RHD is the presence of valvular lesion diagnosed by echocardiography in a person with no clinical manifestation of RHD. This study aimed at determining the prevalence, types and factors associated with subclinical RHD among primary school children in Dar Es Salaam, Tanzania. METHODS A descriptive community-based cross-sectional study was conducted in primary school children from February to May 2019. A standardized structured questionnaire was used to collect demographic characteristics, history of upper respiratory tract infections (URTIs), anthropometric measurements, and chest auscultation findings. Moreover echocardiographic screening was done to all children recruited into the study. World Heart Federation echocardiographic classification was used to define the types and prevalence of subclinical RHD. RESULTS A total of 949 primary school children were enrolled with females being predominant (57.1%). The prevalence of subclinical RHD was 34 per 1000. All the participants had mitral valve disease only whereby 17 had definite disease and 15 had a borderline disease. The associated factors for subclinical RHD were older age of more than 9 years (OR 10.8, 95% CI 1.4-82.2, P = 0.02) having three or more episodes of URTI in previous six months (OR 21, 95% CI 9.6-46, P = 0.00) and poor hygiene (OR 3, 95% CI 1.3-6.8, P = 0.009). CONCLUSION Subclinical RHD as detected by echocardiographic screening is prevalent in primary school children, uniformly affects the mitral valve, and is associated with potentially modifiable risk factors. Children with a history of more than three episodes of URTI in six months represents a high-risk population that should be targeted for RHD screening.
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Affiliation(s)
- Parvina Titus Kazahura
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania.
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania.
| | - Theophylly L Mushi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Pedro Pallangyo
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Rodrick Kisenge
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Mazen Albaghdadi
- Division of Cardiology and Section of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Naizihijwa Majani
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
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Lyimo FR, Pallangyo P, Majani N, Mushi TL, Kubhoja S. Complex congenital cardiac anomalies in the setting of right isomerism in a 31-month-old infant: a case report. J Med Case Rep 2018; 12:324. [PMID: 30352615 PMCID: PMC6199716 DOI: 10.1186/s13256-018-1835-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 09/05/2018] [Indexed: 11/15/2022] Open
Abstract
Background Congenital cardiac defects are not rare among neonates. Prompt assessment for life-threatening anomalies is essential for rapid management decisions and positive outcomes. Extracardiac anomalies can occur in congenital heart defects, and their presence increases morbidity and mortality in these neonates. Case presentation We report a case of a 31- month-old infant black girl in Tanzania who presented with an on-and-off history of difficulty in breathing, easy fatigability, facial and lower-limb swelling, recurrent respiratory tract infections, and failure to thrive. Conclusions Management of patients with heterotaxy syndrome is complex and largely depends on specific anatomy of both cardiac and noncardiac lesions. Cardiac and noncardiac management must be tailored to individual anatomy, including prophylaxis against encapsulated organisms for asplenic patients.
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Affiliation(s)
- Frederic R Lyimo
- Department of Radiology, Muhimbili National Hospital, P.O. Box, 65000, Dar es Salaam, Tanzania.
| | - Pedro Pallangyo
- Department of Pediatrics Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania
| | - Naizihijwa Majani
- Department of Pediatrics Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania
| | - Theophylly L Mushi
- Department of Pediatrics Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania
| | - Sulende Kubhoja
- Department of Pediatrics Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania
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