Cardiac surgery capacity in sub-saharan Africa: quo vadis?

BACKGROUND: Current data on cardiac surgery capacity on which to base effective concepts for developing sustainable cardiac surgical programs in Africa are lacking or of low quality. METHODS: A questionnaire concerning cardiac surgery in Africa was sent to 29 colleagues-26 cardiac surgeons and 3 cardiologists in 16 countries. Further, data on numbers of surgeons practicing in Africa were retrieved from the Cardiothoracic Surgery Network (CTSNet). RESULTS: There were 25 respondents, yielding a response rate of 86.2%. Three models emerged: the Ghanaian/German model with a senior local consultant surgeon (Model 1); surgeons visiting for a short period to perform humanitarian surgery (Model 2); and expatriate surgeons on contract to develop cardiac programs (Model 3). The 933 cardiothoracic surgeons listed by CTSNet translated into one surgeon per 1.3 million people. In North Africa, the figure was three surgeons per 1 million and in sub-Saharan Africa (SSA), one surgeon per 3.3 million people. The identified 156 cardiac surgeons represented a surgeon to population ratio of 1:5.9 million people. In SSA, the ratio was one surgeon per 14.3 million. In North Africa, it was one surgeon per 1.1 million people. Open heart operations were approximately 12 per million in Africa, 2 per million in SSA, and 92 per million people in North Africa. CONCLUSION: Cardiothoracic health care delivery would worsen in SSA without the support of humanitarian surgery. Although all three models have potential for success, the Ghanaian/German model has proved to be successful in the long term and could inspire health care policy makers and senior colleagues planning to establish cardiac programs in Africa.

Coronary bypass in an adult with Kawasaki disease.

We present the case of a 30-year-old female patient with few coronary risk factors for atherosclerosis but with 3-vessel coronary artery disease possibly secondary to Kawasaki disease. Coronary angiography showed total occlusion of the left anterior descending artery and a right coronary artery aneurysm. Quadruple coronary artery bypass was performed. The postoperative course was uneventful.

[Right atrial myxoma in a patient with mood disturbances]. / Myxome geant de l'oreillette droite revelee par un trouble de l'humeur.

Cardiac myxomas represents 50% of the benign heart tumors. Right atrial myxomas are more rare than left localisations. Their major risks are in occurrence of pulmonary embolisms. The clinical features are non specific and the diagnosis is based on echocardiography. The treatment of choice for myxomas is surgical removal. We report a case of 32-year-old woman with an abnormality of the heart auscultation found when examined for humour disturbance. Echocardiography revealed a giant echogene, mass of the right atrium, prolapsing in the tricuspid orifice. Per-operative findings mentioned a mass with 10 cm of length. Anatomo-pathologic results conclude to atrial myxoma. The evolution after 8 months of surgical treatment was normalisation of heart auscultation and the improvement of the patient humour.

Acute pulmonary embolism due to the rupture of a right ventricle hydatic cyst.

Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst (often in the liver) into the venous circulation. We report a case of hydatid pulmonary embolism following rupture of a hydatic cyst in the right ventricle. Pulmonary angiography showed right pulmonary occlusion. Echocardiography, computed tomography scan and magnetic resonance imaging showed images suggesting a hydatid cyst. The patient underwent sternotomy and cardiopulmonary bypass in order to treat the heart cyst and remove the hydatic pulmonary obstruction. A concomitant lung hydatid cyst was extirpated.

[Coronary reoperation through left thoracotomy without cardiopulmonary bypass: 3 case reports]. / La chirurgie coronarienne redux à coeur battant par thoracotomie gauche: à propos de trois cas.

With the increasing number of patients who have undergone coronary artery bypass grafting, the incidence of reoperative coronary grafting is also increasing. Reoperative coronary artery bypass grafting is associated with morbidity and mortality rates greater than those of primary coronary operations. Left thoracotomy can provide access for reoperation when repeat median sternotomy is extremely dangerous. Coronary artery grafting on a beating heart and via left thoracotomy can be a good alternative strategy when redo coronary surgery is necessary in the circumflex or left anterior descending territories.