Pioneer human open heart surgery using cardiopulmonary by pass in Uganda.

INTRODUCTION: For the first time in Uganda in April 2007,two open-heart surgeries were done using cardiopulmonary by pass. A multidisciplinary team of largely indigenous Ugandans professionals working in Uganda formed the pioneering team. CONTEXT: Access in cardiac surgery in the developing countries is very limited. The challenges that impede access to adequate and appropriate health care including open-heart surgery are in the least complex and daunting. PATIENT SELECTION: Two 13 and 17 year old males with Secundum Atrial Septal defects were chosen from a long waiting list. The criteria used included no or minimal co morbidity states, patient fitness and available ICU ventilation facilities. PREPARATION: Took an eleven months period, including formulation and adoption of peri and intra operation protocols, training of staff, sourcing of usable and mobilizing the financing. OUTCOMES: The procedure for the two patients was successfully performed. The immediate and short-term postoperative periods were uneventful. At the twelve months review point both patients were leading a normal life. In the months that followed 19 other open-heart procedures were done including two mitral valves replacements. CONCLUSION: This program has greatly enhanced the level of care for the critically ill at this facility. Its sustenance and replication in other centres in the country is essential. Government and development partners' support is critical. The educational value of this program ought to be exploited by health professions students in the country.

Intraaortic balloon pumping in children.

BACKGROUND: Intraaortic balloon pump (IABP) usage in young children remains a rarity because, first, there is a widespread misconception that the greater elasticity of the aorta in children may prevent effective augmentation, and second, children in low cardiac output states are more likely to have associated right ventricular failure and pulmonary problems. We report our experience with the use of IABP in children undergoing cardiac surgery in whom mechanical support was necessary for the treatment of refractory cardiac failure. METHODS: Over a 3-year period, 14 children were identified as requiring IABP support after cardiac surgery. Their median age was 3 years (range 7 days to 13 years) and their median weight was 13.3 kg (range 3.5-51 kg). Indications for IABP use were: failure to wean from cardiopulmonary bypass (5 patients), sudden deterioration in intensive therapy unit (ITU) (3 patients), progressive deterioration in ITU (4 patients), and prophylactic therapy for known poor preoperative ventricular function (2 patients). RESULTS: Ten of 14 patients (71%) were successfully weaned from the IABP, of whom 8 became long-term survivors (57%). Among the survivors, the mean duration of IABP usage was 127 h (range 12-260 h), while for those who died while on IABP, the mean duration was 15 h (range 8-24 h). The most major IABP-related complication encountered was mesenteric ischemia, which had a fatal outcome. CONCLUSIONS: IABP therapy, used as an adjunct to conventional medical treatment, can give properly selected young children in refractory low cardiac output states after heart surgery a greater than 50% chance of long-term survival.

Pulmonary artery sarcoma mimicking pulmonary embolism: successful surgical intervention.

Because of its rarity and the similarity of its presentation to that of pulmonary thromboembolic disease, the diagnosis of pulmonary artery sarcoma is often not considered early in patients presenting with recurrent or chronic pulmonary emboli. We present a case of pulmonary artery sarcoma that was treated as pulmonary embolism for 3 years before surgical resection was carried out. Two years after the resection the patient is well with no clinical or radiologic evidence of recurrent or metastatic disease.