Search

Abstract: In Africa in general and in Cameroon in particular, post rheumatic cardiopathies are a health care problem and one of the causes of infertility in the women population [1]. It is also a major cause of death of many children and adults. Management of a pregnant patient with mechanical heart valve is a complex issue for all health care providers involved in the care of such patients [2]. Clinicians caring for pregnant women with prosthetic valves are faced with a dilemma when trying to provide optimal treatment. Inadequate anticoagulant therapy can result in thrombosis of the mechanical prosthetic valve while, on the other hand, anticoagulant therapy is associated with foetal and maternal bleeding and teratogenic effects. The present report describes a case of pregnancy on a patient with a mechanical valve at the mitral position.

Background: In recent years, patient-reported outcomes (PROs) have received increasing prominence in cardiovascular research and clinical care. An understanding of the variability and global experience of PROs in adults with congenital heart disease (CHD), however, is still lacking. Moreover, information on epidemiological characteristics and the frailty phenotype of older adults with CHD is minimal. The APPROACH-IS II study was established to address these knowledge gaps. This paper presents the design and methodology of APPROACH-IS II., Methods/design: APPROACH-IS II is a cross-sectional global multicentric study that includes Part 1 (assessing PROs) and Part 2 (investigating the frailty phenotype of older adults). With 53 participating centers, located in 32 countries across six continents, the aim is to enroll 8000 patients with CHD. In Part 1, self-report surveys are used to collect data on PROs (e.g., quality of life, perceived health, depressive symptoms, autonomy support), and explanatory variables (e.g., social support, stigma, illness identity, empowerment). In Part 2, the cognitive functioning and frailty phenotype of older adults are measured using validated assessments., Discussion: APPROACH-IS II will generate a rich dataset representing the international experience of individuals in adult CHD care. The results of this project will provide a global view of PROs and the frailty phenotype of adults with CHD and will thereby address important knowledge gaps. Undoubtedly, the project will contribute to the overarching aim of improving optimal living and care provision for adults with CHD., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: The management of patients with mechanical heart valves remains a major concern in populations with limited resources and medical facilities. This study reports the clinical outcomes of patients who underwent mechanical valve implantation in a sub-Saharan center over an 8-year period., Methods: A total of 291 mechanical valves were implanted in 233 patients in our institution between February 2008 and June 2016. A total of 117 patients underwent mitral valve replacement (MVR, 50.2%), 57 had aortic valve replacement (AVR, 24.4%), and 59 underwent both AVR and MVR (double valve replacement [DVR], 25.7%). The mean age at surgery was 27.6 ± 13.4 years (range, 7-62 years). Rheumatic etiology was found in 80.6% of the patients. Hospital mortality, late deaths, and valve-related events were reviewed at follow-up (839 patient-years, range: 1-9.4 years, complete in 93%)., Results: The 30-day mortality was 4.7% (11/233). The overall survival at 1 and 6 years for the whole cohort was 88.8 ± 2.1% and 78.7 ± 3.3%, respectively. The 6-year survival for AVR, MVR, and DVR was 89.3 ± 4.8%, 73.2 ± 5.4%, and 79.3 ± 5.8%, respectively ( p  = 0.15). The freedom from neurologic events and anticoagulation-related bleeding at 6 years was 93.1 ± 2.1% and 78.9 ± 3.7%, respectively. No patient had reoperation at follow-up. No case of prosthetic valve thrombosis was identified. Eight full-term pregnancies were reported., Conclusion: This preliminary experience reports acceptable midterm results after mechanical heart valve implantation in our region. Both accurate surgical evaluation and strategies, either financial or social, facilitating patient's education and medical assistance are crucial to ensure good results. Long-term follow-up and further studies comparing current nonthrombogenic options are warranted to draw reliable conclusions., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)

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., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Congenital heart diseases (CHD) are present in nearly 1% of live births; according to WHO, there are 1. 5 million newborns affected by CHD per year and more than 4 million children waiting for cardiac surgery treatment worldwide. The majority of these children (~90%) could be treated, saved and subsequently have a good quality of life but unfortunately, in developing countries with a suboptimal care or no access to care, they are destined to die. Cameroon, one of the 40 poorest countries in the world, is a typical example of this dramatic scenario and this is why we started a collaboration project with a local religious partner (Tertiary Sisters of Saint Francis) in 2001 with the aim of establishing the first cardiac surgery center in this country. There are various well-known organizational models to start a cooperation project in pediatric cardiac surgery in a developing country. In our case, the project included a long-term collaboration with a stable local partner, a big financial investment and a long period of development (10 years or more). It is probably the most difficult model but it is the only one with the greatest guarantee of success in terms of sustainability and autonomy. The aim of this study is to analyze the constructive and problematic aspects of the 17-year collaboration in this project, and to assess possible solutions regarding its critical issues. Although much has been done during this 17-year we are aware that there is still a lot that needs to be done.

The aim of the study was to investigate the pattern of valvular lesions, the mortality and the challenges in five years follow-up in children with post-rheumatic valvulopathies in natural history in St. Elizabeth Catholic General hospital Shisong, cardiac centre. This retrospective analysis included 270 patients aged between 5 and 16 years old suffering from post-rheumatic valvulopathies who consulted in the cardiac centre from July 2008 through July 2013. Postrheumatic valvulopathies were diagnosed according to the World heart federation criteria. Data from patients' records, two-dimensional echocardiographic studies, and electrocardiograms were reviewed. Patients and their family were contacted every six months. The duration of the follow-up was 60months. Patients aged between 5 and 16 years old with a mean age of 12.4±4.5 years. Female gender was representing 63% (n=170) of the population. Surgery was indicated in 256 cases. Lesions of the valves needing prophylaxis with penicillin was diagnosed in 14 cases. In 95 patients surgical correction could not be performed. Mitral regurgitation was the commonest echocardiographic diagnosis present in 61.5%, n=164 patients; 38.5%, n=103 patients had aortic regurgitation. Mitral stenosis and mitral disease were also represented in 6%, n=16, and 8%, n= 21 patients respectively. Pulmonary hypertension was the common echocardiographic complication of the disease in=234, 87% of cases. Clinically, complications of the disease included congestive heart failure (n=229, 85%), growth retardation (n=162, 60%), sudden death (n=27, 10%). On presentation, n=210, 78% of cases were admitted. Mortality in two years was 35%, (p≤0.05, 95% CI=2.5-6.5), in five years was 65% (p≤ 0.05, 93% CI= 2.7-7.21). The challenges faced are patients' negligence and poor discipline, wrong beliefs, poverty. Post-rheumatic mitral valve regurgitation is the pathology the most encountered. Pulmonary hypertension is the most common echocardiographic complication of the disease. Five years mortality is very high in our setting. Due to financial limitation and illiteracy of parents, the follow up of patients is difficult.

Introduction: Lutembacher syndrome (LS) is a rare cardiac clinical entity marked by the combination of an atrial septal defect (ASD) and mitral stenosis (MS). Its prognosis is influenced by several factors., Case Report: We present the case of a young adult male who presented with a 10-month history of exertional dyspnea, orthopnoea, fatigue and cough. Clinical examination revealed features suggestive of advanced congestive heart failure. Echocardiography revealed severe MS and a secundum type ASD with pulmonary hypertension. Patient died on second day of admission., Conclusions: LS is a very rare condition. The outcome is better if treated before the onset of heart failure and pulmonary hypertension. However, surgical and percutaneous trans-catheter therapy is costly and not readily available in low-income settings in developing countries.

Burkitt lymphoma is a non-Hodgkin lymphoma that is endemic in the Equatorial Belt of Africa, usually affecting children and adolescents with primary head-neck or abdominal involvement. Primary cardiac lymphomas are rare entities (1.3% of all primary cardiac tumors) of difficult clinical identification. Delayed discovery contributes to significant mortality. We report a case of a primitive Burkitt lymphoma in a 14-year-old Cameroonian immunocompetent child, presenting with signs and symptoms of severe right inflow impairment. Echocardiography revealed a right atrial mass involving the right atrial ventricular junction. Surgical excision and chemotherapy regimens, administered according to established protocols, were effective in inducing complete remission at 6 months.

The cardiac centre of Shisong inaugurated few years ago is a good example of the mobilization of humanitarian resources from the north and south for the improvement of cardiovascular diagnosis and treatment in Africa. From the inauguration of the Center to December 2011, 23 surgical missions have been organized, (5 peadiatric and 18 adults) and 204 patients have been operated with the help of the partners: Associazione Bambini Cardiopatici nel Mondo and Cuore Fratello. The Catheterisation Laboratory has performed a total of 117 diagnostic and interventional procedures while 22 pace makers were implanted (12 single-chambers and 10 dual-chambers). Many problems and challenges are faced everyday but with the enthusiasm, the dynamism and the professional skills of the personnel, the help of the partners we see a bright future.

Aim: To study early post-operative results and follow up of patients over a year old, operated on for tetralogy of Fallot (ToF)., Methods: This retrospective analysis included 22 patients (14 male and eight female) with a mean age of 9.18 ± 6.5 years (range 13.5 months to 26 years), who underwent complete repair of ToF between April 2003 and June 2009. Data from patients' records, pre-operative cardiac catheterisation studies, operative intervention, and pre-operative and postoperative two-dimensional echocardiographic studies were reviewed. All patients underwent complete repair including closure of ventricular septal defect (VSD). A trans-annular patch was used in 12 patients while an infundibular patch was used in 10 others. Patients were evaluated one, three, six and 12 months after surgery, and annually thereafter. The duration of follow up was from eight months to six years post surgery., Results: Classical ToF was found in 10 patients. Twelve cases had associated anomalies: two patients with hypoplastic pulmonary artery branches, two with arterial duct malformations, and eight had proximal stenosis of the left branch of the pulmonary artery. NHYA class distribution was as follows: class I: two patients; class II: five subjects; class III: 10 patients; class IV: five subjects. The mean stay in hospital was 15 ± 7 days. Two patients (9%) died during the early post-surgical period. At a mean follow-up interval of 32 ± 9 months, all patients were asymptomatic and in NYHA class I. No late deaths occurred. In three patients, we registered isolated monomorphic ventricular extrasystoles. The right ventricle outflow tract (RVOT) pressure gradient was 29 ± 1.5 mmHg in the acute post-surgical period and it did not change significantly during follow up. The right ventricular function was defined as normal in 95% of the patients in the study and was mildly depressed in 5%., Conclusion: Even if treated later in life, our study showed very good surgical results of patients with ToF.

Unlabelled: The extent of congenital heart disease in Cameroon remains largely unknown. The aim of this study was to determine the occurrence and pattern of congenital heart diseases in the Cardiac Centre of St Elizabeth Catholic General Hospital, situated in a rural area of Cameroon., Methods: Between November 2002 and November 2008, a population of 2 123 patients with suspected cardiac pathologies were consulted at St Elizabeth Catholic General Hospital referral cardiac centre. Of these patients, 292 subjects were recruited for the study, based on detection of (1) precordial murmurs and/or cardiomegaly on chest X-ray examination, or (2) congenital heart diseases on transthoracic Doppler echocardiography examination., Results: Congenital heart diseases and inorganic murmurs were found in 95.5 and 4.5% of the patients, respectively. Congenital heart diseases included tetralogy of Fallot (26.1%), isolated ventricular septal defect (38.8%), atrioventricular cushion defect (7.3%), isolated atrial septal defect (2.8%), arterial duct cases (12.4%), common arterial trunk (1.3%), isolated stenosis of the pulmonary artery (2.6%), coarctation of the aorta (1.1%), congenital mitral valve regurgitation (1.2%), atresia of the triscupid valve (1.6%), double-outlet right ventricle (2.1%), anomalous pulmonary venous return (1.5%) and left isomerism (1.2%)., Conclusion: Our data show that there is a high occurrence of congenital heart disease in this hospital in a rural zone of sub-Saharan Africa and that isolated ventricular septal defect is the predominant pathology. Post-surgical follow up remains very challenging as many parents cannot afford their children's medical treatment or are generally not well educated.

Unlabelled: The aim of the study was to investigate the occurrence, pattern and clinical aspects of congenital heart diseases and their management in Cameroon. In this multicentred retrospective study from January 2006 till November 2009, out of 51,636 consulting in three referral centres, 505 were recruited. All the patients presented with the following symptoms: cyanosis, clubbing, frequent respiratory tract infections, failure to thrive, growth retardation, precordial murmur and dyspnoea. Patients were sent for the screening of congenital heart disease. After the comprehensive Doppler echocardiography, the recruited patients were diagnosed with congenital (67.2%) and in few, acquired heart disease. Heart murmur, dyspnoea and growth retardation was the triad mostly encountered. The occurrence of congenital heart diseases in Cameroon is 9.87%. In Douala, isolated ventricular septal defect, interatrial septal defect and isolated pulmonary valve stenosis were more diagnosed than in Shisong (P <0.05) and Yaoundé (P <0.05). In Yaoundé, there were more cases of common arterial trunk, transposition of great arteries with ventricular septal defect and Ebstein disease than in Shisong (P <0.05) and Douala (P < 0.05). At Shisong, tetralogy of Fallot, arterial duct, coarctation of the aorta, congenital mitral valve regurgitation, atresia of the tricuspid valve, double outlet right ventricle, anomalous pulmonary venous return and left isomerism were more diagnosed than in Yaoundé (P <0.05) and in Douala (P <0.05). Thirty percent of the patients were operated abroad; 9% in the cardiac centre., Conclusion: Our data show that congenital heart diseases are represented in Cameroon as in the literature; isolated ventricular septal defect is the predominant pathology.

Background: In Africa in general and in Cameroon in particular, post rheumatic cardiopathies are a health care problem, one of the causes of infertility in the women population and a major cause of death among children and adults. Management of a pregnant woman with mechanical heart valve is a complex issue for all health care providers involved in the care of such patients., Patient and Case Report: Miss A is 26-years old and consulted for cardiac assessment; referred from Bamenda (North-West province of Cameroon) for better management of a cardiac problem including arrhythmia and a history of recurrent tonsillitis. The cardiac echo-dopplerography showed severe post-rheumatic mitral valve regurgitation with pulmonary hypertension and a dysfunctional left ventricle. The patient was later evacuated in a surgical centre in Milan San Donato (Italy) where a St. Jude mechanical heart valve N.27 was implanted. Two years after surgery, during a follow-up visit, the patient brought a pelvic ultrasound showing a single live intrauterine foetus, gestational age estimated at 7 weeks., Conclusion: Management of mechanical valve in a pregnancy context, resulting in a favourable outcome (no thromboembolic events and the delivery of a healthy baby) is possible in sub-Saharan Africa. Close observation, adherence to existing clinical guidelines, patient cooperation and an appropriate technical infrastructure are critical factors to consider.