We retrospectively reviewed the surgical treatment of 12 patients (nine female, mean age 16.1+/-8.7 years) with sub-mitral aneurysms managed in our institution between 1991 and 2002. We identified three groups of patients in accordance with the degree of posterior mitral annular involvement by the aneurysm. A single aneurysm neck was found in seven patients, multiple necks in two and involvement of the entire posterior mitral annulus in three patients. Involvement of the entire posterior annulus by the aneurysmal process has not been previously described. The mean age of this latter group 29+/-5.1 years was significantly older than the former (P=0.001), suggesting a possible progressive nature of sub-mitral aneurysms. An intracardiac surgical approach was used in six patients and a combined intra and extracardiac approach in the remainder. There was no operative mortality. The mitral valve was initially repaired in eight patients. Failure of closure of the aneurysm necessitating reoperation occurred in four patients (33.3%). An understanding of the inter-relationship between the aneurysm and mitral valve is essential for successful surgical repair. Histology of the aneurysm tissue showed rheumatic heart disease in two patients and tuberculosis in two patients. Hence, although sub-valvar aneurysms are thought to be congenital, a third of our patients had evidence of co-existent rheumatic heart disease or tuberculosis.

Oxygenation of the foetus is probably the most important single environmental factor which has a bearing upon the eventual well-being of the infant. Throughout pregnancy imperfect oxygenation is inimical to continued viability. At delivery, inadequate oxygenation can jeopardize the baby's immediate survival. Hypoxia, not severe enough to cause immediate or neonatal death can result in permanent neurological damage.At caesarean section it is possible to control the conditions of oxygen administration to the mother accurately and at the same time to observe the effect of this upon the maternal and foetal blood. This study was designed to investigate the effects of various inspired maternal oxygen concentrations on babies delivered by elective caesarean section, inspired oxygen concentration being the only variable. MIITHODThirty-four women at term (38 to 42 weeks gestation) were studied. They were undergoing caesarean section under general anaesthesia for either cephalo-pelvic disproportion or previous caesarean section. All the mothers were healthy by clinical, radiological and biochemical assessment as regards cardiovascular, respiratory and urinary systems and the course of their pregnancies was uncomplicated. During the hours preceding operation each was given about one litre (700 to 1350ml) of 10% invert sugar in Ringer Lactate to minimise the effect of overnight starvation on metabolism.Immediately prior to induction of anaesthesia, arterial blood was taken anaerobically into a heparinized glass syringe by discrete puncture of the radial artery. Intravenous atropine 0.65mg was given just before induction with an appropriate hypnotic dose of thiopentone. Following suxamethonium 50mg the trachea was sprayed with 4 % lignocaine and then intubated with a 9.0mm cuffed Magill endotracheal tube. The cuff was optimally inflated to prevent gas leaks. Intermittent positive pressure ventilation was imposed using the non-return circuit of an Engstrom ventilator. A M .

IntroductionCongenital and acquired heart diseases are highly prevalent in developing countries despite limited specialised care. Namibia established a paediatric cardiac service in 2009 with significant human resource and infrastructural constraints. Therefore, patients are referred for cardiac interventions to South Africa.ObjectivesTo describe the diagnoses, clinical characteristics, interventions, post-operative morbidity and mortality, and follow-up of patients referred for care.MethodsDemographics, diagnoses, interventions, intra- and post-operative morbidity and mortality, as well as longitudinal follow-up data of all patients referred to South Africa, were recorded and analysed.ResultsThe total cohort constituted 193 patients of which 179 (93%) had CHD and 7% acquired heart disease. The majority of patients (78.8%) travelled more than 400 km to Windhoek before transfer. There were 28 percutaneous interventions. Palliative and definitive surgery was performed in 27 and 129 patients, respectively. Out of 156 patients, 80 (51.3%) had post-operative complications, of which 15 (9.6%) were a direct complication of surgery. Surgical mortality was 8/156 (5.1%, 95% confidence interval 2.2–9.8), with a 30-day mortality of 3.2%. Prolonged ICU stay was associated with a 5% increased risk of death with hazard ratio 1.05, 95% confidence interval 1.02–1.08, p=0.001. Follow-up was complete in 151 (78%) patients for more than 7 years.ConclusionsDespite the challenges associated with a cardiac programme for referring patients seeking intervention in a neighbouring country and the adverse characteristics of multiple lesions and complexity associated with late presentation, we report good surgical and interventional outcomes. Our goal remains to develop a comprehensive sustainable cardiac service in Namibia.

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