Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustainability. Methods: Records of patients undergoing heart surgery at LASUTH from December 2004 to March 2006 were retrospectively reviewed for clinical and outcome data. Results: Twenty four patients age 10 -50, mean 28.0 +/− 10.49 years and 13 (54.2%) males underwent surgery. 12 (50.0%) patients had mechanical valve replacements, 11 (45.8%) closure of septal defects and 1 (4.2%) left atrial myxoma resection. Logistic euroscore for valve patients was 5.81 +/− 4.74 while observed mortality was 8.3% (1/12). Overall 30 days operative mortality was 8.3% (2/24) and major morbidity 4.2% (1/24). Patients with septal defects closure stopped clinic visits within a year. Valve patients follow up was complete in 90.1% with mean duration of 55.2 +/− 15.3 months. Late events occurred only in females with mitral valve replacements. The 5-year freedom from thromboembolism and bleeding was 74.0% and survival 82.0% in valve patients. Conclusion: Despite limited resources heart surgery can safely be performed with good outcomes by trained local personnel under supervision of visiting foreign teams until they are proficient to operate independently. Patients with less complex congenital defects have excellent postsurgical outcomes, while patients with rheumatic valve replacement are subject to ongoing valve related morbidity and mortality therefore require lifetime follow up. Choice of prosthetic valve for the mostly indigent and poorly educated population remains a challenge. We now prefer stented tissue valve despite its known limitations, in child bearing age females desirous of childbirth and others unlikely to comply with anticoagulation regimen. Barriers to sustainability include poor infrastructures, few skilled manpower, inadequate funding and restricted patient access due to inability to pay without third party insurance or government Medicaid.

Background. This study investigated plasma sodium/potassium ratio, markers of oxidative stress, renal function, and endothelial dysfunction in hypertensive Nigerians. Materials and Methods. Five hundred forty-nine volunteers consisting of three hundred and twenty-four hypertensive and two hundred twenty-five controls participated in this study. Blood samples were collected from the participants and were analyzed for electrolytes, markers of oxidative stress, endothelial dysfunction, renal function, and inflammation, using ion-selective electrodes, spectrophotometric, and enzyme-linked immunosorbent assay methods, respectively. Results. The mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure, and body mass index (BMI) were significantly elevated among the hypertensive group when compared with control ( p < 0.001 ). The mean sodium increased, while potassium and bicarbonate (HCO3−) decreased ( p < 0.001 ) in hypertensive volunteers. The sodium-potassium ratio (Na+/K+) and urea were raised ( p < 0.001 ) in the hypertensive group when compared with the control. Glutathione, superoxide dismutase, nitric oxide (NO), and catalase were significantly reduced ( p < 0.001 ) while malondialdehyde (MDA), high-sensitivity C-reactive protein (hs-CRP), and ferritin were raised significantly ( p < 0.001 ) in hypertensive participants. The odds of hypertension and its complications increased ( p < 0.001 ) with an increase in BMI, Na+/K+, hs-CRP, MDA, and ferritin and a decrease in estimated glomerular filtration rate (eGFR), glutathione, superoxide dismutase, and catalase. Conclusion. An increase in Na+/K+, urea, hs-CRP, ferritin, MDA, and BMI and a decrease in eGFR, glutathione, and superoxide dismutase were associated with an increased risk of hypertension complication. Abnormal values of markers of oxidative stress, inflammation, and endothelial function could impact deleterious effects on the cardiovascular system among hypertensive Nigerians. A decreased bicarbonate possibly suggests an occult acid-base imbalance among hypertensive volunteers.

The choice and regimen of anticoagulation therapy in pregnant women with mechanical valve prostheses have always been a daunting task. It is a delicate balance that takes into consideration the risk of thromboembolic complications in the mother and the risk of potential Warfarin embryopathy to the foetus. Medical practice in a low socioeconomic setting also has the peculiar challenge of financial constraints on the part of the patients and difficulties in monitoring the efficacy of anticoagulation therapy. We report our experience in managing two pregnant women with mechanical valve prostheses and review the existing literature on this complex but interesting subject.

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