Experience with Palliative Procedures for Congenital Cyanotic Heart Diseases in Ghana: A 20-Year Review

Abstract

Background:Currently, in the management of congenital cyanotic heart diseases with favourable anatomy, primary correction is the preferred choice. But palliative procedures have still maintained an important role in resource-poor regions of the world.We sought to analyze our institutional results for such palliation over a 20-year period. The purpose of the study was to provide information that would guide both practitioners and referring doctors on the future management of congenital cyanotic heart diseases, and also to provide data for comparative studies in the sub region in the future.Patients and Methods: A retrospective study was carried out in the National Cardiothoracic Centre involving all patients who had palliative procedures for congenital cyanotic heart diseases from January 1992 to December 2011.Results: There were 264 patients, 59% males and 41% females. The case load increased from 2 cases per year in the first year to 34 in the last year of the study. The age range was 4 months – 42 years, with a mean of 7.1 ± 6.9 years. Tetralogy of Fallot comprised 257 (97.4%) of the cases, tricuspid atresia 4 (1.5%), and double outlet right ventricle 3 (1.1%). The modified Blalock-Taussig shunt (MBTS) was performed in 262 (92.2%), and the Waterston shunt in 2 (0.8%) of the cases. The overall complication rate was 11.8%, comprising shunt occlusion 7.6%, bleeding requiring re-exploration 0.8% and early mortality of 3.4%.Conclusion: The modified Blalock-Taussig shunt provided good palliation for congenital cyanotic heart diseases in this environment. We consider it a suitable management alternative when financial and logistic constraints delay primary repair in resource-poor settings.