Pattern and Outcome of Cardiac Interventions Performed within and Outside Nigeria for Children with Structural Heart Diseases in Sokoto, North-western Nigeria

Abstract

Background: Management of structural heart diseases is quite challenging in Nigeria, due to limited availability and access to cardiac care services. There is paucity of data on the pattern and outcome of cardiac interventions in children from the study area. 
 Aims: To determine the pattern of cardiac interventions and the early outcome (within six-months) of such interventions in children with structural heart diseases (SHD) seen in our hospital.
 Study Design: Descriptive cross-sectional study.
 Place and Duration of Study: Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, between August 2012 to September 2019.
 Methodology: All children with SHDs seen at our hospital, but had Cardiac surgery or interventional cardiac procedures within and outside Nigeria were recruited. Relevant information including type of lesion, procedure performed and the outcome within the first six months and length of hospital stay was analyzed.
 Results: Only 63 out of 780 (8.1%) children with structural heart diseases, aged 6 months-15 years (Mean age 6.5± 5.0 years, M: F = 1.3:1), had cardiac interventions. The interventions were surgical in 61 ((96.8%) and catheter-based in 2 (3.2%) patients; with 49 (77.8%) of these performed abroad. Patent Ductus arteriosus 14 (22.2%), Tetralogy of Fallot 14 (22.2%), ventricular septal defect 13 (20.6%) and atrial septal defect 6 (9.5%) were the commonest lesions for which interventions were undertaken. Early post-operative complications included pulmonary hypertensive crises, pericardial and pleural effusion, complete heart block and left branch pulmonary artery stenosis warranting re-intervention. During the first six months after the interventions, three (4.8%) patients died while 60 (95.2%) survivors were followed up. However, 25 (39.7%) of them were thereafter lost to follow.
 Conclusion: Majority of the cardiac interventions were surgical, performed predominantly in older children with CHDs; and associated with good outcome. However, most of them were undertaken outside the country, highlighting the need to ensure these services are available and accessible locally.