Surgery for rheumatic mitral valve disease in sub-saharan African countries: why valve repair is still the best surgical option

Mvondo, Charles Mve; Pugliese, Marta; Giamberti, Alessandro; Chelo, David; Kuaté, Liliane Mfeukeu; Boombhi, Jerome; Dailor, Ellen

doi:10.11604/pamj.2016.24.307.7504

Cited by 19 publications

(23 citation statements)

References 41 publications

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“…Adequacy of the repair with only trivial regurgitation in both patients was confirmed by intra-operative trans-oesophageal echocardiography. Mitral valve repair in these patients with favourable mitral valve apparatus is recommended [ 11 ] as it precludes the adverse complications associated with prosthetic mechanical valves and anticoagulation including prosthetic valve thrombosis and embryotoxicity of warfarin [ 11 – 14 ].…”

Section: Discussionmentioning

confidence: 99%

Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience

Onakpoya

Adenle²,

Adenekan

2017

Pan Afr Med J

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IntroductionMore than forty years after the first open heart surgery in Nigeria, all open heart surgeries were carried out in government-owned hospitals before the introduction of such surgeries in 2013 at Biket Medical Centre, a privately owned hospital in Osogbo, South-western Nigeria. The aim of this paper is to review our initial experience with open heart surgery in this private hospital.MethodsAll patients who underwent open heart surgery between August 2013 and January 2014 were included in this prospective study. The medical records of the patients were examined and data on age, sex, diagnosis, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted and the data was analysed using SPSS version 16.ResultsEighteen patients comprising of 12 males and 6 females with ages ranging between 8 months and 52 years (mean= of 15.7 +/- 15 years) were studied. Pericardial patch closure of isolated ventricular septal defect was done in 7 patients (38.9%) while total correction of isolated tetralogy of Fallot was carried out in 5 patients (27.8%). Two patients had mitral valve repair for rheumatic mitral regurgitation. Sixty day mortality was 0%.ConclusionSafe conduct of open heart surgery in the private hospital setting is feasible in Nigeria. It may be our only guarantee of hitch free and sustainable cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience

Onakpoya

Adenle²,

Adenekan

2017

Pan Afr Med J

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“…But repair is more complex, as the RHD valves get worse with time, and requires more experience, confidence, and advanced skills to achieve a favorable operative result 46 . For younger patients, there are a number of surgical repair techniques available 44,47 …”

Section: Surgery For Rhdmentioning

confidence: 99%

Rheumatic heart disease: The role of global cardiac surgery

Vervoort

Antunes

Pezzella³

2021

Journal of Cardiac Surgery

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Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high‐income countries due to timely detection and treatment of acute rheumatic fever, RHD remains highly prevalent in low‐ and middle‐income countries (LMICs) and among indigenous and disenfranchised populations in high‐income countries. As a result, over 30 million people in the world have RHD, of which approximately 300,000 die each year despite this being a preventable and treatable disease. In LMICs, such as in Latin America, sub‐Saharan Africa, and Southeast Asia, access to cardiac surgical care for RHD remains limited, impacting countries' population health and resulting economic growth. Humanitarian missions play a role in this context but can only make a difference in the long term if they succeed in training and establishing autonomous local surgical teams. This is particularly difficult because these populations are typically young and largely noncompliant to therapy, especially anticoagulation required by mechanical valve prostheses, while bioprostheses have unacceptably high degeneration rates, and valve repair requires considerable experience. Devoted and sustained leadership and local government and public health cooperation and support with the clinical medical and surgical sectors are absolutely essential. In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.

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“…Mitral valve (MV) repair is a surgical procedure that has become the most attractive approach to the treatment of severe MR, with excellent immediate and long-term results [8]. One method of MV repair, remodeling annular annuloplasty, which was designed to restore the shape of the distorted fibrous ring of the MV, has yielded predictable and stable results [9]. Ring annuloplasty has allowed the development of additional methods to respond to various emerging lesions [10].…”

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confidence: 99%

Partial Annuloplasty Rings in the Repair of Functional Ischemic Mitral Regurgitation

Kunwar

Imran

Khan

et al. 2020

Cureus

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Background Acute myocardial infarction (MI) is the leading cause of worldwide cardiac morbidities and mortalities. Mitral regurgitation (MR) is a common complication of MI. The severity of ischemic MR (IMR) can range widely, both clinically and hemodynamically. Mitral valve (MV) repair by lifting annuloplasty is a surgical procedure used to correct the pathology of IMR. The immediate outcomes of this technique have not yet been determined. The present study, therefore, evaluated the immediate results of MV annuloplasty performed to complement MV repair in patients with IMR. Methodology All adult patients with IMR who underwent lifting posterior mitral annuloplasty (LPMA) plus concomitant coronary artery bypass grafting (CABG) were included. Immediate outcomes were evaluated by transesophageal color Doppler echocardiography. The frequency of successful outcomes was compared in patients with different baseline characteristics. Results Posterior mitral annuloplasty was successful in 93.1% of patients, including in 92.8% of men and 94.1% of women. The percentages of successful immediate outcomes differed significantly in patients with and without diabetes and hypertension, and in patients with two-and threevessel disease. Conclusion LPMA resulted in a high percentage of successful immediate outcomes in patients with IMR. Further studies should compare rates of immediate, intermediate, and late outcomes of this technique.

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Surgery for rheumatic mitral valve disease in sub-saharan African countries: why valve repair is still the best surgical option

Cited by 19 publications

References 41 publications

Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience

Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience

Rheumatic heart disease: The role of global cardiac surgery

Partial Annuloplasty Rings in the Repair of Functional Ischemic Mitral Regurgitation

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