Surgical management of CHD in the adult population: the role of humanitarian cardiac surgery mission in Nigeria

Ia, Nwafor; Eze, JC

doi:10.1017/s1047951118000793

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…See Table 2(a) & Table 2(b). We confirm a similar study in Nigeria, the predominant lesions noted were VSD and among cyanotic lesions, TOF [24]. However, in our study and in others, critical congenital heart defects such as left-sided obstructive lesions were rare, suggesting the poor survival of affected children.…”

Section: Discussionsupporting

confidence: 90%

Status of Congenital Heart Defects in Nigeria: The Role of Cardiac Surgery

Nwafor¹,

Eze²

2019

WJCS

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Background: Unlike in developed countries, the delivery of cardiovascular services to children born with congenital heart defects in Nigeria is inadequate. There are problems at both pediatric and adult ages with high morbidity and mortality on account of inadequate surgical care. Objective: To determine the status of congenital defects and assess the impact of foreign cardiac missionary missions vis-à-vis the effects on the magnitude as well as on the educational program for the local cardiac team. Materials and Method: In the last 5.5 years, Foreign Cardiac Surgery missions were reinstituted at National Cardiothoracic Center of Excellence, Enugu, Nigeria. The participants performed cardiac interventions on a variety of patients with CHD. We performed a retrospective review of this endeavor. Patients' demographics, number of patients, age ranges, types of CHD and clinical evaluation methodology were obtained from our hospital's record department. We also assessed types of cardiac interventions, outcome and challenges and the impacts of the foreign cardiac surgery missions. Results: During the study period, a total of 72 children with CHD were evaluated. They were 39 males and 33 females. The age ranged between 0-10 years in children and 41-50 years in the adult. We studied both simple and complex anomalies. A VSD was the commonest (n = 22, 27.16%). Conclusion: Foreign congenital cardiac surgery missions were not able to provide adequate services for the care of CHD that require cardiac surgery both in terms of reduction in magnitude as well as adequate educational program for the local cardiac team. Thus infants, in particular, suffer an early death. The need for governmental support to develop a comprehensive program to care for these patients is essential in Nigeria and other developing countries.

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Section: Discussionsupporting

confidence: 90%

Status of Congenital Heart Defects in Nigeria: The Role of Cardiac Surgery

Nwafor¹,

Eze²

2019

WJCS

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“…This initiative has enormous value and helps many children, but that alone does not solve the problem. There is a need to create self-sustained centers; this implies building local teams, providing consumable material, and developing referral centers across entire countries (2,15,26,(34)(35)(36).…”

Section: Congenital Heart Surgery Centresmentioning

confidence: 99%

Narrative review in pediatric and congenital heart surgery in sub-Saharan Africa: challenges and opportunities in a new era

Manuel¹,

Miana²,

Edwin³

2021

AME Surg J

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Objective: Describe the dimension of this problem, present the challenges and show opportunities and probable solutions.Background: Congenital heart disease (CHD) remains a public health problem in developing countries, accounting for a significant portion of child mortality. In sub-Saharan Africa, this situation appears to be worse and requires urgent intervention.Methods: A narrative overview of the literature was carried out that summarizes the situation of pediatric and congenital heart surgery in sub-Saharan Africa with a focus on challenges and opportunities in this region of the world.Conclusions: A series of coordinated actions including governmental action (creation of laws and financing infrastructure) supplemented by non-governmental organizations (financial support for training, and education) are highly desirable. The challenges are many and widely described in the literature. However, with the continuous interest of the World Society for Pediatric and Congenital Heart Surgery in Africa and the creation of the African Society for Pediatric and Congenital Heart Surgery, a great opportunity emerges as never before. This will certainly help efforts to improve the care of these children with CHD in one of the poorest regions on the planet.

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“…The article in the current issue by Nwafor et al 1 reports the outcomes of cardiac surgery procedures performed for adults with CHD in Nigeria over a period of 5.5 years. There were 18 cases reported, of which 14 underwent surgical repair.…”

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Cardiac surgery for adult CHD in Nigeria: a too-familiar tale

Bolman

Mucumbitsi

2018

Cardiol Young

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The article in the current issue by Nwafor et al 1 reports the outcomes of cardiac surgery procedures performed for adults with CHD in Nigeria over a period of 5.5 years. There were 18 cases reported, of which 14 underwent surgical repair. The most common pathology was atrial septal defect in five patients, followed by sinus of valsalva aneurysm and patent ductus arteriosus in three patients each. Two patients had tetralogy of Fallot, but were not able to undergo surgical repair because there were no resources available to perform right heart catheterisation. The immediate operative survival was 77.9%, and no follow-up data are provided. Worldwide, CHD contributes significantly to infant morbidity and mortality, accounting for 7% of all neonatal deaths. 2 Cardiac surgery services are not available or inadequate in most developing countries, with estimates of only 2500-3000 children accessing heart surgery every year in Africa. 3 The scarcity of cardiac centres with appropriate diagnostic and surgical capacity on the African continent, combined with widespread poverty, the absence of universal health coverage systems, a high birth rate, and a lack of awareness of the signs and symptoms of CHD, indicates that many children with CHD are never able to be diagnosed and treated. Given low literacy levels in those countries, CHD diagnosis is delayed even more because some children are taken to herbalists and other non-conventional caregivers before seeking conventional care, even if it was available. Although Nigeria, the most populous nation on the African continent, is among the few countries to have cardiac surgery services since 1974, 4 it has no permanent and sustainable cardiac surgery programme for CHD. Some patients with CHD, however, manage to survive to adulthood, provided complications of the underlying lesion(s) do not supervene. These patients form the basis of this report. The authors describe a situation that is all too common in the developing world. Competing healthcare priorities, primarily communicable diseases, consumes many of the limited resources available for healthcare. As life expectancies increase through improved control of communicable diseases, non-communicable diseases are emerging as major public health challenges. Among non-communicable diseases, cardiovascular diseases, mainly ischaemic heart disease, remain the number one killer worldwide with more than 80% of the estimated 17.3 million annual deaths happening in low-and middle-income countries. 5,6 For the patients in the present report, all surgeries were carried out by humanitarian, visiting itinerant teams of surgeons and accompanying caregivers. The authors observe that some of these teams demonstrated a laudable focus on teaching and knowledge and skill transfer and improving the capabilities of the local team. Unfortunately, these teams were the ones who visited less frequently, with the result that the impact of their missions was limited. Other visiting teams, some of which visited more frequently, devoted less time and energy...

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Surgical management of CHD in the adult population: the role of humanitarian cardiac surgery mission in Nigeria

Abstract: During the period, a total of 18 CHD patients were treated.

Cited by 5 publications

References 23 publications

Status of Congenital Heart Defects in Nigeria: The Role of Cardiac Surgery

Status of Congenital Heart Defects in Nigeria: The Role of Cardiac Surgery

Narrative review in pediatric and congenital heart surgery in sub-Saharan Africa: challenges and opportunities in a new era

Cardiac surgery for adult CHD in Nigeria: a too-familiar tale

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