African Annals of Thoracic and Cardiovascular Surgery
Annales Africaines de Chirurgie Thoracique et Cardiovasculaire

Volume 1 Number 3 1st Semester 2007 / Volume 1 Numéro 3 1er Semestre 2007
EDITORIAL.
Surgery for Cardiovascular Disease in Africa.

Despite progress in the treatment of cardiovascular disease worldwide, the application of corrective surgery to the armamentarium available for treatment of patients presenting in the developing nations remain an infrequent occurrence. Notwithstanding the constraints imposed by infrastructural underdevelopment and dearth of financial support the medical specialist dedicated to the care of these patients continue to demonstrate that it is indeed possible to make the biblical “bricks without straws”!

The current issue of the Journal represents a compendium of publication attesting to the achievement of “respectable” outcomes of surgery in the medium of high risk deriving from non-medical factors.

The first paper, “Long term follow-up of 226 patients with Heart valve prostheses” by Ayegnon et al from the National Institute of Cardiology in Egypt demonstrates the outcome in a centre with “large volume” surgical experience with valve replacement. Unlike most other countries in Africa the majority of their patients (73%) presented in functional class II NYHA at time of surgery. They documented the negative impact of atrial fibrillation on long term survival of their patients, especially those with mitral prosthesis. Hopefully the modern surgical techniques now available for addressing atrial arrhythmias will improve future outcomes in these patients.
The second paper, “Complications in adult cardiac surgery” is a review by Pezzella from Worcester, Massachusetts. This excellent contribution is especially relevant as a template for Institutions at the inception of developing an Open Heart surgery programme. It emphasizes the need for structured protocols to enable early response to or prevention of anticipated complications. The next paper, “Thrombolysis for prosthetic valve thrombosis: A report of 6 cases and review of the literature”, comes from the group in Accra, Ghana and is a report of their experience with the use of thrombolytic drugs for treatment of thrombosed prosthetic heart valves. With an 83% success rate, they recommended the use of the drugs as first line management due to cost saving and safety.
The paper, by Ba et al from Dakar, entitled “Reconstructive surgery for rheumatic mitral regurgitation in Children” provides relevant information on mitral valve repair in a selected group of children. Despite the know difficulty with repair in such patients good results were recorded in 77% of cases. However the mean follow-up period of 67 days does not allow for a meaningful assessment of its contribution to valve surgery in these children.
Tettey et al from Accra, presents a case report, of a patient with a retained ingested denture who developed tracheosophageal fistula that subsequently required a colon bypass after tracheal repair and oesophagectomy. The dire consequences of failure to extract ingested objects lodged in the aero-digestive system is once again highlighted especially given that some may be intentionally so located in pursuit of “obscure” goals by the patient! Interestingly, the very next paper from Libreville, Gabon, by Mbamendame et al, is a case report of a retained foreign body in the bronchus is a 9 year old child. The subsequent pulmonary destruction necessitated bio-lobar resection and post-operative empyema; all preventable by early resort to trans-endoscopic extraction.

Ndiaye et al reports their experience with surgical intervention for abdominal aortic aneurysms in Dakar. Fifty percent of their cases presented with pulsatile abdominal mass and confirmation was obtained by ultrasonography in 13 of 16 cases; only 1 patient had the benefit of arteriography. Despite the limited facilities for evaluation of patients the medium outcome was favourable in 11 patients.
Diallo et al investigated the incidence of venous thrombosis on their Cardiology services over a period of five years using Doppler for confirmation. They document an incidence of .52%, with 56% female occurrence and a mean age of 51 years. Deep venous involvement was seen in 40% of the cases with pulmonary embolism in 12%. However, it is doubtful that all patients were detected given the poor diagnostic accuracy of clinical signs.
This issue of the Journal also includes abstracts from the cardiothoracic session hosted at the West African College of Surgeons Scientific meeting in Dakar, Senegal in February 2007.
We are indeed most grateful for all the contributors.

Prof Oluwole Adebo.