Abstract This case suggests that clinicians should consider seizures as a differential diagnosis of paroxystic cough with loss of consciousness. Focal cortical dysplasia should equally be screened for with magnetic resonance imaging (MRI) scans even in adults with epilepsy in sub‐Saharan Africa.
The real incidence of thoracic aorta aneurysm and dissection (TAA) in the sub-Saharan region is unknown. Owing to diagnostic limitations and the absence of specialized centers, reports on TAA surgery have been anecdotal. We report our 30-day outcomes over an 8-year period following TAA surgery at the Shisong Cardiac Center, a Cameroonian cardio-surgical institution. Between November 2010 and May 2018, TAA was diagnosed in 35 patients at the Shisong Cardiac Center. Twenty eight (n=28) patients underwent surgical repair during the same period [Mean age: 43.8±14.7 years, range: 18-72 years; males: 18/28 (64.2%)]. Patient profiles, disease etiology and surgical outcomes were retrospectively reviewed. Uncontrolled hypertension was the commonest risk factor (17/28, 60.7%). Genetic disorders were found in 5/28 patients (17.8%) including 4 with bicuspid aortic valve and 1 with Marfan’s Syndrome. The operative mortality was 10.7% (n=3/28). Twenty one (n=22/28, 75%) patients had composite aortic root replacement (Bentall and De Bono); four patients (n=4/28, 14.2%) had ascending aorta graft replacement and two patients (n=2/28, 7.1%) underwent reductive aortoplasty (Robiscek). Associated procedures were mitral surgery (4/28, 14.2%), tricuspid repair (3/28, 10.7%) and CABG (1/28, 3.5%). One case of stroke was reported in the immediate postoperative period. The incidence of TAA in the sub-Saharan region seems to be underestimated due mainly to insufficient number of specialists and medical infrastructures. A major attention should be paid during the evaluation of patients with risk factors. These early results demonstrate the feasibility of surgical correction in our country with encouraging results.
Key words: Thoracic aneurysm, aneurysm repair, Sub-Saharan Africa.
Despite the alarming and growing burden of cardiovascular diseases in sub-Saharan Africa (SSA), there is still a huge lack of specialised institutions in the region with a mean of one cardio-surgical unit for 33 million inhabitants. Despite the numerous efforts from humanitarian organisations made in recent years, the setting up of cardio-surgical units in the region remains challenging with regards to long-term sustainability. Indeed, besides the lack of financial resources, the insufficient local expertise in addition to the inadequate health infrastructure, unpredictable threats from external factors such as recurrent conflicts and humanitarian crises are still major concerns in an environment characterised by endemic socio-political instability. In Cameroon, located in the North West Anglophone region at 500 km from the capital, the cardiac centre of Shisong (CCS) is currently the lone cardio-surgical institution of the country. Fruit of a joint initiative of two Italian Non-governmental organisations namely, Bambini Cardiopatici nel Mondo (ABCnM) and Cuore Fratello (CF), and a local religious partner, the Tertiary Sisters of Saint Francis (TSSF), the CCS was faced with in the middle of a socio-political crisis that led to the urgent need of revision of the cardio-surgical project. The current paper reviews the impact of the ongoing socio-political crisis on the CCS over the past 3 years, in terms of clinical activities, staff perspectives, and long-term sustainability.
Introduction: The practice of cardiac surgery (CS) in sub-Saharan Africa faces a number of challenges. We report on the surgical activities of the first 17 months of the program launched at the Yaoundé General Hospital (YGH), describing the types of interventions and the early results. Patients and Methods: This was a descriptive cross-sectional study including patients who underwent CS from September 2022 to January 2024 at the YGH. Clinical, operative and postoperative data were collected and analysed retrospectively by R software. Results: A total of 37 patients underwent CS during the study period, divided into 23 (62.2%) open-heart and 14 (37.8%) closed-heart cases. Males predominated (sex ratio 1.17). The median age and interquartile range (IQR) were 36 years (9 - 51). Isolated valve surgery, in 15 (40.5%) cases, was the most common procedure in open-heart surgery cases. Closed-heart surgery involved closure of the patent ductus arteriosus in 9 (24.3%) cases, coronary artery bypass grafting in 3 (8.1%) cases, and pericardectomy in 2 (5.4%) cases. The median duration of extracorporeal circulation and aortic cross-clamping was 101 min (IQR 84 - 143) and 74 min (IQR 54 - 112) respectively. The median duration of mechanical ventilation was 2 hours (IQR 2 - 3). The median intensive care unit stay and median hospital stay were 2 days (IQR 2 - 3) and 7 days (IQR 5 - 8) respectively. Operative mortality was 2 (5.4%). Conclusion: Cardiac surgery remains a major challenge for African populations. The early results achieved by the local team are satisfactory. An increase in surgical activity should be strongly encouraged to facilitate local training and ensure the sustainability of the activity.
Type A aortic dissection (TAAD) is associated with high mortality in the absence of appropriate surgical therapy. The involvement of the aortic root by the intimal tear and the presence of severe aortic insufficiency will require a more radical approach with composite root replacement (CRR) in most of the patients. We briefly report our surgical experience following CRR in 12 patients presenting with TAAD in our department. Between November 2009 and January 2022, a total of twelve (n=12) patients diagnosed with TAAD were operated in our institution. Clinical data and surgical outcomes were retrospectively reviewed. The mean age at admission was 51.1 ± 12.43 years (range: 34-72). One patient met the criteria for Marfan´s disease (1/12, 8.3%). The operative mortality was 16.66% (2/12). Composite root replacement with a mechanical valved conduit was performed in the majority (11/12, 91.66%;) whereas a separated supracoronary graft replacement and aortic valve replacement were performed in one patient. Concomitant aortic arch surgery (hemi or total) was done in 9/12 patients (75%). The commonest postoperative complications were: chest re-exploration for bleeding in 2/12 (16.66%), transitory cerebral ischemia in 1/12 (8.33%) and low cardiac output syndrome in 2/12 (16.66%). The mean length of stay in the Intensive Care Unit (ICU) was 4.8±3.8 days (range: 2-17). Delayed referral of patients with TAAD was observed in the majority of patients as they were operated in the subacute or chronic phase. Composite root replacement in these patients is associated with acceptable outcomes despite complex anatomic-pathological lesions.
Introduction-Objectifs : La presence d’une tachycardie ventriculaire (TV) doit necessiter une prise en charge rapide. L’objectif de cette etude etait d’etudier les aspects epidemiologiques, cliniques, paracliniques, etiologiques, therapeutiques et evolutifs de la TV en hospitalisation de cardiologie au CHU-YO.Materiel et methodes : il s’est agi d’une etude retrospective descriptive allant du 1er Janvier 2012 au 31 decembre 2014.Ont ete inclus les patients âges de plus de 18 ans, hospitalises dans le service de cardiologie du CHU Yalgado Ouedraogo, ayant presente une TV soutenue ou non soutenue a l’ECG de surface douze derivations ou a l’enregistrement continu Holter ECG.Resultats : Trente-six (36) cas de TV ont ete retenus. La prevalence hospitaliere de la TV etait de 2,34 %. L’âge moyen des patients etait de 61,44 ± 14,55 ans (extremes 34-85 ans). Le sex-ratio etait de 2,6. Un antecedent d’hypertension arterielle etait retrouve dans 47,22 %. A l’admission un syndrome d’insuffisance cardiaque etait present dans 88,88 %. Le collapsus, l’etat de choc et les palpitations ont ete les manifestations cliniques les plus retrouvees au moment de la TV. La TV etait soutenue dans 36,11% et non soutenue dans 63,88 %. Les principales etiologies etaient representees par les cardiopathies hypertensives (30,30%) et les cardiopathies ischemiques (30,30%). La reduction de la TV soutenue a ete effectuee par choc electrique externe dans 77 %. L’amiodarone a ete utilisee dans 87% en cas de TVNS. La reduction et le maintien en rythme sinusal a ete obtenu globalement dans 63,88 % des cas. La duree moyenne d’hospitalisation etait de 14,30 ± 9,99 jours (extremes 2-36 jours). La mortalite globale etait de 44,44 %.Conclusion : Le pronostic de la TV suggere une surveillance rigoureuse des patients presentant des cardiopathies sous-jacentes a risque.Mots cles : tachycardie ventriculaire, trouble du rythme, cardiopathie
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