The sum of its parts: The importance of methodology on presented data
Use of a composite survival curve to optimise the surgical strategy for repair of transposition of the great arteries
The arterial switch operation (ASO) is considered the gold standard for repair of D-transposition of the great arteries. However, when patients present after the third week of life, the early operative outcomes may be less predictable. Current guidelines recommend extra corporeal membrane oxygenation (ECMO) availability when the arterial switch is performed on patients between 3 to 6 weeks of age. Controversy remains...
Use of a composite survival curve to determine the age at which surgery offers the highest survival benefit for Tetralogy of Fallot
Contemporary surgical practice relating to Tetralogy of Fallot is shifting towards earlier correction; however, a recent large study proposes later correction to increase event free survival. Surgery aims to improve the quantity and quality of life at minimal risk to the patient. Surgical outcome and risk assessment requires a comparison of externally valid studies of natural history and surgical outcome. The authors...
Native arteriovenous fistulas in hemodialysis patients: Our experience with 1467 patients operated on in Abidjan
This study aim to report our experience in the fabrication of arteriovenous fistulas (AVF) by describing the operative technique and the immediate surgical results. The study carried out retrospective study of the records of 1467 patients who underwent AVF creation during the period from January 2008 to December 2020. 1396 patients (95.2%) had already been dialyzed with a central venous catheter for one month (1...
Use of a composite survival curve to optimise timing of surgical repair of Truncus arteriosus
Surgical repair of Truncus arteriosus aims to improve long term survival. A clear understanding of the natural history and achievable surgical outcomes informs surgical decision making with respect to the timing of surgery. We sought to determine if it is ever too late to repair T. arteriosus. Pubmed and Google scholar were searched between January 1st 1966 and July 31st 2021. The proximal similarly model was used to...
Bovine aortic arch: Cases report
A bovine aortic arch is the most common variant of aortic arch branching in humans with a frequency ranging from 15 to 27% (1-2). It will be considered as a risk factor for aortopathy as anevrysm and dissection. Two cases were reported with association of bovine aortic arch and aortopathy. In both cases, the discovery of the anomaly of the aortic arch was fortuitous. A bovine aortic arch is frequent in patients with...
Surgical management and long term postoperative follow-up of atrial septal defects in adults
The aim is to report an Ivorian experience of the surgical management of atrial septal defects in adulthood. Our retrospective study included 19 patients over 18 years old operated on for atrial septal defects (ASD) between January 2005 and December 2015 at the Abidjan Heart Institute (AHI). 13 women and 6 men with a mean age of 26±9.07 years were included. For each patient we noted the clinical and para-clinical...
The relationship between peripheral arterial disease severity and allostatic load: A national health and nutrition examination survey study
Major socioeconomic disparities persist in the management and outcomes of peripheral artery disease (PAD) globally. Allostatic load, which is described as a measure of physiologic adaptation to socio-environmental stress, has been reported to partially explain higher mortality rates in US Blacks. However, it is not clear if allostatic load is associated with PAD severity. The National Health and Nutrition Examination...
Comparison between ultrasound guided regional anaesthesia and general anaesthesia in arteriovenous fistula creation at the Douala General Hospital
Anaesthetic modalities for arteriovenous fistula (AVF) creation include general (GA), local (LA) and regional anaesthesia (RA). Ultrasound guided regional anaesthesia (USRA) proved to have more benefits in AVF creation than the other two. This study conducted at the Douala General Hospital aimed to assess these benefits over GA and RA. A retrospective review was performed on 217 records of patients who underwent an AVF...
Short-term follow-up of patients implanted with aortic valve bioprosthesis sutureless type Intuity Elite at the Robert Debré University Hospital in Reims (France)
To report the operative data, the immediate surgical results and the short-term follow-up of patients who were implanted with an Edwards’s elite intuity bioprosthesis at the Thoracic and Cardiovascular Surgery Department of Reims (France). This was a retrospective and prospective study that was carried out from May 2015 to October 2017 in the Thoracic and Cardiovascular Surgery Department of the Robert...
Surgical repair of thoracic aortic aneurysm and dissection in the Sub-Saharan Africa: 30-day outcomes from a Cameroonian Center
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...
Possible impairment of surgical decision making and confounded outcome in Fontan surgery by Nakata Index
Since cardiac structuring dimensions inform surgical decisions making, Z-score systematic error impairs surgical decision making and confounds outcome measurement, hence a similar error may affect the Nakata index. In this study, PubMed was searched using the terms: “pulmonary,” “artery,” “size,” “Nakata,” “Fontan,” and “outcome”. Studies that did...
Chest surgical approaches in Africa: a constant challenge
Objective: Thoracic surgical approach has taken a decisive turn since videoscopy utilization for cardiac and non-cardiac thoracic surgery. This study aims to present indications and results of chest surgical approaches performed in Cote d’Ivoire. Methods: Using the 1998 and 2014 nationwide inpatient database, we identified retrospectivly 814 patients including 475 men and 339 women who underwent a...
Prise en charge des varices des membres inferieurs au centre hospitalier universitaire de brazzaville
Aim : To describe epidemiological, clinical, etiologic, and therapeutic aspects of lower limbs varicose veins. Patients-methods : It was a retrospective study, carried out from May 2016 to June 2018 at Brazzaville teaching hospital. All patients who has been operated and medical records had surgical approach data were included. Patients were classified according to modified Hawai 2004 classification. Surgery and...
The diagnosis and comprehensive management of congenital heart diseases in nations with severely restricted general and specialist healthcare services.
Disease (CHD) in clinically sub-optimal settings. It is presented to provide simple diferences between certain conditions commonly seen in children with CHD for training doctors and nurses and other staff working within the speciality. In the majority of clinical presentations, a comprehensive, well structured training of a multidisciplinary team and carefully chosen hospital equipment and resources, can permit CHD to...
Using technology and innovation to address the three delays in access to cardiac surgery.
Cardiovascular diseases (CVD) make up the leading cause of mortality in the world with 17.65 million deaths every year, of which more than 80% occurs in low- and middle-income countries (LMICs). (1) With the ongoing shift of the global burden of CVD towards low-resource settings, a mortality rate of 25 million deaths is projected in these regions by 2030. (2) Nevertheless, it is estimated that 93% of the population in...
Challenges in open heart surgery (OHS) in Africa: CÃ´te d'Ivoire experience
I would like to thank the United States Chapter of the ISS (slide 3) for inviting me at the ACS clinical congress 2015(slide 4) and give me an opportunity to speak on ”Challenges in Open Heart Surgery in Africa: Cote d’Ivoire Experience”(slide 5).
Surgical aspects of rheumatic heart disease: Part 3
Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) remain significant noncommunicable diseases in developing countries and emerging economies. Part one of this five part series discussed general aspects of ARF and RHD. Part two focused on medical and interventional approaches and treatment. The present part three will focus on surgical aspects of RHD. This will highlight the history, indications, timing, and...
CÃ´te cervicale inductrice dâ€™un pseudo-anÃ©vrysme de lâ€™artÃ¨re sousclaviÃ¨re et dâ€™un syndrome de la traversÃ©e thoraco-brachiale : Ã€ propos dâ€™un cas Ã YaoundÃ© (Cameroun).
La cote cervicale est une anomalie congénitale exceptionnelle, tout comme l’anévrysme de l’artère subclavière qui est une pathologie rare. Nous rapportons le cas d’un homme, travailleur manuel présentant des douleurs et gonflement cervical bas à droite dont le bilan scénographique a révélé une côte cervicale avec...
Insurance type is a major predictor of lower extremity amputation following infra-popliteal arterial trauma
Background: Following traumatic infrapopliteal arterial injury, salvageability of the leg is often attributed to injury-related variables. We investigated factors influencing amputation. Method: The United States’ National Trauma Data Bank was retrospectively examined identifying subjects aged ≥ 18 with tibial arterial injuries. Demographic, injury-related, co-morbid, and other variables were analyzed....
Chirurgie a coeur ouvert en Afrique de lâ€™Ouest: histoire, experience chirurgicale, et defis en Afrique de lâ€™Ouest
Outcome of feeding enterostomy for nutritional rehabilitation in dysphagia
Background: feeding enterostomy is used to build up patients with dysphagia bj definitive surgery. Objective: to evaluate the achievement of nutritional goals in dysphagia patients and to suggest management protocols. Methodology: A retrospective study of feeding enterostomies for dysphagia over 4 years. The preoperative, post-operative weights and progression to definitive esophageal replacement were analyzed. Results:...
Difficulties in the management of civilian peripheral vascular trauma and their complications at the University Teaching Hospital of YaoundÃ©, Cameroon
Background. The incidence of peripheral vascular lesions remains undetermined in Cameroon. The objective of this study is to report our experience with the management of peripheral vascular trauma in civil life at the University Teaching Hospital of Yaoundé. Patients and methods. We have reviewed retrospectively all the cases of peripheral vascular trauma treated at the Yaoundé’s University Teaching...
Open heart surgery in West Africa: history, surgical experience, and challenges
Surgical aspects of rheumatic heart disease: Part 2
The overall global growth or expansion of cardiac surgery favors the developing countries and emerging economies. At present, it is estimated that over 2 million open-heart operations are performed annually worldwide. It is also estimated that over 10,000 cardiothoracic surgeons, in over 3,000 centers, that include specialty clinics, hospitals or institutes, be that public, private or charitable, are involved in that...
Outcomes of abdominal aortic aneurysm repair in Immunodeficiency Virus (HIV) positive patients
Background: HIV-infected patients are at an increased risk for accelerated vascular disease. Abnormal endothelial function and aneurysmal dilation of the large arteries have been described; however, data is lacking on the outcomes of HIV-infected patients undergoing abdominal aortic aneurysm (AAA) repair on a national level. Methods: This study is a retrospective analysis of hospital discharge data using the Nationwide...
Mitro-tricuspid valve disease: Cote dâ€™Ivoire surgical experience
The objective of this study was to report our experience on mitro-tricuspid valve disease treated surgically. Material and Methods: 72 patients with mitro-tricuspid valve disease were collected between December 1983 and November 2009. We have studied the epidemiological, clinical, paraclinical and therapeutic data. Only patients with mitral disease (mitral regurgitation and mitral stenosis) associated with tricuspid...
Risk factors for morbidity and mortality after ascending aorta aneurysms repair
Objective: The aim of this study is to assess the mortality and morbidity factors of surgery for ascending aorta aneurysm. Methods: This is a retrospective study of 229 sheet records of patients who underwent ascending aorta replacement for aneurysm; the statistical analyze permitted to assess the mortality and morbidity factors. Results: A replacement of the ascending aorta with the aortic valve (Bentall) was done in...
Total intra-cardiac repair of cyanotic congenital heart disease in Accra â€“ 20 years experience
Objective: To analyse the spectrum of cyanotic congenital heart disease that had total intra-cardiac repair in this Centre and the outcome over a 20-year period. Patients and Methods: A retrospective study was done for all patients who had intra-cardiac repair for cyanotic congenital heart disease from January 1992 to December 2011. Results: There were 115 cases, with 56.5% of them being male. The modal age group was 5...
Acute lower limbs ischemia in Bamako (Mali)
The aim of this work was to analyze the results of the management of acute lower limbischemia. Materials and methods : It was a retrospective study for 12 years (2000 -2011) at teaching hospital Point “G” Bamako. The medical files and the operational reports of the patients dealt with for acute arterial ischemia of the lower limb were re-examined. Results: We managed 50 patients for an acute lower limb...
Traumatic chylothorax: a case report
Chylothorax is an uncommon condition, and more so chylothorax secondary to blunt trauma. However, when it occurs it can be debilitating and life threatening, unless appropriate treatment is instituted on time. We present the case of a 39-year old man who felt from a height and developed chylothorax secondary to blunt trauma, amidst other injuries. He was admitted, managed conservatively and discharged home 17 days later...
TRAITEMENT DES HYPERPLASIES THYMIQUES : A PROPOS DE 5 CAS OPERES
Les hyperplasies thymiques se caractérisent par une pathogénèse complexe et des tableaux cliniques variés sources d’attitudes thérapeutiques controversées. Insister sur la rareté, les difficultés diagnostiques et rapporter les résultats de la chirurgie dans les hyperplasies...
Pediatric Thoracic Hydatid Cysts in Peru : Case Report and Review
Hydatid cyst secondary to the parasite Echinococcus granulosus, involving the lung parenchyma, is an endemic disease in Peru, especially in the rural areas involved with animal domestication. Despite aggressive government public health directives for prevention, poor recognition and compliance remain major factors in human infection, especially in children. Medical treatment alone is not effective in the majority ...
DEVICE OCCLUSION OF ATRIAL SEPTAL DEFECT THROUGH MINIMALLY INVASIVE RIGHT ANTERIOR CHEST APPROACH
Occlusion of atrial septal defects through a small right chest incision is minimally invasive and safe.
CALCIFIED PSEUDO-ANEURYSM OF ASCENDING AORTA FROM CANNULATION SITE ERODING INTO THE STERNUM : A CASE REPORT
We report the successful surgical treatment of a nonmycotic pseudoaneurysm of the ascending aorta in a 15 year old male who underwent surgical closure of an atrial septal defect at the age of 3 years. A Computed Tomography (CT) scan was performed to investigate the palpable mass on the healed sternotomy scar. It revealed a densely calcified...
SUIVI A LONG TERME DE 80 PATIENTS OPERES D’UNE DISSECTION AORTIQUE AIGUË DE TYPE A/LONG-TERM FOLLOW-UP OF 80 PATIENTS OPERATED FOR AN ACUTE AORTIC DISSECTION TYPE A
Identifier et évaluer les facteurs de risque de morbi-mortalité à court et long terme d’une dissection aortique aiguë de type A de Stanford. C’est une étude rétrospective de 80 patients (57 hommes et 23 femmes) consécutifs opérés d’une dissection aortique aiguë de type A de...
Migrating Aspirated Foreign Body With Associated Intra-Atrial :Clot A Case Report
The authors report a case of 10-year-old girl who presented with cough and breathlessness of 7 weeks and orthopnoea of 4 weeks. An earlier consultation at a private hospital revealed echocardiographic findings of right intra-atrial clot, confirmed at our institution. Plain chest radiographs showed right lower lobe consolidation and atelectasis. Cough worsened and she desaturated (SaO2 67%) on the 5th week of antibiotic...
Les Decortications Pulmonaires Au Centre Hospitalier Et Universitaire (Chu) Yalgado Ouedraogo
The aim of study is to report the indications and results of lung decortication at CHU Yalgado Ouedraogo. It is a retrospective study including all the patients who underwent lung decorticaion at CHU Yalgado Ouedraogo from May 2005 to March 2008. Lung decortication accounted for 50% of thoracotomies carried out for this period. 10 women and 6 men...
Angioplastie Pulmonaire Per-Operatoire Des Cardiopathies Congenitales
L’angioplastie percutanée des branches de l'artère pulmonaire (AP) peut être indiquée dans la sténose étendue à la chambre de chasse ventriculaire droite, mais limitée en cas de la complexité anatomique des branches de l’AP accompagnant les cardiopathies congénitales. Une approche hybride, associant une angioplastie de l’AP...
Le Drainage Chirurgical pour Pericardites Liquidiennes Dakar
Notre étude a pour but de déterminer la morbi-mortalité et les étiologies des péricardites liquidiennes à Dakar. Patients et méthodes: Il s’agissait d’une étude rétrospective de 1994 à 2008 colligeant 55 dossiers de patients opérés dans le service de chirurgie cardiovasculaire du CHU de Dakar. La triade...
Atrial Septal Defect Closure In A 70 Year Old Woman: Case Report And Literature Review
Time was when it was thought that Atrial Septal Defects (ASDs) diagnosed in adulthood, especially in the elderly should only be managed conservatively. The trend is gradually changing and most “elderly ASDs” are getting closed, especially percutaneously if they are the ostium secumdum type. The Ostium primum, sinus venosus and coronary sinus ASDs still need open-heart surgery. We present the case of a woman...
Surgery of congenital heart diseases in Dakar, from a series of 102 Cases
The surgical treatment of congenital heart diseases is recent in our practice. As developing country, our surgical indications are adapted to our possibilities and only the operated patients are reported in this study. One hundred and two patients were operated on between 1992 and 2002. There were 54 patent ductus arterious (PDA), 27 cases of tetralogy of Fallot (TF), 17 cases of atrial setal defect (ASD) and 4 cases of...
The Klippel-Trenaunay-Weber Syndrome. A case report and literature review
Association of bone and soft tissues hypertrophy, cutaneous haemangioma and superficial varicosity classically form the Klippel-Trenaunary-Weber syndrome. One case was diagnosed in a 12-year-old patient, admitted for a right lower limb congenital oedema. The goal of this study is to attract clinicians' attention upon this rare affliction with a difficult diagnosis and treatment. Clincally generalised oedema of the...
Thrombolys for blocked arterio-venous dialysis shunts
This was a retrospective study that looked at the effectiveness of thrombolytic agents in re-establishing flow in thrombosed Brescia-Cimino shunts for 10 patients on chronic dialysis. The thrombolysis was done in an intensive care setting under monitoring for arrhymias, hypotension and desaturation of blood. Of the ten patients 6 (60%) of them were male and 4 (40%) were famale. The average age of the patients was 53.9 +...
Chirurgie a coeur ouvert en cÃ´te d'ivoire. vingt annees d'experience chirurgicale
The aim of this study is to report our surgical experience with open heart surgery in Cote d'Ivoire. From 1978 to 2000, 1665 patients have been operated on by cardiopulmonary by pass (CPB). There were 994 for acquired valvular heart diseases, 408 for congenital heart diseases and 263 for others cardiac diseases. Concerning vavular cardiac surgery (n = 994). 776 were monovavular (mitral n -606, aortic n = 126,...
Pulmonary valvotomy under normothermic caval inflow occlusion
Ffity nine patients underwent an operation between January, 1993 and April, 2000 for isolated pulmonary valve stenosis utilizing the inflow stasis technique. Patient ages ranged from 4 months to 44 years. All patients underwent preoperative two dimensional/doppler echocardiography (2D ECHO) to quantitate the peak systolic gradient between the right ventricle and pulmonary artery. Forty seven patients were studied...
Intensive care unit readmission after cardiac and thoracic surgery
Critical care services are one of the most demanding specialties in clinical practice and readmission to the intensive care unit has substantial financial and resource implications. Readmission and use of an expensive intensive care bed may be for a preventable complication. The aim of this study is to determine the readmission rate in the intensive care unit at the National Cardiothoracic Center, the causes of...
Global expansion of Cardiothoracic Surgery. The african challenge
A case of cardiac tumor observed in the point "G" hospital
The heart can be the seat of neoplastic clinical demonstrations. In the case brought back here, the clinical picture associated to a recent and quickly increasing dyspnoca, a supirioir vena cava syndrome. The trans-thoracic echocardigraphy objectivised a tissulary mass and inhomogeneous two right cavities. The thoracic TDM confirmed the intra thoracic tumor with images of lymphangitidis carcinoma and of pleural...
Traitement chirurgical des pericardites chroniques constrictives a Libreville
In tropical Africa, constructive chronic pericarditis are essentially from tuberulous origin. If the diagnosis of this affection has neatly improved during these last years, because of our sanitary units acquiring soecialised explorations, the surgical treatment always leads to difficulties, related to material conditions. The goal of this study is to present the experience of the Thoracic Vascular and Visceral unit of...
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