PROFILE OF PATIENTS UNDERGOING CARDIAC SURGERY AND EARLY OUTCOME IN THE CARDIAC CENTER OF SHISONG

Bihle Nestor Mbinkar (bihlenestor@googlemail.com)
Internal medicine, University of Yaounde 1
June, 2013
 

Abstract

Introduction
The incidence of significant congenital heart disease is generally reported at about 1% of live births. Rheumatic heart disease, reported to be almost eliminated in developed countries is still a public health concern in Sub Saharan Africa. Without appropriate treatment about one in three children born with significant congenital heart disease will die within the first month of life, half will die in infancy or early childhood and most of those who survive become debilitated by the cardiac defect. In the case of rheumatic heart disease, one in five will die within the first 15 years, and almost 4 in 5 will be dead by 25 years. In most case, the only hope for these patients lies in surgery which is largely unavailable in Africa.
From the inauguration of the Cardiac Centre at Shisong in 2009, little is known about the characteristics of patients undergoing heart surgery. Consequently, we sought to carry out a study entitled “Profile of patients undergoing cardiac surgery and early outcome in the Cardiac Centre of Shisong”.

Objectives
Our main objective was to describe the clinical characteristics in patients undergoing heart surgery and outcome of surgery. Specifically, we were to describe our study population, clinical presentation, the different indications of heart surgery and outcome of surgery on our study population.

Methods
This was a retrospective study covering a period of 3 years, from January 1st, 2010 to December 31st, 2012. Hospital records of patients who underwent cardiac surgery were reviewed.

Results
Out of a total of 250 records the proportion of males (48%) was slightly less than that of females (52%). The minimum age was 2 months and the maximum was 74 years. The median age was 16 years while the mean age was 20±18 years. Congenital heart diseases (CHD) accounted for 46.4% while acquired heart disease (AHD) accounted for 53.6%. A greater proportion of patients (84%) were referred from urban areas.
Most patients with CHD had acyanotic presentation (68.6%) compared to 31.4% cyanotic cases. The three most frequent congenital heart defects were tetralogy of Fallot (26%), isolated ventricular septal defect (16%) and patent ductus arteriosus (15%). Most patients with AHD presented with heart failure (87.6%). Valvular heart diseases were the most common form of AHD (88.8%) with frequent lesions being mitral regurgitation associated with tricuspid regurgitation (21%), isolated mitral regurgitation (16.8%) and isolated aortic regurgitation (14%). CHD were more common (46.6%) than RHD (42.5%).
Post operative complications were found in 46.4% of patients. The most common complications in CHD were fever with no clinical focus (13.2%), acute renal injury (9.6%) and arrhythmia (7%). In AHD, low cardiac output was the most common (20.2%), followed by fever (15.6%) and acute renal injury (11.6%). A majority of these patients recovered and were discharged home in good conditions (93.6%). The in-hospital mortality was 6%. Most of these patients died from heart failure, acute renal injury, respiratory failure and arrhythmia.

Conclusion
A majority of patients operated at the Cardiac Centre were children less than 20 years of age with most of them presenting with heart failure. Congenital heart diseases were more common than rheumatic heart diseases. Tetralogy of Fallot, ventricular septal defect and patent ductus arteriosus were the most frequent indications of heart surgery among patients with CHD while mitral regurgitation associated with tricuspid regurgitation, isolated mitral regurgitation and aortic regurgitation were the most common indications among patients with AHD. Although the rate of complications was relatively high, most patients responded well to treatment and were discharged home in good conditions. The in-hospital mortality was comparable to those of other centres.


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