6 research outputs found
Cardiac Surgery: One year experience of cardiac surgery at Muhimbili National Hospital, Dar es Salaam- TANZANIA
Background: Establishing a cardiac unit in developing countries is usually difficult as it is associated with many obstacles of both expertise and financial constraints and more alarming is the mortality rate that may be high. Even after success in the initial stage sustainability of such program is a dilemma. The aim of this study was to determine pattern of disease profile, type of cardiac surgery done and the overall outcome.Methods: All patients who underwent cardiac operation at the centre were prospectively recruited. Patients’ demography and disease characteristics as demonstrated at echocardiography and its confirmation at operation were recorded. Peri-operative factors were the measurable statistics that determined the overall patients’ outcome. All data were entered and analyzed using a spss11.5 window program.Results: A total of 105 cases of cardiac surgery were done 21% were male and 79% were females. Mean age was 19.4±12.3. The majority of cases were due to Rheumatic heart diseases (47.6%), congenital heart disease (35.2%), myxomatous valvular degeneration (16.2%) and pericardial disease 1%. Mitral valve disease was the commonest cause of cardiac disease (58.1%). Prolonged duration of aortic cross-clamp and total operation time were associated with prolonged intensive care stay and poor patients’ outcome respectively (p<0.05). While, ventricular dysfunction and total cardiopulmonary bypass time were not. The overall mortality rate was 13.3%. Majority of all death (64.3%) followed mitral valve repair.Conclusion: The majority of patients (86.7%) who underwent cardiac surgery had full recovery. The mortality of (13.3%) is probably comparable to other settings. The diversity of spectrum of cardiac disease found elsewhere is also found in our community and therefore need to increase community awareness. Mitral valve repair deserve a special entity that requires skills and expertise. The mere presence of suboptimal ventricular dysfunction is probably not a contraindication to cardiac operation. The duration of aortic cross-clamp and total operation time were determinant of postoperative outcome
Right atrial myxoma at Muhimbili National Hospital: a case report
Background: Primary cardiac neoplasms are rare most of them are benign. Cardiac myxomas are the commonest benign lesion and the initial presentation may be accompanied with pulmonary, cerebral or systemic complications. Complete resection of the tumour is associated with good prognosis but recurrence is a frequent post operative complication. We report a first rare case from our centre of right atrial myxoma occurring in a young lady of 20 years old, a diagnosis and technique of resection is also explained. Case presentation: We report a rare case of a young girl who had presented to us with history of shortness of breath and easy fatigability, she was also found to have features of both upper andlower cava hypertension and was in NYHA class IV. The 2-D echocardiography revealed a right atrial tumor encroaching the tricuspid valve, chest radiography showed gross cardiomegally and right lower lung collapse. A clinical diagnosis of right atrial tumour was reached. The patient was scheduled to undergo open heart surgery and tumour resection on 23rd September 2009 and was prepared accordingly. A classical median sternotomy followed by major vessel cannulation in which the cava were cannulated distally. Patient was cooled to 22 centigrade the tumour was found filling the whole of right atrium cavity, friable with a broad stalk on the right atrial appendage extending and infiltrating the crista terminalis. It was excised and tissue was taken for histopathology. The right atrium was reconstructed and closed with adequate size of atrium. The histopathology revealed a typical right atrial myxoma. Postoperatively the patient developed massive right sided pleural effusion that was managed by tube thoracostomy. Eventually the patient recovered and was discharged to be followed at outpatient clinic. Conclusion: Right atrial myxomas are rare lesion occurring in 5- 10% of all cases of cardiac myxoma. The peak incidence is between 3rd to 6th decades of life. Our case was unusual as it occurred in the 2nd decade and in the right atrium with multicentric origin though still confined in the right atrium. She also presented with pulmonary complication of right sided lung collapse. Early diagnosis andresection is followed by good prognosis and recurrence rate is low. Resection was done and the postoperative period was uneventful.Keywords: cardiac myxoma, atrial tumour, cardiac tumour, multicentric, subendocardium, mesechymal tissu
Cardiac Surgery: One Year Experience of Cardiac Surgery at Muhimbili National Hospital, Dar es Salaam - Tanzania
Background: Establishing a cardiac unit in developing countries is
usually difficult as it is associated with many obstacles of both
expertise and financial constraints and more alarming is the mortality
rate that may be high. Even after success in the initial stage
sustainability of such program is a dilemma. The aim of this study was
to determine pattern of disease profile, type of cardiac surgery done
and the overall outcome. Methods: All patients who underwent cardiac
operation at the centre were prospectively recruited. Patients’
demography and disease characteristics as demonstrated at
echocardiography and its confirmation at operation were recorded.
Peri-operative factors were the measurable statistics that determined
the overall patients’ outcome. All data were entered and analyzed
using a SPSS 11.5 window program. Results: A total of 105 cases of
cardiac surgery were done 21% were male and 79% were females. Mean age
was 19.4±12.3. The majority of cases were due to Rheumatic heart
diseases (47.6%), congenital heart disease (35.2%), myxomatous valvular
degeneration (16.2%) and pericardial disease 1%. Mitral valve disease
was the commonest cause of cardiac disease (58.1%). Prolonged duration
of aortic cross-clamp and total operation time were associated with
prolonged intensive care stay and poor patients’ outcome
respectively (p<0.05). While, ventricular dysfunction and total
cardiopulmonary bypass time were not. The overall mortality rate was
13.3%. Majority of all death (64.3%) followed mitral valve repair.
Conclusion: The majority of patients (86.7%) who underwent cardiac
surgery had full recovery. The mortality of (13.3%) is probably
comparable to other settings. The diversity of spectrum of cardiac
disease found elsewhere is also found in our community and therefore
need to increase community awareness. Mitral valve repair deserve a
special entity that requires skills and expertise. The mere presence of
suboptimal ventricular dysfunction is probably not a contraindication
to cardiac operation. The duration of aortic cross-clamp and total
operation time were determinant of postoperative outcome
Closed Mitral Valvotomy-a Life Saving Procedure in Facility Deprived Countries: Experience at Muhimbili National Hospital, Tanzania.
Background: Rheumatic heart disease remains a major health cardiac problem in developing countries as the culprit of rheumatic fever. Mitral valve stenosis is the most common complication of valvular heart disease and its consequences of increase in pulmonary hypertension, heart failure, pulmonary vascular disease and if untreated death ensues. The management of this condition varies depending on availability of expertise and resource; however in a facility deprived country with low economic status closed mitral valvotomy remain the standard palliative treatment! The aim of this study was to evaluate the clinical status of patients with mitral stenosis following closed mitral valvotomy treated at Muhimbili National Hospital, Cardiothoracic Unit. Methods: All patients presenting with severe mitral stenosis in absence of calcification in its leaflets and regurgitation were enrolled for the study from May 2008 to November 2009. Excluded were those who failure consents. Results:A total of fourteen patients were included in the study of which 10 (71.4%) were females and 4 (28.6%) were males. They had a mean age of 21.5±8.8 and range from 11 to 41 years. The diagnosis was based on clinical evaluation using NYHA class and 2D-Echocardiography findings. All patients’ demographic data, preoperative and post operative findings were taken and data analysis was done using an SPSS 11.5 program. Categorical data were compared and analyzed using two Tailed- χ2 and values were taken 5% significance level. Conclusion: There was an overall highly significant improvement in clinical stage of the disease, reduction in mean pressure gradient across the mitral valve, reduction in pulmonary hypertension and mean left atrial size. Similarly there was improvement in ventricular function in terms of ejection fraction and increase in mean mitral valve area
Closed Mitral Valvotomy-a Life Saving Procedure in Facility Deprived Countries: Experience at Muhimbili National Hospital, TANZANIA.
Background: Rheumatic heart disease remains a major health cardiac
problem in developing countries as the culprit of rheumatic fever.
Mitral valve stenosis is the most common complication of valvular heart
disease and its consequences of increase in pulmonary hypertension,
heart failure, pulmonary vascular disease and if untreated death
ensues. The management of this condition varies depending on
availability of expertise and resource; however in a facility deprived
country with low economic status closed mitral valvotomy remain the
standard palliative treatment! The aim of this study was to evaluate
the clinical status of patients with mitral stenosis following closed
mitral valvotomy treated at Muhimbili National Hospital, Cardiothoracic
Unit. Methods: All patients presenting with severe mitral stenosis in
absence of calcification in its leaflets and regurgitation were
enrolled for the study from May 2008 to November 2009. Excluded were
those who failure consents. Results:A total of fourteen patients were
included in the study of which 10 (71.4%) were females and 4 (28.6%)
were males. They had a mean age of 21.5±8.8 and range from 11 to
41 years. The diagnosis was based on clinical evaluation using NYHA
class and 2D-Echocardiography findings. All patients’ demographic
data, preoperative and post operative findings were taken and data
analysis was done using an SPSS 11.5 program. Categorical data were
compared and analyzed using two Tailed- χ2 and values were taken
5% significance level. Conclusion: There was an overall highly
significant improvement in clinical stage of the disease, reduction in
mean pressure gradient across the mitral valve, reduction in pulmonary
hypertension and mean left atrial size. Similarly there was improvement
in ventricular function in terms of ejection fraction and increase in
mean mitral valve area