Surgical Experience with Closure of an Isolated PDA at Muhimbili Cardiothoracic Unit in Dar es Salaam, Tanzania

Background: This study describes our experience in the management of isolated patent ductus arteriosus; complications and mortality rate. Further it describes the innovative technique for the closure of the duct.Methods: We retrospectively recruited all patients’ files that underwent PDA closure from May 2008 to July 2011 in all these patients clinical evaluation and confirmation of diagnosis was made by echocardiography. There were two-treatment group. The first group underwent a standard surgical closure and these were 26 patients this group was obtained from the usual and routinely done PDA ligation. The second group also comprised 26 patients who had undergone a modified closure technique as illustrated by Kirklin1. Patients’ age, sex duration of illness, stage of the disease as classified by New York Heart Association, ventricular function as depicted by left ventricular ejection fraction, any associated lesion were noted. During operation, confirmation of the PDA was done and the total operation time (TOT), total duration of ventilation (VT), and any complication were noted. The total duration of intensive care stay and the postoperative period stayin the ward were noted. Patients had been followed at six months interval for two years; in which during follow up evaluation for their cardiac status to exclude congestive heart failure, presence of residual PDA had been done. All data were entered in a structured data sheet and analyses using Spss window 17 statistical program.Results: A total of 52 patients with clinical diagnosis of PDA, 26 patients in each treatment group of either standard closure or new closure technique. Female patients had outnumbered male patients by 5.5 folds. A total of 46.1% of patients were under five years old. A relatively younger  population of patients was seen with the new closure technique as compared to patients in the standard closure technique (p=0.02). Similarly a correspondingly less heavier weight was noted in patients who underwent new closure technique as compared to those who had standard closuretechnique(p=0.03). Long- term follow up of patients with their treatment modalities it was found that 3 patients and 2 patients had residue lesion and congestive cardiac failure respectively who were exclusively in the standard closure technique, none of such complications were seen with thenew closure technique (p=0.04). With such evidence, the practice to date has been the new closure technique for definitive surgical treatment for PDA.Conclusion Open surgery for PDA closure remains the procedure of choice for facility and technically deprived countries. The approach and the technique of closure that minimize the postoperative complications is a challenge from centre to centre. However this study with a new closure in which a purse string on the ampulla of the PDA followed by a silk ligature has proved to be efficient and reliable technique that leaves no residual lesion with no long term complications.Key words: Closure, Isolated, Patent, ductus arteriosus, PD

Early outcome of Mitral Valve replacement: Results from Chordal Preservation at Muhimbiba National Hospital, Tanzania

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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