Surgical Treatment of Valvular Heart Disease in Nigeria: A 6-Year Experience

Surgical treatment of valvular heart disease in Nigeria, the most populous country in sub-Saharan Africa, is adversely affected by socioeconomic factors such as poverty and ignorance. To evaluate our experience in this context, we identified all patients who underwent surgery for acquired or congenital valvular heart disease at our Nigerian center from February 2013 through January 2019. We collected data from their medical records, including patient age and sex, pathophysiologic causes and types of valvular disease, surgical treatment, and outcomes. Ninety-three patients (43 males [46.2%]; mean age, 38.9 ± 10.0 yr [range, 11–80 yr]) underwent surgical treatment of a total of 122 diseased valves, including 72 (59.0%) mitral, 26 (21.3%) aortic, 21 (17.2%) tricuspid, and 3 (2.5%) pulmonary. The most prevalent pathophysiologic cause of disease was rheumatic (87 valves [71.3%]), followed by functional (20 [16.4%]), congenital (8 [6.6%]), degenerative (5 [4.1%]), and endocarditic (2 [1.6%]). All 3 diseased pulmonary valves had annular defects associated with congenital disease. Surgical treatment included mechanical prosthetic replacement of 92 valves (75.4%), surgical repair of 29 (23.8%), and bioprosthetic replacement of 1 (0.8%). We conclude that, in Nigeria, valvular disease is mainly rheumatic, affects mostly younger to middle-aged individuals, and is usually treated with prosthetic replacement

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Unusual Giant Right Atrium in Rheumatic Mitral Stenosis and Tricuspid Insufficiency

Case Reports in Cardiology ◽

10.1155/2011/762873 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Jean Baptiste Anzouan-Kacou ◽

Christophe Konin ◽

Iklo Coulibaly ◽

Roland N'guetta ◽

Anicet Adoubi ◽

...

Keyword(s):

Heart Disease ◽

Mitral Regurgitation ◽

Tricuspid Regurgitation ◽

Valvular Heart Disease ◽

Right Atrium ◽

Mitral Stenosis ◽

Sub Saharan Africa ◽

Severe Tricuspid Regurgitation ◽

Tricuspid Insufficiency ◽

Sub Saharan

Dilation and hypertrophy of the atria occur in patients with valvular heart disease especially in mitral regurgitation, mitral stenosis or tricuspid abnormalities. In sub-saharan Africa, rheumatic fever is still the leading cause of valvular heart disease. We report a case of an unusual giant right atrium in context of rheumatic stenosis and severe tricuspid regurgitation in a 58-year-old woman.

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Contemporary outcomes of aortic and mitral valve surgery for rheumatic heart disease in sub-Saharan Africa

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2020.02.139 ◽

2020 ◽

Cited By ~ 3

Author(s):

Shibikom Tamirat ◽

Amine Mazine ◽

Louis-Mathieu Stevens ◽

Fekede Agwar ◽

Kefelegn Dejene ◽

...

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

Rheumatic Heart Disease ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Rheumatic Heart

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Establishing Cutoffs for Streptococcal Antibody Titers in Uganda: Implications for Rheumatic Fever Diagnosis

10.1101/19010447 ◽

2019 ◽

Author(s):

Emmy Okello ◽

Meghna Murali ◽

Joselyn Rwebembera ◽

Jenifer Atala ◽

Nada Harik ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Fever ◽

Rheumatic Heart Disease ◽

Normal Values ◽

Sub Saharan Africa ◽

Age Group ◽

Upper Limit ◽

Antibody Titers ◽

Sub Saharan ◽

Rheumatic Heart

AbstractBackgroundCentral to rheumatic fever (RF) diagnosis is evidence of streptococcal exposure, specifically antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies. It is unknown if these antibody titers should be adjusted to the background exposure rates of GAS or if published standards should be used. Here, we establish the normal values of ASO and ADB in Uganda and examine RF case detection using published vs. population-specific thresholds.MethodsParticipants (age 0-50 years) were recruited. ASO was measured in-country by nephelometric technique. ADB samples were sent to Australia (PathWest) for ADB determination by enzyme inhibition assay, andthe 80% upper limit values by age were established. The published standard values for ASO (200IU/ml) and ADB (375IU/ml) were compared to the Ugandan 80% upper limit of normal values (ULN) for RF case detection in children 5-15 years.FindingsOf the 428 participants, 16 were excluded from analysis (9 sore throat, 1 skin sores, 5 fever, 4 echocardiograms showing occult RHD), and 183 of the remaining were children 5-15 years. The median ASO titer in this age group was 220 IU/ml, with the 80th percentile value of 389 IU/ml. The median ADB titer in this age group was 375 IU/ml, with the 80th percentile value of 568 IU/ml. Application of new Ugandan cutoffs to 528 children enrolled in our prospective RF study, reduced the number of definite RF cases to 120/528 (22·7%), as compared to 173/528 (32·8%) using published normal values.InterpretationThe 80th percentile ULN for ASO and ADB are higher in Uganda than in other countries. Applying these higher values to RF diagnosis in Uganda results in higher diagnostic specificity, but some unknown loss in sensitivity. Implications of over-diagnosis and missed cases will be explored through a longitudinal follow-up study of children in the RF research program.FundingThis work was supported by American Heart Association Grant #17SFRN33670607 / Andrea Beaton / 2017 and DELTAS Africa Initiative.Research in contextEvidence before this studyWe searched PubMed for data on normal values of streptococcal antibody titers within diverse populations between database inception and January 1, 2019, using the search terms (rheumatic fever) OR (streptococcal antibodies). Nine studies were identified, but only one was from sub-Saharan Africa (2018, Ethiopia) and it was limited by vague exclusion criteria and lack of data on anti-DNase B. Given the high burden of rheumatic heart disease in sub-Saharan Africa, further data is needed to determine normal streptococcal antibody titers in this population and to assess the clinical impact of different cutoffs for RF diagnosis.Added value of this studyOur study utilized a rigorous approach to exclude patients with history of recent possible streptococcal exposure including skin and throat infection and employed echocardiography to exclude patients with pre-existing rheumatic heart disease. Additionally, this study was conducted in parallel to a larger epidemiological cohort study of rheumatic fever in Uganda, allowing us, for the first time, to prospectively determine how utilization of different streptococcal antibody titer cutoffs affect diagnosis of rheumatic fever.Implications of all the available evidenceRheumatic fever remains a challenging diagnosis based on a clinical decision rule with imperfect sensitivity and specificity. Improved understanding of streptococcal antibody titers in rheumatic heart disease endemic populations may improve diagnostic performance. Our study also points to the need for development of a rheumatic fever diagnostic test, in order to provide a more definitive assessment of risk.

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Epidemiology of left sided valvular heart disease in patients undergoing echocardiography in a Sub-Saharan African population, South West region of Cameroon

Journal of Xiangya Medicine ◽

10.21037/jxym-20-46 ◽

2020 ◽

Vol 5 ◽

pp. 25-25

Author(s):

Clovis Nkoke ◽

Jean Jacques Noubiap ◽

Anastase Dzudie ◽

Denis Teuwafeu ◽

Cyrille Nkouonlack ◽

...

Keyword(s):

Heart Disease ◽

Valvular Heart Disease ◽

African Population ◽

West Region ◽

South West ◽

Sub Saharan ◽

South West Region

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An assessment of the knowledge of medical doctors on Electronic Medical Records in a Tertiary Health Center in Sub-Saharan Africa: A Cross sectional study

Trends in Research ◽

10.15761/tr.1000136 ◽

2019 ◽

Vol 2 (2) ◽

Author(s):

AO Poluyi ◽

OO Onigbogi ◽

EO Poluyi

Keyword(s):

Health Center ◽

Electronic Medical Records ◽

Medical Records ◽

Cross Sectional Study ◽

Sub Saharan Africa ◽

Medical Doctors ◽

Sectional Study ◽

Cross Sectional ◽

Sub Saharan

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Surgical Treatment of Degenerative Lumbar Spine Disease in Rural Sub-Saharan Africa: A Retrospective Study of 450 Cases and Its Future Implications

World Neurosurgery ◽

10.1016/j.wneu.2015.11.077 ◽

2016 ◽

Vol 87 ◽

pp. 417-421 ◽

Cited By ~ 5

Author(s):

Bert E. Park

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

Lumbar Spine ◽

Sub Saharan Africa ◽

Degenerative Lumbar Spine ◽

Sub Saharan ◽

Spine Disease

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Brain growth after surgical treatment for infant postinfectious hydrocephalus in Sub-Saharan Africa: 2-year results of a randomized trial

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.2.peds20949 ◽

2021 ◽

pp. 1-9

Author(s):

Steven J. Schiff ◽

Abhaya V. Kulkarni ◽

Edith Mbabazi-Kabachelor ◽

John Mugamba ◽

Peter Ssenyonga ◽

...

Keyword(s):

Surgical Treatment ◽

Brain Volume ◽

Mitigation Strategies ◽

Cognitive Outcome ◽

Growth Potential ◽

Sub Saharan Africa ◽

Third Ventriculostomy ◽

Normal Brain ◽

Brain Growth ◽

Sub Saharan

OBJECTIVE Hydrocephalus in infants, particularly that with a postinfectious etiology, is a major public health burden in Sub-Saharan Africa. The authors of this study aimed to determine whether surgical treatment of infant postinfectious hydrocephalus in Uganda results in sustained, long-term brain growth and improved cognitive outcome. METHODS The authors performed a trial at a single center in Mbale, Uganda, involving infants (age < 180 days old) with postinfectious hydrocephalus randomized to endoscopic third ventriculostomy plus choroid plexus cauterization (ETV+CPC; n = 51) or ventriculoperitoneal shunt (VPS; n = 49). After 2 years, they assessed developmental outcome with the Bayley Scales of Infant Development, Third Edition (BSID-III), and brain volume (raw and normalized for age and sex) with CT scans. RESULTS Eighty-nine infants were assessed for 2-year outcome. There were no significant differences between the two surgical treatment arms in terms of BSID-III cognitive score (p = 0.17) or brain volume (p = 0.36), so they were analyzed together. Raw brain volumes increased between baseline and 2 years (p < 0.001), but this increase occurred almost exclusively in the 1st year (p < 0.001). The fraction of patients with a normal brain volume increased from 15.2% at baseline to 50.0% at 1 year but then declined to 17.8% at 2 years. Substantial normalized brain volume loss was seen in 21.3% patients between baseline and year 2 and in 76.7% between years 1 and 2. The extent of brain growth in the 1st year was not associated with the extent of brain volume changes in the 2nd year. There were significant positive correlations between 2-year brain volume and all BSID-III scores and BSID-III changes from baseline. CONCLUSIONS In Sub-Saharan Africa, even after successful surgical treatment of infant postinfectious hydrocephalus, early posttreatment brain growth stagnates in the 2nd year. While the reasons for this finding are unclear, it further emphasizes the importance of primary infection prevention and mitigation strategies along with optimizing the child’s environment to maximize brain growth potential.

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