Outcomes of Atrioventricular Septal Defects Surgery in Senegal
Diop Momar Sokhna,
Ba Papa Ousmane,
Diagne Papa Amath,
Sow Ndeye Fatou,
Ba Papa Salmane,
Ciss Amadou Gabriel
Issue:
Volume 9, Issue 4, July 2023
Pages:
45-50
Received:
28 May 2023
Accepted:
19 June 2023
Published:
6 July 2023
Abstract: Introduction: The incidence of atrioventricular septal defect (AVSD) varies between 0.24 to 0.31 per 1000 births and represents 4% of congenital heart disease. AVSD surgery has known a fast evolution with better results due to a better perioperative management of these patients and an earlier complete cure in the first 3 to 6 months. In Senegal, AVSD surgery represents a real challenge because a diagnosis is most often late. These patients are operated on at a later age. It is in this context that this work was carried out to see the results of the surgery of these patients and compared them with those of the literature. The aims of this work were to study the epidemiological profile as well as the clinical specificities of AVSD; to evaluate the results of surgery in terms of morbidity and mortality. Materials and Methods: This is a retrospective, descriptive and analytical study carried out from the chart of patients followed at the CUOMO cardio-pediatric center in Dakar over a period from January 2017 to May 2021. Results: The average age of patients is 77 months. The average duration of cardiopulmonary bypass (CPB) was 151 ± 78 min (62–375min), the average duration of aortic cross clamping was 113 ± 63.8 min (41-271min). Morbidity was dominated by heart rhythm disorders (13%) and hemodynamic instability (13%). The early mortality rate was 13% (3 patients), late mortality was nil. The mortality risk factors that were found in our study are patients with a diagnosis of complete AVSD, a CPB duration greater than 150 min, an intubation duration greater than 45 hours and an inotropic support duration greater than 136 hours. Conclusion: Our long-term results are satisfactory and encouraging in terms of survival and quality of life. Even though they were operated late most often beyond the indicated period, we have had good results in the follow-up of these patients after surgery. The recommendations go to the earlier management of these patients in our countries with an awareness in early diagnosis and more appropriate care to further reduce morbidity and mortality.
Abstract: Introduction: The incidence of atrioventricular septal defect (AVSD) varies between 0.24 to 0.31 per 1000 births and represents 4% of congenital heart disease. AVSD surgery has known a fast evolution with better results due to a better perioperative management of these patients and an earlier complete cure in the first 3 to 6 months. In Senegal, AV...
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Obstructive Thrombosis of a Mitral Prosthetic Valve in the Context of COVID-19 in Senegal
Ba Papa Ousmane,
Diagne Papa Amath,
Diop Momar Sokhna,
Ismael Ibouroi Moina-Hanifa,
Ikponmwosa Gold,
Dioum Momar,
Ba El Hadj Boubacar,
Bizrane Myriam,
Ba Papa Salmane,
Ciss Amadou Gabriel
Issue:
Volume 9, Issue 4, July 2023
Pages:
51-55
Received:
31 May 2023
Accepted:
18 July 2023
Published:
5 August 2023
Abstract: COVID-19 causes a hypercoagulable state, predisposing to a thrombotic state, particularly in patients with mechanical valve. Thrombosis of a prosthetic valve is a rare but serious complication of valve replacement by mechanical prosthesis. It is a medical and surgical emergency. Diagnosis is based primarily on trans-thoracic echocardiography. All obstructive thromboses of the left heart require surgery. We report the case of a 30-year-old female patient with a background COVID-19 infection who presented with New York Heart Association (NYHA) class III dyspnea, chest pain and fever, a transthoracic echocardiography showed obstructive mechanical mitral valve thrombosis. She was hospitalized in the cardiology department and anticoagulant therapy was initiated. The mechanical valve was, then, removed. On H15 postoperatively she was febrile with a temperature of (40°C), the pupils were isocoric, and there was a decerebrate rigidity, however, her hemodynamic state was stable. The PCR test result for COVID-19 was positive 15 hours after the surgery, a thoracic computer tomography angiography scan revealed a mild form of COVID-19. A brain computer tomography scan revealed a COVID-19 encephalopathy. Unfortunately at H20, the infectious workup showed leucocytosis and a positive CRP, which required initiating empiric antibiotic therapy with ceftriaxone and gentamicin awaiting for microscopy, culture and sensitivity results. Treatment with methylprednisolone was also started. The dose of immediate postoperative anticoagulation was maintained at 200 IU/Kg/D. On H24 her Glasgow Coma Scale was 3/15, pupils were fixed and dilated with loss of brainstem reflexes. Death was declared at Day 2 postoperatively as a result of neurological complications. Standard prophylactic and therapeutic protocols need to be reviewed when COVID-19 occurs in a patient with a mechanical valve prosthesis.
Abstract: COVID-19 causes a hypercoagulable state, predisposing to a thrombotic state, particularly in patients with mechanical valve. Thrombosis of a prosthetic valve is a rare but serious complication of valve replacement by mechanical prosthesis. It is a medical and surgical emergency. Diagnosis is based primarily on trans-thoracic echocardiography. All o...
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Administration of Low-Dose Landiolol Prevents Postoperative Atrial Fibrillation After Aortic Valve Replacement
Takeshi Oda,
Ryusuke Mori,
Eiki Tayama,
Shigeaki Aoyagi
Issue:
Volume 9, Issue 4, July 2023
Pages:
56-62
Received:
25 July 2023
Accepted:
10 August 2023
Published:
22 August 2023
Abstract: Background: Postoperative atrial fibrillation (POAF), a common complication of cardiac surgery, increases postoperative mortality, morbidity, and medical costs. POAF after coronary artery bypass grafting is well investigated; however, little is known about POAF after aortic valve replacement (AVR). This study aimed to investigate the efficacy of low-dose landiolol in preventing POAF after AVR. Methods: Thirty patients who underwent AVR were randomized into two groups, with or without administration of landiolol (Landiolol, N=15; Control, N=15). In Landiolol, continuous infusion of landiolol (3 µg/kg/min) was maintained for 48 h from admission to the intensive care unit. The occurrence of POAF during seven days after surgery, heart rate, blood pressure, cardiac index, and mixed venous oxygen saturation were compared between the two groups. Results: POAF occurred in one and seven patients in Landiolol (6.7%) and Control (46.7%), respectively, with significantly lower incidence in Landiolol than in Control (p=0.0352). The heart rate was significantly lower in Landiolol than in Control. No significant differences were observed in blood pressure, cardiac indices, and mixed venous hemoglobin oxygen between the two groups. Conclusions: The administration of low-dose landiolol following AVR significantly decreased the incidence of POAF without hemodynamic deterioration, suggesting that it may safely and effectively prevent POAF in patients undergoing AVR.
Abstract: Background: Postoperative atrial fibrillation (POAF), a common complication of cardiac surgery, increases postoperative mortality, morbidity, and medical costs. POAF after coronary artery bypass grafting is well investigated; however, little is known about POAF after aortic valve replacement (AVR). This study aimed to investigate the efficacy of lo...
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