J C AMBASSA,  KONGNYUY ALFRED, JACQUES CABRAL TANTCHOU, MVE CHARLES MVONDO.

Gianfranco Butera, Alessandro Giamberti.

St. Elizabeth Catholic General Hospital Shisong Cardiac Centre (Cameroon)                                                      Department Of Pediatric Cardiology And Cardiac Surgery San Donato (Italy)

Background:  During a 8 year period, a Cardiac Centre has been designed and developed in Sub-Saharan Africa. Three partners have worked towards the realization of this project: two Italian charities (Associazione Bambini Cardiopatici Nel Mondo and Cuore Fratello) and a local general hospital run by the Tertiary Franciscan Sisters of Bressanone. Two cardiologists, one anaesthesiologist, one cardiac surgeon and 18 nurses have been trained. A fully equipped centre for cardiac care (2 operating theatres, 12 ICU beds, one flat panel Siemens catheterization laboratory, 38 beds in the ward, 6 neonatal beds and two out patient clinics) have been developed by this Euro-African collaboration..

Objective: The aim of this study was to analyse the safety and efficacy of percutaneous closure of patent ductus arteriosus (PDA) in symptomatic pediatric and adult patients in a Sub-Saharan African centre.

Methods: We conducted a retrospective study on 44 patients with clinically significant PDA. 30 were children aged between 2 and 17 years and 14 were adults aged between18 and 29 years old. The median age of the study was 12 years (range 2-29 years).The median weight was 26kg (range 14-58kg).The sex ratio was (F/M 2/1).

The following signs and symptoms were shown by the patients: cardiac failure (2) dyspneoa (2), failure to thrive (2), left ventricle overload (36), arrhythmias (2), other symptoms (0).

Regarding the morphology of the duct it was defined as large (PAP>3/4 systemic pressure), moderate (PAP between 1/4-3/4 of the systemic pressure and QP/QS>1.5) restrictive duct (normal PAP, QP/QS=1).

The procedure was carried out under deep sedation or general anesthesia with fluoroscopic control. The Amplatzer Duct Occluder (ADO I) and Muscular ventricular septal defect devices were used.  Physical examinations, 12 leads ECG, echocardiogram, and chest X-ray were performed prior to the procedure.

Results: In 3 patients, there were restrictive PDAs, 19 patients had moderate PDAs with increased pulmonary flow and 22 patients with large PDAs. Pulmonary arterial pressures in these patients were between 75 and 100% of the systemic pressure and 3 patients had Eisenmenger syndrome. Two patients had complications with devices embolization in one in whom the device was retrieved  and was successfully closed with a muscular VSD device .In 1 patient the embolised device needed surgical retrieval. In all patients the ADO I and muscular ventricular septal defect were used. No problems occurred during long term follow-up.

Conclusion: Successful and safe percutaneous treatment of PDA can be performed in a centre in sub-Saharan Africa.Collaboration between developed countries and local developing countries is mandatory to succeed and have long lasting results.