A Short Reflection on the Congenital Heart Disease of African Children

¹Cardio-Thoracic Center. Clínica Girassol Luanda - Angola.

²Cardiology Department. Hospital Militar Principal/Instituto Superior Luanda - Angola.

Corresponding Author: Valdano Manuel, Revolução de Outubro Avenue, Street Comandante Gika, 225, second flow, Luanda - Angola. Tel: +5511949768625; E-Mail: [email protected]

Received Date:  01 Feb 2016    Accepted Date:  11 Feb 2016    Published Date: 16 Feb 2016

Copyright © 2016 Valdano M

Citation: Valdano M and Morais H. (2016). A Short Reflection on the Congenital Heart Disease of African Children. Mathews J Cardiol. 1(1): 002.

INTRODUCTION

Congenital heart diseases (CHD) are serious anomalies making it one of the most common classes of birth defect that account for nearly one-third of all major congenital anomalies and are defined as abnormalities in the cardiovascular structure or function that are present at birth, although can be diagnosis later[1,2]. There is no evidence for differences in prevalence in different countries or times. In an analysis of 62 studies published after 1955, Hoffman et al found that although the prevalence of CHD varied from 4 to 50 in 1000 live births, the differences could be attributed to the differences in relative frequency of ventriclular septal defect of the deferent studies cohorts [2]. In African populations, the epidemiological data are still scarce. There are some Africans studies released in countries like Nigeria, South Africa, Mozambique and Egypt which showed prevalence around 2 to 12% [3-11]. The pediatric population constitutes a large portion of the population in African countries, the lack of correction of the CHD due to the absence of heart surgery, certainly leads an accumulation of large numbers of children and adults with non operated CHD [4,11]. In Angola, there is no study about the prevalence of CHD. Although, there are same in-hospital studies that give an idea about the spectrum of CHD [10,11]. In one of this study, with a 1267 children, showed that only 58% of the children have the diagnose under the age of one year. The ventricular septal defect and tetralogy of Fallot were the most frequents cyanotic a acyanotic CHD with 30% and 8.6% respectively. It was observed that have been increased the number of children diagnosed with CHD over the past ten year apparently due to increased diagnostic facilities and more trained pediatric cardiologists in the country [12,13]. Advances in pediatric cardiac care have resulted in an increasing number of patients with CHD being observed in same African reports [5,6,8]. With the recent wide-implementation of fetal cardiac diagnosis, the prevalence and spectrum of CHD at live birth may also be modified in Nigeria, Angola and Mozambique for intense [4,5,11]. Postnatal echocardiographic diagnosis for minimal cardiac symptoms, such as a murmur only or even as a means of newborn screening may increase the detection rate of mild types of CHD, such as small ventricular septal defect, patent ductus arteriosus or secundum atrial septal defect [5]. Early detection of these cardiac diseases in children is important in order to prevent serious complications and to institute endocarditis prevention. Africa this is so far from this reality, medical assistance is scarce, and majority of these children never have been seen by a medical doctor since their birth. Poor diagnostic tools, poor referral systems and lack of skilled personnel justify the increased mortality rates in African children with CHD [14]. In 2011 the Angolan Ministry of Health installed a tertiary pediatric cardiac center in Luanda at Clinica Girassol as a result of a joint Angolan-Portuguese venture. Organization of a patient referral system, political commitment of Angolan and Portuguese professionals is resulting in no waiting list for children with CHD requiring surgical correction in the capital. Referrals, originally from secondary centers in Luanda were progressively extended to provincial capitals. Contrary to the visiting team model, whereby expatriate teams visit the country for a limited period of time (1-2 weeks, 3-4 missions/year) we created a collaborative program between an Angolan team and a Portuguese multidisciplinary permanent rotating team of surgeons, anesthesiologists, pediatric cardiologists, nurses and perfusionists. Complex cases, particularly in neonates and young infants are performed by Portuguese surgeons while all other cases are performed by an Angolan surgeon. This centre can help to solves not only the Angolan children with CHD, but also from the closed countries. In other hand, a new population of patients surgically treated is generated and it is very important the investment in the training of national professionals, a heart team, for solving future problems as reoperation, follow-up of these patients and continuity of the project. In conclusion, the CHD remains a serious problem in Africa and more investment needs.

REFERENCES

1. Samanek M and Voriskova M. (1999). Congenital heart disease among 815,569 children born between 1980 and 1990 and their 15 year survival: a prospective Bohemia survival study. Pediatr Cardiol. 20(6), 411-417.
2. Hoffman JI. (2000). Incidence, prevalence and inheritance of congenital heart disease. Ped Cardiovasc Dis. New York, NY: Churchill Livingstone. 257-262.
3. Sani MU, Mukhtar-Yola M and Karaye KM. (2007). Spectrum of congenital heart disease in a tropical environment: an echocardiography study. J Nat Med Ass. 99(6), 665-669.
4. Mocumbi AO, Lameira E, Yaksh A, Paul L, et al. (2011). Challenges on the management of congenital heart disease in developing countries. Int J Cadiol. 148(23), 285-288.
5. Sadoh WE, Uzodimma CC and Daniels Q. (2013). Congenital Heart Disease in Nigerian Children A Multicenter Echocardiographic Study. World J Pediatr Congenit Heart Surg. 4(2), 172- 176.
6. Zuhlke L, Mirabel M and Marijon E. (2013). Congenital heart disease and rheumatic heart disease in Africa: recent advances and current priorities. Heart. 99(21), 1554-61.
7. Bassili A, Mokhtar SA, Dabous NI, Zaher SR, et al. (2000). Congenital heart disease among school children in Alexandria, Egypt: an overview on prevalence and relative frequencies. J Trop Pediatr. 46(6), 357-362.
8. Ali MSK and Karani Z. (2007). Diagnosis, Management and Outcome of Children with Heart Disease in a Sudanese Cardiac Centre. The Cardiology. 3(2), 15-19.
9. Marijon E, Tivane A, Voicu S, Ferreira B, et al. (2006). Prevalence of congenital heart disease in schoolchildren of sub- Saharan Africa, Mozambique. Int J Cardiol. 113(3), 440-441.
10. António Y, Morais H and Gamboa, A. (2012). Cardiopatias Congénitas em recém-Nascidos, Crinaças e Adolescentes em Angola. An HMP/IS. 4, 177-182.
11. Manuel V, Morais H, Manuel A, David B and Gamboa S. (2014). Ventricular septal defect in children and adolescents in Angola: Experience of a tertiary center. Rev Port Cardiol. 33(10), 637-640.
12. Manuel V, Sousa-Uva M, Morais H, Magalhães MP, et al. (2015). Anomalous Origin of One Pulmonary Artery from the Ascending Aorta From Diagnosis to Treatment in Angola. World J Pediatr Congenit Heart Surg. 6(4), 521-525.
13. Manuel V, Morais H, Magalhães MP, Nunes MA, et al. (2015). Ebstein’s anomaly in children: A single-center study in Angola. Rev Port Cardiol. 34(10), 607-612.
14. Mirabel M, Grimaldi A, Freers J, Jouven X and Marijon E. (2015). Access to cardiac surgery in sub-Saharan Africa. The Lancet. 385(9968), 606.