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[Closed-heart mitral commissurotomy: our experience at the Main Hospital in Dakar]
G Cloatre1, J M Andreu, G Angel
1Travail des Services Médicaux et Chirurgicaux de l'Hôpital Principal, Dakar.
Insights
Closed heart mitral commissurotomy is a viable option in African hospitals, showing good short-term results for mitral stenosis patients. This technique offers a safe and effective alternative to complex evacuations.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery
Context:
- Challenges in accessing specialized cardiovascular surgical care in Europe necessitate exploring alternative treatment modalities.
- Limited resources and infrastructure in some regions pose significant barriers to advanced cardiac procedures.
Purpose:
- To evaluate the feasibility and outcomes of performing closed heart mitral commissurotomy in an African hospital setting.
- To assess patient selection criteria, safety, short- and medium-term results, and cost-effectiveness of the procedure.
Summary:
- A cohort of 15 patients (8 women, 7 men) with symptomatic mitral stenosis underwent closed heart mitral commissurotomy between June 1995 and January 1997.
- Inclusion criteria focused on mitral stenosis (area < 1.5 cm²), excluding other valvulopathies, high Wilkin scores, severe pulmonary hypertension, and auricular thrombosis.
- One perioperative death occurred; one patient experienced transient hemiplegia. The remaining 14 patients showed significant clinical improvement, with mitral valve area increasing from an average of 0.89 cm² to 1.64 cm² (planimetry) and 0.82 cm² to 1.71 cm² (Hatle formula).
Impact:
- Demonstrates the successful implementation of closed mitral commissurotomy in an African hospital (Dakar Principal Hospital), offering a valuable treatment option.
- Highlights good short- and medium-term clinical outcomes and provides cost data (2nd class: 1,000,000 F CFA; 3rd class: 820,000 F CFA).
- Encourages continued development and study of this surgical technique by African surgeons to improve access to cardiac care.
Abstract:
Confronted with difficulties of medical evacuation to cardiovascular surgical hospitals in Europe, the authors decided to bring up to date closed heart mitral commissurotomy. The aim of the study was to estimate possibility to select patients, to operate them safety to appreciate the results in medium and short time and the intervention's cost. 8 women and 7 men had a closed heart mitral commissurotomy from June 1995 to January 1997 in Dakar Principal Hospital; inclusion criteria were a symptomatic mitral stenosis with area less 1.5 cm2; exclusion criteria were an other valvulopathy, a Wilkin score above 8, a severe pulmonary arterial hypertension, an auricular thrombosis. One patient died on the forth day; a completely regressive hemiplegia was the only complication; 14 patients were clinically very improved: the average mitral area by planimetry form 0.89 cm2 +/- 0.15 became 1.64 cm2 +/- 0.33 and by Hatle formula from 0.82 cm2 +/- 0.12 to 1.71 cm2 +/- 0.37; the intervention cost was in second class 1,000,000 F CFA, in third class 820,000 F CFA. This study shows closed mitral commissurotomy can be realised in an african hospital as Dakar Principal Hospital; short and medium results are good; African surgeons must go on studying this surgical technic.