CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
110
AFRICA
1676: STATUS OF PAEDIATRIC CARDIAC SURGERY IN
THE LEAST-DEVELOPED COUNTRIES
Nazmul Hosain
1
, Farzana Amin
2
1
Cardiac Surgery, Chittagong Medical College, Bangladesh
2
University of Northern British Columbia, Canada
Background:
The least-developed countries (LDCs) are a group of
countries that have been identified by the United Nations in terms
of their low gross national income (GNI), weak human assets and
high degree of economic vulnerability. As per 2011 statistics, the
average GNI in these countries is US$ 567, far below the world aver-
age of US$ 9 488. Currently there are 36 countries in this category,
mostly in Africa and Asia. Paediatric cardiac surgery in these nations
is poorly developed or totally absent. The developed world has a
responsibility to recognise the deficiency and to help the growth of
cardiac surgical facilities in these countries.
Methods:
Cardiac surgeons and cardiologists of these 36 countries
were contacted through e-mail, phone calls and postal questionnaires
to gather information about the status of paediatric cardiac surgery
in the respective countries, with an emphasis on quality, cost and
number, if any. The cardiac societies and national heart foundations
were also approached for information.
Results:
The estimated total population of these countries is 816 810
477, which is 11.7% of the world population. Their combined GDP is
only 0.6% of the world GDP. This unfair distribution of wealth makes
these countries vulnerable in terms of healthcare facilities. Facilities
for paediatric cardiac surgery are either absent or primitive but where
present, the cost of surgery may be surprisingly low, sometimes as
low as US$ 1 000.
Conclusions:
LDCs are part of the same world. This unfavourable
economic situation deprives 11.7% of the world’s population of this
expensive modality of cardiac treatment. Cardiac surgeons from
the developed world should help grow the facilities in the LDCs.
They can take advantage of relatively inexpensive surgery and boost
growth, thereby saving thousands of lives in these parts of the global
village.
1677: A BOTTOM-UP MULTIDISCIPLINARY APPROACH
TO IMPROVE PAEDIATRIC CARDIOLOGICAL CARE IN
SWEDEN
Jan Bergils
1
, Malin Linder
1
, Anette Leion
1
, Katarina Hansus
2
1
Central County Hospital, Kristianstad, Sweden
2
University Hospital, Lund, Sweden
Background
: Paediatric cardiac surgery in Sweden is concentrated at
two centres (paediatric cardiology is practised in about 30 hospitals)
and the results of surgery regarding survival are excellent, with a
mortality rate of below 2%. In order to promote survival and good
quality of life, collaboration between all levels of care is mandatory,
however distances, diagnostic ability and accuracy, follow up and
resource use varies greatly within the country. Every third year, a
multi-professional (including representatives from the parents’ asso-
ciation) meeting is held, with the aim to improve communications
and cooperation in different levels of care. At the fourth meeting in
2011 a new approach was tried in order to promote national collabo-
ration, inter-disciplinary work and evidence-based care.
Methods
: Four areas of concern were defined: follow up, commu-
nication, education and incoming referrals. Locally used guidelines,
healthcare programmes and ‘tips and tricks’ were presented on a
public webpage. About 150 persons (of approximately 300 possible),
mainly physicians and nurses, but also medical secretaries, biomedi-
cal laboratory scientists, physiotherapists, dieticians, occupational
therapists, psychologists and social workers attended this three-day
meeting. The congress’ main part consisted of multi-professional
workshops, with the objective to share and develop material and
improvement ideas. The workshops were led by professional facilita-
tors and the results were further discussed in a plenary session, and
plans of actions were created.
Results
: Thirty specific topics were defined, called ‘heroic deeds’
and for every topic a leader with responsibility for the continuing
progress was defined. Seven new professional networks were also
created.
Conclusion
: With a bottom-up approach, involving different profes-
sions nationwide, it is possible to create a foundation for national
guidelines and standardised care, which has the potential to make
better use of resources and increase the quality of care for children
with heart disease.
1688: FIVE CENTRES, ONE HEARTBEAT: A NETWORK
APPROACH TO HEALTHCARE DELIVERY
Angela Krizan
Western Canadian Children’s Heart Network, Canada
Background:
For more than 10 years, the Western Canadian
Children’s Heart Network (WCCHN) has coordinated and inte-
grated cardiac and surgical care for patients across the four western
Canadian provinces. The WCCHN clinicians work collaboratively
across all jurisdictions to ensure the highest standard of care is
accessible to all patients and families. Surgical care is regionalised
in two surgical centres ensuring adequate volumes to maintain a high
standard of technical skill and optimal outcomes.
Objectives:
to develop an understanding of the factors to consider
when looking at a regionalised approach to providing specialised
healthcare services; to identify the benefits/challenges to regionalis-
ing specialised services; impacts of regionalisation of specialised
services on families – the good and the bad; sustainability of this
model.
Discussion:
History of paediatric cardiac surgery in western Canada
• Outcome data that necessitated looking at a different approach
to providing highly specialised services to paediatric cardiac
patients
• Stakeholders – how they came together and reached the decision
to regionalise services
• Building a network of paediatric cardiac and surgical care
• Successes/challenges encountered along the way
• Reflection after 10 years of practicing this way
• Future directions for this model of delivering healthcare.
1720: THE ‘VIRTUAL ICU’: ADDING EXPERIENCE IN
PAEDIATRIC CARDIAC SURGERY
Thamine De Paula Hatem, Sandra da Silva Mattos, Kalessa Ponte
Vaz, Marisa Wanderley Casado, Sheila Maria Vieira Hazin, Lúcia
Roberta Didier Nunes Moser, Claudio Teixeira Régis, Juliana Sousa
Soares de Araújo, Carolina Paim Gomes de Freitas, Felipe Alves
Mourato
Instituto do Coração de Pernambuco, Recife, Brazil
Introduction:
Similar to other developing countries, some areas
in Brazil experience a shortage of resources to establish paediatric
cardiology (PC) programmes. Within this context, a telemedicine PC
network was established between two states to add competences and
train local teams.
Objective:
To report on the experience with a new model of tele-
medicine, the ‘virtual ICU’, within a PC network for poor children
in north-east Brazil.
Methods:
Besides medical equipment and a TV screen, an iPAD
and wireless Internet connection were added to the ICU. Local teams
underwent face-to-face and online training sessions. Surgical and
post-operative checklists were developed. Cases are discussed online.
Specialised teams travel once a week to perform more complex surgi-
cal cases and initial post-operative follow up (24-hour). Local teams,
under online supervision, perform the remaining post-operative and
surgical cases of lesser complexity.
Results:
From October 2011 to July 2012, 74 surgeries were
performed in children aged 20 days to 17 years. Cardiac bypass was
used in 59.6%. Jenkins’ complexity scores were one to three in 50%,
three to six in 44.5% and over seven in 5.4%. Total mortality was
