CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
112
AFRICA
at Windhoek Central Hospital (WCH) on 18 October 2010. We report
early results from a new single-surgeon programme over the first
two years.
Methods:
This was a case series of 231 patients between October
2010 and 31 August 2012. In year one, surgery was limited to chil-
dren above 20 kg and in year two, those above 10 kg body mass.
Data were entered prospectively into a hospital-based registry, File
maker pro data.
Results:
Two hundred and thirty-one patients had surgery, 208 on
cardio-pulmonary bypass. Age ranged between four months and 83
years, of whom 56% were under 18 years; 105 cases (45%) had rheu-
matic heart disease (RHD) with aortic valve replacement (20), mitral
valve replacement (41), and a mitral valve-sparing annuloplasty and
repair in 33; 86 patients had congenital heart disease (25 adults).
The common lesions were VSD (31), secundum ASD (20), primum
ASD (16), PDA (16) tetralogy (17), aortic coarctation (four), DORV
(three), Ebstein’s anomaly (two). There have been nine post-operative
(
<
28 days) deaths with a mortality rate of 3.6%.
Conclusion:
This new service is a novel model of integrated cardiac
care that dispensed with age-related barriers to delivery and concen-
trated on ‘uncomplicated’ and common diseases. Adults with CHD
represent survivors of native heart disease. Low numbers of small
babies reflect strategic choices in a resource-limited environment
but also the parlous state of diagnostic services for children with
CHD. High numbers of patients needing surgery for RHD reflect the
absence of a national programme for prevention and control of RHD.
Without further development and support, the future of this new
service remains precarious.
