CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 2, March/April 2011
AFRICA
65
Transthoracic Doppler echocardiogram
Congenital heart diseases were distributed as follows (Tables 2,
3): tetralogy of Fallot (26.1%), isolated ventricular septal defect
(38.8%), atrioventricular cushion defect (7.3%), isolated atrial
septal defect (2.8%), arterial duct cases (12.4%), common arteri-
al trunk (1.3%), isolated stenosis of the pulmonary artery (2.6%),
coarctation of the aorta (1.1%), congenital mitral valve regurgita-
tion (1.2%), atresia of the triscupid valve (1.6%), double-outlet
right ventricle (2.1%), anomalous pulmonary venous return
(1.5%) and left isomerism (1.2%).
There was a significantly (
p
≤
0.005) high percentage of
large isolated peri-membranous ventricular septal defects (85%)
compared to restrictive (10.2%) and muscular (4.8%) defects.
Complete atrioventricular cushion defects (63.5%) were also
significantly higher (
p
≤
0.005) than incomplete (39.5%) cushion
defects. Combined pathologies, such as ventricular septal defect
with isolated atrial septal defect were found in 1.8% (
n
=
5) of
patients; ventricular septal defect with arterial duct in 2.1% (
n
=
6); ventricular septal defect with pulmonary valve stenosis in
8.9% (
n
=
25); and left isomerism with arterial duct in 1% (
n
=
3) of cases.
Pre- and post-surgical follow up
One hundred and eleven patients underwent open-heart surgery
in Italy at the Polyclinico San Donato, while 12 patients were
operated on at St Elizabeth Catholic General Hospital during
organised cardio-surgical missions. One hundred and fifty-eight
patients were left on the surgical waiting list for the next surger-
ies. Four per cent of the patients were lost during follow up
and three post-surgical patients died suddenly. In addition, 25
patients died while still on the waiting list.
Discussion
This study shows that over a period of six years, 2 123 patients
were seen at the St Elizabeth Catholic General Hospital cardiac
centre and that congenital heart diseases were the most prevalent
diagnosed pathologies, found in 13.1% (
n
=
279) of the patients.
This observation is in line with previously published studies.
Transthoracic echocardiography data from the retrospective
study of Mahmoud
et al
. conducted in two of Kano’s labora-
tories in Nigeria over a period of 48 months showed that 9.3%
(
n
=
122) of the patients (aged 9 days to 35 years old) present-
ing abnormal echocardiograms had congenital heart diseases.
7
However, another study by Bassili
et al.
conducted in Egypt
showed a low incidence (1.01/1 000) of congenital heart diseases
among school children.
8
Because of its state-of-the-art facility, the Shisong Cardiac
Centre, which is relatively new, is a renowned referral centre
in the region. Consequently, many patients have been referred
by practitioners in various disciplines, including cardiologists,
paediatricians and general practitioners from different parts of
the country, for better management of heart murmurs, confirma-
tion of suspected diagnosis of congenital heart diseases and/or
enrolment in the sanitary evacuation programme. This could
explain the difference between our results and those of the
Egyptian study.
We found that the most encountered congenital patholo-
gies were isolated ventricular septal defect and tetralogy of
Fallot. Both pathologies were also most frequently found by
Bannerman and el Haq among patients with congenital heart
diseases.
9,10
In addition, Ejim and colleagues showed that isolated
ventricular septal defect was the most prevalent pathological
condition, being diagnosed in 70% of all the cases of congenital
heart diseases.
11
Acyanotic congenital heart diseases were more
prevalent than cyanotic heart diseases. Cushion defects were
mostly diagnosed in patients with trisomy 21.
The majority of these patients could not afford treatment due
to the high cost and, as evidence of the difficulty in accessing
healthcare, numerous late presentations to practitioners were
registered. In a previous study by Ariane
et al
., late presentation
to practitioners was observed in 79.3% of cases.
12
Both access
to healthcare and the high cost of treatment also explain the
very high incidence of late presentations (68.2%) recorded in
Bannerman’s study in Zimbabwe.
9
We diagnosed a peri-membranous ventricular septal defect
and a tetralogy of Fallot in a 13- and 16-year-old boy and girl,
respectively. Adults with natural evolutive congenital heart
diseases were found in 1.5% of cases.
In the sub-Saharan region of Africa, St Elizabeth Catholic
General Hospital has registered the highest percentage (41%,
n
=
114) of cardiac surgeries realised abroad. Previous studies
from Senegal,
13
Sudan,
14
Mauritania,
15
and Tunisia
16
have reported
respectively, that only 17.3% (
n
=
75), 28% (
n
=
435), 26% (
n
=
61), and 22.5% (
n
=
12) of the patients who needed a cardiac
surgical intervention actually had one done. Updated data from
these countries could help clarify the state of the situation to
date.
Although the cardiac centre of St Elizabeth Catholic General
Hospital is relatively new, it has been the point of attraction for
a growing number of new patients from neighbouring countries.
Cameroon is a bilingual nation characterised by a French- and
English-speaking region. However, despite the cardiac centre
being located in the English-speaking region, more than 60% of
the consulting patients come from the French-speaking region.
In a country with over 260 tribes, all patients are seen irre-
spective of their tribe and/or religious beliefs. In that respect, the
hospital is a crossroads of several tribes. It might seem taboo,
TABLE 3. PATHOLOGY DISTRIBUTIONWITH REGARD
TO PATIENTAGEAT THE TIME OF DIAGNOSIS
Pathology
Age
2 months
– 2 years
(%)
2–5
years
(%)
>
5
years
(%)
Isolated ventricular septal defect
22
14.8 2
Tetralogy of Fallot
10
13.1 3
Arterial duct
6
3.9 2.5
Atrioventricular cushion defect
5
2.3
-
Isolated atrial septal defect
0.9 1.1 0.8
Isolated stenosis of the pulmonary artery
0.9 1.2 0.5
Double-outlet right ventricle
1.8 0.3
-
Atresia of the triscupid valve
1.1 0.5
-
Anormalous pulmonary venous return
0.6 0.7 0.2
Common arterial trunk
0.8 0.5
-
Congenital mitral valve regurgitation
0.2 0.3 0.7
Left isomerism
0.4 0.8
-
Coarctation of the aorta
0.2 0.4 0.5
