29 / 102
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 3, May/June 2016
AFRICA
151
evolving technique.
Am Heart J
1999;
138
(1 Pt 1): 114–121.
15. Gottdiener JS, Bednarz J, Devereux R,
et al
. American Society of
Echocardiography recommendations for use of echocardiography in
clinical trials.
J Am Soc Echocardiogr
2004;
17
(10): 1086–1119.
16. Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right
atrial pressure from the inspiratory collapse of the inferior vena cava.
Am J Cardiol
1990;
66
(4): 493–496.
17. Martinez-rios MA, Tovar S, Luna J, Eid-Lidt G. Percutaneous mitral
commissurotomy.
Cardiol Rev
1999; 7(2): 108–116.
18. Padial LR, Freitas N, Sagie A,
et al
. Echocardiography can predict
which patients will develop severe mitral regurgitation after percutane-
ous mitral valvulotomy.
J Am Coll Cardiol
1996;
27
(5): 1225–1231.
19. Lau KW, Hung JS, Ding ZP, Johan A. Controversies in balloon mitral
valvuloplasty: the when (timing for intervention), what (choice of valve),
and how (selection of technique).
Cathet Cardiovasc Diagn
1995;
35
(2):
91–100.
20. Chen CG, Wang X, Wang Y, Lan YF. Value of two-dimensional echo-
cardiography in selecting patients and balloon sizes for percutaneous
balloon mitral valvuloplasty.
J Am Coll Cardiol
1989;
14
(7): 1651–1658.
21. Lau KW, Gao W, Ding ZP, Hung JS. Immediate and long-term results
of percutaneous Inoue balloon mitral commissurotomy with use of a
simple height-derived balloon sizing method for the stepwise dilation
technique.
Mayo Clin Proc
1996; 71(6): 556–563.
22. Sanati HR, Kiavar M, Salehi N,
et al.
Percutaneous mitral valvuloplasty
– a new method for balloon sizing based on maximal commissural diam-
eter to improve procedural results.
Am Heart Hosp J
2010; 8(1): 29–32.
What procedures must any cath lab in Africa offer?
Answering this question, Dr Francois Bourlon from Monaco
named these as some of the key procedures any African cath
lab should offer:
•
right- and left-sided pressure studies
•
coronary angiography
•
percutaneous coronary intervention (notably with radial
access)
•
mitral/pulmonary valvuloplasty
•
PDA closure
•
atrial septostomy
•
pacing, both permanent and temporary
•
pericardiocentesis
•
bilateral iliac intervention.
This is an ideal scenario and Africa as a whole is still a long
way from achieving it. As Dr Bourlon pointed out, facilities
vary greatly across the continent. ‘There are a few cath labs
that are well equipped and manned by well-trained staff. Many
others have extremely limited resources, however, requiring
interventional cardiologists to be versatile and skilful. And in
many parts of Africa, a cath lab is just a dream.’
A Tanzanian success story
But dreams can be achieved. Dr Robert Mvungi, from
Tanzania, shared an inspiring update on what his cath lab
has accomplished in the past year since AfricaPCR 2015.
Established in Dar-es-Salaam in 2013, it is the country’s
first cath lab. Its first procedure, a permanent pacemaker
implantation, took place on 19 November 2013 and the first
coronary angiogram was performed on 25 June 2014.
Dr Mvungi noted that there were challenges in equipping
the facility and training the team. The cath lab nurses had to
be trained in India, and returned with good skills. To date
the laboratory has undertaken 365 adult procedures and
85 paediatric ones, most of the latter being PDA closures.
Overall, many more procedures were undertaken in 2015
than in 2013/2014 – these included pacemaker procedures,
stenting, right heart studies and fluoroscopies. ‘We’ve also
done eight percutaneous mitral balloon valvuloplasties to
date’, he told delegates at AfricaPCR 2016. Coronary artery
bypass grafting procedures are now performed onsite.
There are many plans in view to ensure the laboratory
goes from strength to strength. ‘We’re establishing a database
registry to monitor ongoing quality improvement and
focusing on building human resource capacity. I’m also
looking forward to our acquiring new equipment that will
enable us to undertake more complex procedures in the
future.’
He believes the following are critical elements for
establishing a cath lab in Africa:
•
government support (73% of the laboratory’s work is
funded by Tanzania’s national health insurance)
•
human resource capacity
•
adequate funding
•
a continuous supply of consumables
•
a fluoroscopy and haemodynamic system
•
supporting equipment
•
maintenance services.
He concluded by underscoring the importance of institutional
relationships. These will allow African cardiologists to train
with recognised leaders internationally and then return
to their own countries with the skills necessary to run an
autonomous African cath lab.
Source:
AfricaPCR 2016.