Cardiovascular Journal of Africa: Vol 32 No 5 (SEPTEMBER/OCTOBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 5, September/October 2021 AFRICA 287 Cardiovascular News Enhancing cardiovascular skills development in Africa: Khartoum first PTMC workshop Published online 28/9/21 DOI: 10.5830/CVJA-2021-046 The African continent continues to face unique challenges in the management of the cardiovascular pandemic, largely because of the exponential increase in coronary and degenerative heart diseases, but also because of the persistence of rheumatic heart disease. 1 This combination of disease and the limitation of resources, both manpower and economic, means systems must adapt in order to optimise care to this diverse population. The training of cardiologists in Africa is one of the challenges systems grapple with. Some countries have locally developed programmes, whereas others rely on external training and skills development. Training within the continent Whereas training in Europe and America exposes one to high- quality training with the latest science, training in rheumatic heart disease remains limited. This skill can be obtained from India, which has a disease mix that mirrors Africa, but there are challenges, particularly with the onset of the corona virus pandemic. Transfer of skills within the continent offers easier, more affordable training forAfrican cardiologists in a similar healthcare setting, with similar challenges and resources, especially for conditions prevalent in Africa, such as rheumatic mitral stenosis, which continues to plaque young patients, with the resultant poor quality of life and premature mortality. 2,3 With many interventional cardiologists practicing on the continent, we envisioned skills acquisition in percutaneous mitral commissurotomy (PTMC), also known as balloon mitral valvuloplasty (BMV) to be feasible. This effort was endorsed by the Sudan Heart Society, PASCAR (Pan-African Society of Cardiology) and its daughter society, PASCI (Pan-African Society of Cardiovascular Interventions). PASCAR has previously endorsed a similar intra-continental hands-on training programme for pacemaker implantation. 4 Indeed, an article published in the South African Heart Journal recommends the upgrading of cardiology training to include new skills in imaging (cardiac computed tomography and cardiac magnetic resonance imaging) to practicing cardiologists and having them be part of a cardiology fellowship training curriculum. 5 Outline of the workshop The workshop was conducted at the Sudan Heart Center, located in the capital city Khartoum, from 25–27 March 2021. The workshop was CME-accredited by the Sudan Medical Council and endorsed by PASCAR, PASCI and the Sudan Heart Society. The main trainer was Ahmed Suliman. Trainees were a cardiologist from the Aga Khan University hospital, Dr Mzee Ngunga, who had prior experience in PTMC using the multitrack balloon, a catheterisation laboratory (cath lab) nurse from the same institution, Julina Mangene, and a local cardiologist, Dr Mujahid Mohammed, who had prior basic experience with the Inoue technique PTMC. Training was hands on, with the trainee as first operator, under guidance of the trainer as second operator. The trainee nurse also scrubbed as an assistant and was supervised with balloon preparation and inflation during the procedure. Surgical back-up was available at the time of the procedure. The trainees performed trans-septal puncture using a Brockenborough TM needle and valvuloplasty was performed using an Inoue-like SYM BMV balloon from SYM Medical (China). The cath lab was a Toshiba biplane, which facilitated simultaneous anteroposterior and lateral views during trans- septal puncture. Transthoracic echocardiography was performed after each balloon inflation to assess splitting of the mitral valve and degree of mitral regurgitation, if any. The workshop was three days. Patients were examined clinically and counselled prior to the procedure. Transthoracic and transoesophageal echoes were viewed, and equipment preparation and procedure planning was done by the whole team. All procedures were performed under local anaesthesia with fluoroscopy guidance only. Six cases were performed. Table 1 outlines the characteristics of the different patients. Faculty of Medicine, University of Khartoum, Khartoum, Sudan Ahmed AA Suliman, sudanheartgroup@gmail.com Agha Khan University Hospital, Nairobi, Kenya Mzee Ngunga Mohamed Jeilan Al Shaab Teaching Hospital, Khartoum, Sudan Mujahed Mohammed Minha Mohamed Table 1. Characteristics of the patients Case no. Age (years) Gender Residence by state Wilkins score Transmitral gradient before PTMC (mmHg) Transmitral gradient after PTMC (mmHg) Immediate complications 1 29 F Jazeera 9 19 3 None 2 58 F Jazeera 10 15 5 None 3 27 F N Kordofan 9 30 11 None 4 22 F W Kordofan 8 30 5 None 5 54 M Jazeera 8 15 5 None 6 19 F Darfour 9 26 5 None