Anticoagulation in pregnant women with mechanical heart valve prostheses: Case reports and a literature review.

The choice and regimen of anticoagulation therapy in pregnant women with mechanical valve prostheses have always been a daunting task. It is a delicate balance that takes into consideration the risk of thromboembolic complications in the mother and the risk of potential Warfarin embryopathy to the foetus. Medical practice in a low socioeconomic setting also has the peculiar challenge of financial constraints on the part of the patients and difficulties in monitoring the efficacy of anticoagulation therapy. We report our experience in managing two pregnant women with mechanical valve prostheses and review the existing literature on this complex but interesting subject.

Is transcatheter closure superior to surgical ligation of patent ductus arteriosus among Nigerian Children?

BACKGROUND: Patent ductus arteriosus (PDA) is common among Nigerian children. It is the second only to ventricular septal defect among congenital heart diseases in Nigeria children. The study centers are the only centers in Nigeria which are able to offer both transcatheter closure of PDA and surgical ligation. The study aims to compare both methods in terms of the demographics of the individuals, cost and outcome. PATIENTS AND METHODS: Prospective, cross-sectional involving consecutive individuals who had either transcatheter closure or surgical ligation of PDA from June 2010 to January 2014. Individuals were grouped according to the method of closure of their defect. Data on their demographics, size of the defects, cost of treatment and outcome were compared for the two groups. The analysis was done using Microsoft Excel statistical software supplemented by Statistical Package for Social Sciences version 20.0. P < 0.05 was considered statistically significant. RESULTS: A total number of 28 individuals had either surgical ligation or device closure of PDA done at the studied period. The mean age of all the individuals was 4.58 ± 4.20 years with a median age of 3 years. The mean age of individuals that had surgical ligation was 3.40 ± 0.92 years and mean age of those who had transcatheter device closure was 6.69 ± 1.05 years (P = 0.677). Male to female ratio in both groups were 0.4:1. No mortality was recorded in both groups. However, 6 (21.4%) of the surgical patients and 1 (3.57%) of the patient with device closure had complications. The direct cost of the procedure for each of the patient who had device closure of PDA was about $3000 whereas the cost of surgical closure was about $1000. The indirect cost for device closure was about $100 while that of surgical closure was about $5000. CONCLUSION: Device closure of PDA has lesser risk of complications compared to surgical ligation. Its indirect cost is also cheaper. There is a need for availability and accessibility to device closure of PDA in our environment.

Caregivers of Children with Congenital Heart Disease: Does Socioeconomic Class Have Any Effect on Their Perceptions?

BACKGROUND: Studies from other parts of the world have documented knowledge gaps in parents of children with congenital heart disease (CHD). The authors are not aware of any study in the Nigerian population assessing the effect of socioeconomic class on the perceptions of caregivers of children with CHD. OBJECTIVE: The study aimed to evaluate the effect of socioeconomic class on the perceptions of caregivers of children with CHD. METHODS: A descriptive and cross-sectional questionnaire survey was conducted in a tertiary pediatric cardiac center involving 300 caregivers of children with CHD, recruited at the outpatient clinic from April 2008 to March 2012. RESULTS: Age range of the respondents was 16 to 72 years with a mean of 34.7 ± 8.1 years. Forty percent (119) of the caregivers had not heard about CHD; those in the upper socioeconomic class had better awareness (P = .02). Ninety percent of all the respondents knew that the cause of CHD is unknown. Only seven of the respondents (2.3%) had a good knowledge of the indicators, while 9.6% had a fair knowledge, almost 60% of the respondent had a poor knowledge, and up to 30% had no knowledge of the pointers. Nearly one-fifth (19.3%) of the respondents were not aware of any treatment options for children with CHD. Only 12.7% of the respondents knew the best mode of treatment, and only 43% of the respondents believed CHD could be prevented. Further analysis revealed that there was no statistically significant difference between the various socioeconomic classes with regard to knowledge of the indicators of CHD, awareness of the best mode of treatment, and perception of preventability (P = .06, .74, and .13, respectively). CONCLUSION: More parents in the upper socioeconomic class had heard about CHD. However, most parents of children with CHD had poor knowledge of CHD, its indicators, its best mode of treatment, and its preventability, irrespective of their socioeconomic class. Our findings suggest an urgent need to develop an educational program to promote better understanding of CHD among caregivers.