Immediate maternal and fetal outcome following percutaneous mitral valve balloon commissurotomy: a 6-year single-center experience from sub-Saharan Africa.

BACKGROUND: Mitral stenosis is the most common valvular heart disease during pregnancy. When severe, it leads to significant maternal and fetal morbidity and mortality. Percutaneous mitral valve balloon commissurotomy can be performed during pregnancy, and the present study aimed to describe the immediate maternal and fetal outcomes after percutaneous mitral valve balloon commissurotomy was done in a cohort of 23 pregnant patients with severe mitral stenosis in Addis Ababa, Ethiopia. METHODS: Included in the current study were all pregnant mothers who had severe rheumatic mitral valve stenosis and who underwent percutaneous mitral valve balloon commissurotomy at the Cardiac Center of Ethiopia over 6-year period. Data were collected through chart abstraction using a structured proforma and then analysed using STATA version 13.0. RESULT: Median gestational age was 22 weeks and percutaneous mitral valve balloon commissurotomy was successful resulting in a significant increase in the mean mitral valve area of the group from 0.78 ± 0.20 cm2 to 1.89 ± 0.31 cm2 (p < 0.001). The mean mitral valve inflow gradient of the group was 23.95 ± 6.27 mmHg and 6.80 ± 2.44 mmHg, respectively, before and after the percutaneous mitral valve balloon commissurotomy procedure (p < 0.001). Post-procedure, there was no significant increment in mitral valve incompetence. The mean pulmonary artery pressure of the group decreased from 77.68 ± 23.19 mmHg to 42.31 ± 9.95 mmHg (p < 0.001). There was no fetal or maternal death following the procedure. Pregnancy ended at term gestation for 19/23 (82.6%) of the mothers and the mean birth weight of the neonates was 2800 g. CONCLUSION: Percutaneous mitral valve balloon commissurotomy procedure can safely be done for severe symptomatic rheumatic mitral stenosis in pregnancy in our setting.

RECURRENT MYXOMA ARISING FROM MULTIPLE CARDIAC CHAMBERS WITH SYSTEMIC EMBOLIZATION:A CASE REPORT.

Myxomas occupying multiple chambers of the heart are extremely rare, being more common in familial cases. Recurrence of these tumors after surgical excision is also a rare condition, observed in about 3% of patients in sporadic cases. Systemic embolization especially to the brain is one of the common presentations of cardiac myxomas apart from intracardiac obstruction and systemic symptoms. We report an adolescent girl presenting with recurrent myxoma arising from multiple cardiac chambers with systemic embolization. As a diagnostic and preventive measure of recurrence and chronic systemic embolization, we recommend a regular follow up of such patients with echocardiographic evaluation following surgical resection.

Disclosure of HIV diagnosis to children: a poorly addressed issue in pediatric HIV care.

As antiretroviral therapy becomes more widely available in developing countries, increasing numbers of HIV infected children are surviving into adolescence and beyond. As they grow older, human immunodeficiency virus (HIV) serostatus disclosure presents a unique challenge to health care workers and care givers of children with HIV/AIDS. Although disclosure is a crucial component of the continuum of pediatric HIV care with proven health benefits, it is poorly addressed in routine clinical practice. The purpose of this paper is to provide a review of researches on disclosure of pediatric HIV infection. The need for practical interventions including a guideline development to support pediatric HIV disclosure which provides children with developmentally appropriate information about the disease is suggested.

Unifocal langerhans cell histiocytosis presenting with pathological fracture.

A 13-year-old Ethiopian female patient who initially presented with localized pain and minimal soft tissue swelling later developed pathological fracture of the left femnur. The patient was initially treated as a case of osteomyelitis until the diagnosis of Langerhans cell histiocytosis (histiocytosis X, eosiniphilic granuloma) was made by bone biopsy. The clinical presentation of the case and brief review of the literature is discussed.

Hirschsprung's disease and imperforate anus in a new born: unusual assocation.

The association of congenital aganglionic megacolon and imperforate anus is rare. Our patient was a male neonate who initially presented with intestinal obstruction due to imperforate anus without fistula. Intraoperative findings and colonic biopsy revealed the presence of concurrent Hirschsprung's disease (HD). A suspicision that these two disorders may coexist is mandatory for early correct diagnosis.