Challenges and possibilities of developing cardiac surgery in a peripheral hospital of low- and middle-income countries.

OBJECTIVE: Over a million cardiac surgeries are performed every year around the globe. However, approximately 93% of world population living in low- and middle-income countries have no access to cardiac surgery. The incidence of rheumatic and congenital heart disease is high in Nepal, while only 2,500-3,000 cardiac surgeries are performed annually. The aim of our study is to analyze challenges and opportunities of establishing a cardiac surgery program in a peripheral hospital of Nepal. METHODS: We analyzed our effort to establish a cardiac surgery program in a peripheral hospital in Nepal. RESULTS: Out of 2,659 consulted and diagnosed patients, we performed 85 open-heart surgeries in 4 years. Mean age of patients was 38.35 ± 14.13 years. The majority of patients were male (62.4% of patients) with 65.9% suffering from rheumatic heart disease. Average intensive care unit stay and hospital stay were 2.32 ± 1.1 and 8.29 ± 2.75 days, respectively. No in-hospital mortality was observed. CONCLUSION: We conclude that developing cardiac surgical care in a peripheral hospital of a developing country is feasible with support from government, foreign colleagues, local teams, and non-governmental organizations. The availability of a regular cardiac surgery service in the periphery of the country makes such services more accessible for the patients and helps in reducing the long waiting lists and unmanageable workload in the established cardiac centers in the capital city.

Rheumatic Heart Disease Screening Among School Children in Central Nepal.

Rheumatic heart disease is the most common heart disease in developing countries. This Global Health Report uses the results of screening 28,050 school children clinically with 2-dimensional echocardiography. A total of 1,739 students had cardiac murmur, with the most dominant lesion being rheumatic mitral regurgitation. This report concluded that the burden of rheumatic heart disease is decreasing, but it is still significant in Nepal. That is why echocardiographic screening is important in early diagnosis and management. (Level of Difficulty: Beginner.).

Clinical Profile of Atrial Fibrillation in a Tertiary Hospital in Central Nepal.

INTRODUCTION: Atrial fibrillation is a common cardiac arrhythmia in elderly causing morbidity and mortality. METHODS: A cross-sectional descriptive study was conducted in College of Medical Sciences Teaching Hospital from August 2013 to July 2016. All in-patients diagnosed with atrial fibrillation were included. RESULTS: Total 205 patients were studied. There were 154 (75.1%) nonvalvular and 51 (24.9%) valvular causes for atrial fibrillation. Common presentations were shortness of breath 84 (41%), palpitations 57 (27.8%) and stroke 38 (24.6 %). For valvular causes, common lesion was of mitral valve (90%). Warfarin was used in 32 (62.7%) with mean INR of 2.038 ± 0.6. Seventeen (53.1%) had INR below 2. In nonvalvular cases, types were paroxysmal (55.2%), persistent (34.4%) and permanent (10.4%). Common risk factors were heart failure 87 (56.5%), old age (>75 years) 66 (42.8%), hypertension 47 (30.5%), dilated cardiomyopathy 23 (14.9%), degenerative multivalvular heart disease 23 (14.9%) and ischemic heart disease (13.6%). CHADS(2) calculated 2 or more were in 98 (63.6%) patients. Warfarin was used in 39 (25.3%) and aspirin was used in 103 (66.9%) patients in CHADS(2) score 2 or more. Mean INR in nonvalvular AF was 1.5 ±0.4. CONCLUSIONS: Atrial fibrillation occurred as a result of valvular or nonvalvular origin. Common presentations were shortness of breath, palpitations and stroke. Common risk factors in nonvalvular atrial fibrillation were old age, hypertension and heart failure. Warfarin was underused in nonvalvular cases in our setting.