Subxyphoid Pericardial Drainage for Tuberculous Pericardial Effusion in Antananarivo

Introduction: Tuberculosis is the leading cause of pericardial effusion in sub-Saharan African countries. The aim of this study was to describe the diagnosis and the surgical management of tuberculous pericardial effusion in low-income country. Methods: This was a retrospective and descriptive study performed at Vascular Surgery Unit for 10 years-period (from January 2012 to December 2021), including all cases of drainage of pericardial effusion due to tuberculosis. Results: Sixty-seven cases were recorded, including 38 males (56.71%) and 29 women (43.28%). The average age was 35.47 years old. Patients lived in urban areas in 67.16% of cases. Thirteen patients (13.43%) had a previous history of pulmonary tuberculosis. The most common risk factors for tuberculosis infection were malnourishment (80.59%), indoor air pollution (77.61%) and close contact with tuberculosis patient (40.29%). The commonest symptom were dyspnea, (95.52%), chest pain (89.55%), fever (67.16%), tachycardia (95.52%) and cough (80.59%). Twenty-seven patients (39.02%) presented clinical signs of cardiac tamponade. Electrocardiogram showed sinus tachycardia (97.53%) with microvoltage (39.02%). Chest-X-ray showed cardiomegaly (100%) and pleural effusion (56.71%). Echocardiography showed moderate (43.28%) and large (56.71%) pericardial effusion. All patients underwent subxiphoid pericardial drainage. Mycobacterium tuberculosis detection via GeneXpert test of pericardial effusion were positive in 38.80% of patients. Pericardial biopsies confirmed the diagnosis of tuberculosis in 41.79%. The mortality rate was 8.95%. Conclusion: Subxiphoid pericardial drainage reduced thr risk of cardiac tamponade in patients with massive pericardial effusion. Histopathology of pericardial biopsies made a definitive diagnosis for tuberculosis.

Surgical Closure of Isolated Patent Ductus Arteriosus in Cenhosoa Antananarivo

Introduction: Patent ductus arteriosus (PDA) is a congenital heart disease whose seriousness lies in the risk of pulmonary hypertension, congestive heart failure and death. The aim of this study was to describe the surgical closure of an isolated patent ductus arteriosus (PDA) performed in Soavinandriana Teaching Hospital. Methods: This was a retrospective and descriptive study, during thirteen-years-period (January 2004 to December 2016), performed at Cardiac surgery unit of Soavinandriana Teaching Hospital, including all children underwent surgical closures of an isolated PDA. Demographic data, birth weight, clinical signs, diagnostic imaging, time between diagnosis and surgery and hospital left stays were analyzed. Results: A total of eighty-six children were recorded, including 21 males (24.42%) and 65 females (75.58%), giving sex ratio of 30%. The average age was 33.91 months. Children were born with a low birth weight in 12.79% of cases. PDA was symptomatic in 81.39%. The most circumstances of discovery were recurrent lung infections (31.40%), dyspnea (24.41%) and failure to thrive (19.76%). Echocardiography showed left ventricular dilatation (63.95%), pulmonary hypertension (73.25%). The ductus was large in 97.67% and the mean diameter was 5 mm. Chest X-ray showed cardiomegaly (97.67%) and increased pulmonary vascularity (86.04%). Mean delay of surgical procedures after diagnosis was 15.16 months. Surgical procedures consisted left posterolateral thoracotomy with a section and suture after clamping the ductus. Earlier postoperatives courses were simple in all children. The mean duration of hospitalization was 8.93 days. Conclusion: PDA was most common large (97%) and symptomatic (81%) in our study. Surgical closure of an isolated PAD was the only surgical procedure of congenital heart cardiopathy available in Antananarivo.