Angela Onwuzoo
For patients with congenital heart disease, also known as hole-in-the-heart, the introduction of minimally invasive heart surgery, a new procedure into the range of treatment options available in Nigeria, has been heartwarming news.
Recall that a private hospital in Lagos State, Tristate healthcare systems, recently performed Nigeria’s first minimally invasive heart surgery on four patients.
The operations – coronary artery bypass grafting (CABG) – Off-Pump and Mitral valve replacement were carried out without big cuts on the chests, while the hearts were beating.
A renowned Cardiologist and Professor of Medicine, who spoke on the procedure, Kamar Adeleke, revealed that one of the patients was an 81-year-old woman who needed a valve replacement.
Meanwhile, before bringing the procedure to the country, experts say Nigerians with holes in the heart could only get life-saving minimally invasive heart surgeries in the West, India and South Africa.
Heart specialists, who spoke with our correspondent said minimally invasive heart surgery has lots of benefits over open heart surgery, which they noted had been available to Nigerians with the condition since 1974, when the University of Nigeria Nsukka, Enugu State performed the first open heart surgery in the country.
Minimally invasive heart surgery according to experts is a technique used to perform heart surgeries through smaller incisions compared to the traditional open-heart surgery.
The procedure involves making small incisions in the chest, between the ribs or under the breastbone, to access the heart.
Before Tristate healthcare systems performed Nigeria’s first minimally invasive heart surgery last week, the Lagos State University Teaching Hospital, Ikeja, had also recorded a similar feat by becoming the first public tertiary health institution in Nigeria to perform Ventricular Septal Defect closure.
The procedure, which was performed on patients born with a hole in the heart, was done on Tuesday, June 20, 2023, at the hospital’s Cardiac Catheterisation Laboratory.
VSD, the hospital said, is a type of heart procedure that closes a hole between the left and right ventricles of the heart.
Giving insight into minimally invasive heart surgery as one of the treatment options for patients with hole in the heart during an exclusive interview with PUNCH Healthwise, a Consultant Paediatric Cardiologist at LASUTH, Dr. Omolola Lamina-Alaaya, said the procedure is known to have lesser complications, reduces blood loss and hospital stay.
The cardiologist, who is also a consultant paediatrician disclosed that there are several advantages of minimally invasive heart surgery over traditional open-heart surgery, which is largely offered in Nigeria.
The cardiologist, however, noted that not all holes in the heart can be corrected using minimally invasive surgery, stressing that some might still be corrected by the use of open heart surgery depending on the type of heart defect diagnosed.
The physician also pointed out that minimally invasive heart surgery was not really new in Nigeria.
She, however, added that the procedure is more expensive than open heart surgery, noting that only a few hospitals offer the service in Nigeria because the procedure requires a special lab, equipment and highly trained personnel.
Dr. Lamina-Alaaya said, “I know that this minimally invasive heart surgery has been done in adults. It’s not really new in Nigeria; it has been going on for a while.
“But we should know that there are various types of holes in the heart and there are various types of defects in the heart. Some of them are amenable to these minimally invasive surgeries, which is usually done in a catheterisation laboratory.
“So, the first thing is when a patient comes to the hospital and a diagnosis of congenital heart disease is made, the doctor needs to communicate to the patient the type of defect and the treatment options available.”
“If it is one that falls on the path of minimally invasive surgery and the patient can afford it, then it is fine to do it because there are advantages to minimally invasive heart surgery.
“Patients have shorter hospital stays with less complications because there is not too much cutting and you have less blood loss.
“For minimally invasive surgeries, there are many advantages and patients can be discharged way earlier. The patient can be discharged a few days after the procedure has been done.”
The cardiologist, however, pointed out that there is more to treatment options when it comes to having a hole in the heart which many patients seeking care do not know.
She said, “There are many types of defects in the heart and there are many types of holes in the heart. But the first thing is to identify it and then the doctor can then decide on the options available as treatment and the cost as well.
“The doctor will also discuss the pros and cons of the procedure. It is not all holes in the heart that can be corrected using minimally invasive surgery or using a catheterization procedure. If it is too large or if there are other complications, then, an open heart surgery would have to be done, rather than closure by minimally invasive surgery or catheterisation.”
The cardiologist said at the moment the cost of the procedure is still very much on the higher side than doing open heart surgery in the country, stressing that many patients with holes in the heart cannot afford it.
On the prevalence of congenital heart disease, the cardiologist said the condition varies worldwide, averaging 9.3 per 1000 live births.
For Nigeria, the prevalence she added ranges between 7.2 to 18.1 per 1000 live births.
Dr Lamina-Alaaya further said in LASUTH, eight out of every 10 patients seen at the paediatric cardiology clinic have a congenital heart disease called a hole in the heart in a lay man’s words.
According to a non-profit American academic medical centre, Mayo Clinic, congenital heart disease is one or more problems with the heart’s structure that exist since birth.
“Congenital means that you’re born with the condition. Congenital heart disease in adults and children can change the way blood flows through the heart.
“There are many different types of congenital heart defects. Some types of congenital heart disease may be mild. But complex defects may cause life-threatening complications. However, advances in diagnosis and treatment continue to improve survival for those with congenital heart disease.
“People with congenital heart disease need lifelong medical care. Treatment may include regular checkups (watchful waiting), medications or surgery”, the centre stated.
The clinic identified genetics, German measles (rubella), diabetes, medications, alcohol and smoking as some of the risk factors.
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