A.F. Corno / Interactive CardioVascular and Thoracic Surgery
[28] Basaran M, Tuncer E, Guzelmeric F, Cine N, Oner N, Yildirim A et al. Introduction to a Norwood program in an emerging economy: learning curve of a single center. Heart Surg Forum 2013;16:E313–8. [29] Jenkins KJ, Castaneda AR, Cherian KM, Couser CA, Dale EK, Gauvreau K et al. Reducing mortality and infections after congenital heart surgery in the developing world. Paediatrics 2014;134:e1422–30. [30] Oludara MA, Nwiloh J, Fabamwo A, Adebola P. Commencing open heart surgery in resource limited countries: lessons from the LASUTH experience. Pan Afr med J 2014;19:105–11. [31] Dilber D, Malcic I, Dasovic Bulievic A, Anic D, Belina D, Zovko A. Croatian clinical epidemiological study (2008–2011); the use of standardised risk scores in paediatric congenital cardiac surgery for a case complexity selection and gradual progress of cardiosurgical model in developing countries. Cardio Young 2015;25:274–80. [32] Nguyen N, Pezzella AT. Pediatric cardiac surgery in low- and middleincome countries or emerging economies: a continuing challenge. World J Podiatry Congenit Heart Surg 2015;6:274–83. [33] Akhtar MI, Hamid M, Ul-Hag A, Minai F, Rehman N. Feasibility and safety of on table extubation after corrective surgical repair of tetralogy of Fallot in a developing country: a case series. Ann Card Anaesth 2015;18:237–41. [34] Backer CL. Humanitarian congenital heart surgery: template for success. J Thorac Cardiovasc Surg 2014;148:2489–90.
eComment. Paediatric and congenital cardiac surgery in emerging economies Authors: Ho-fon Royce Law UCL Institute of Cardiovascular Science, London, UK doi: 10.1093/icvts/ivw133 © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. I read with great interest the article by Corno about establishing long-term congenital cardiac surgery services in emerging economies [1]. The article identifies impracticalities of existing programmes and suggests areas for improvement in future long-term project planning. After reading the article, I believe local institutions endorsement and medical school curriculum supplementation are as important as oversea surgical missions in the promotion of congenital cardiac surgery in the developing countries. The change should start at the undergraduate level. Medical students should be given more exposure in paediatric cardiology and cardiac surgery in order to spark their interests at the early stage of their careers. Medical school curriculum should also include basic pathophysiology and morphology of various congenital heart diseases. This can be done by using cheap and reproducible 3D models available nowadays. The university can also invite surgeons from the visiting team to give lectures and masterclasses. The local institutions should encourage trainees to pursue their surgical careers oversea. When they are qualified, they can return to the country with the knowledge and experience in the specialty and pass on to the future generations. Research fellowships can also be set up. I believe undergraduate education and local institutions participation are both vital in long-term promotion of congenital cardiac surgery. Together with the help from oversea, a sustainable programme can be created. Conflict of interest: none declared. Reference [1] Corno A. Paediatric and congenital cardiac surgery in emerging economies: surgical ‘safari’ versus educational programmes. Interact CardioVasc Thorac Surg 2016;23:163–7.
STATE-OF-THE-ART
[5] Boneva RS, Botto LD, Moore CA, Yang Q, Correa A, Erickson JD. Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979–1997. Circulation 2001;103: 2376–81. [6] Shah GS, Singh MK, Pandey TR, Kalakheti BK, Bandar GP. Incidence of congenital heart disease in tertiary care hospital. Kathmandu Unit Med J 2008;6:33–6. [7] Wickramasinghe P, Lamabadusuriya S, Narenthiran S. Prospective study of congenital heart disease in children. Ceylon Med J 2001;46:96–8. [8] Chadha S, Singh N, Shukla D. Epidemiological study of congenital heart disease. Indian J Pediatr 2001;68:507–10. [9] Abbag F. Pattern of congenital heart disease in the southwestern region of Saudi Arabia. Ann Saudi Med 1998;18:393–5. [10] Bassili A, Mokhtar SA, Dabous NI, Zaher SR, Mokhtar MM, Zaki A. Risk factors for congenital heart disease in Alexandria, Egypt. Eur J Epidemiol 2000;16:805–14. [11] Davis AJM. Pediatric heart disease in the developing world. In Lake CL, Booker PD (eds). Pediatric Cardiac Anesthesia. Ends. Philadelphia: Lippincott Williams & Wilkins, 2005, pp. 7–12. [12] Dearani JA, Neirotti R, Kohnke EJ, Sinha KK, Cabalka AK, Barnes RD et al. Improving pediatric cardiac surgical care in developing countries: matching resources to needs. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2010;13:35–43. [13] Nguyen N, Jacobs JP, Dearani JA, Weinstein S, Novick WM, Jacobs ML et al. Survey of nongovernmental organizations providing pediatric cardiovascular care in low- and middle-income countries. World J Pediatr Congenit Heart Surg 2014;5:245–55. [14] Young JN, Everett J, Simsic JM, Taggart NW, Litwin SB, Lusin N et al. A stepwise model for delivering medical humanitarian aid requiring complex interventions. J Thorac Cardiovasc Surg 2014;148:2480–9. [15] Deloche A, Babatasi G, Baron O, Roux D, Chauvaud S, Sidi D et al. Pediatric heart surgery in developing countries. Twenty years experience of ‘La chaine de l’espoir’. Bull Acad Natl Med 2011;195:305–7. [16] McKavanagh P, Booth K, Blair L, McNeilly G, Varadarajan B, Nzewi O. Addressing discrepancies: personal experience of a cardiac mission programme in Africa. Int J Cardiol 2014;177:794–9. [17] Unger F. Worldwide survey on cardiac interventions 1995. For Europium 1999;7:128–46. [18] Cox JL. Presidential address: changing boundaries. J Thorac Cardiovasc Surg 2001;122:413–8. [19] Pezzella AT. International cardiac surgery: a global perspective. Semin Thorac Cardiovasc Surg 2002;14:298–320. [20] Neirotti R. Paediatric cardiac surgery in less privileged parts of the world. Cardiol Young 2004;14:341–6. [21] Michael P. Humanitarian surgical mission. Coming home. Ann Chir Plast Esthet 2004;49:320–7. [22] Welling DR, Ryan JM, Burris DG, Rich NM. Seven sins of humanitarian medicine. World J Surg 2010;34:466–70. [23] DeCamp M. Ethical review of global short-term medical volunteerism. HEC Forum 2011;23:91–103. [24] Thiagarajan RI, Scheurer MA, Salvin JW. Great need, scarce resources, and choice: reflections on ethical issues following a medical mission. J Clin Ethics 2014;25:311–3. [25] Novick WM, Anic D, Ivancan V, DiSessa TG. International pediatric cardiac assistance in Croatia: results of the 10 year program. Croat Med J 2004;45: 389–95. [26] Balachandran R, Nair SG, Kumar RK. Establishing a pediatric cardiac intensive care unit. Special considerations in a limited resources environment. Ann Podiatry Cardiol 2010;3:40–9. [27] Walk RM, Glaser J, Marmon LM, Donahue TF, Bastien J, Safford SD. Continuing promise 2009. Assessment of a recent pediatric surgical humanitarian mission. J Pediatr Surg 2012;47:652–7.
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[28] Basaran M, Tuncer E, Guzelmeric F, Cine N, Oner N, Yildirim A et al. Introduction to a Norwood program in an emerging economy: learning curve of a single center. Heart Surg Forum 2013;16:E313–8. [29] Jenkins KJ, Castaneda AR, Cherian KM, Couser CA, Dale EK, Gauvreau K et al. Reducing mortality and infections after congenital heart surgery in the developing world. Paediatrics 2014;134:e1422–30. [30] Oludara MA, Nwiloh J, Fabamwo A, Adebola P. Commencing open heart surgery in resource limited countries: lessons from the LASUTH experience. Pan Afr med J 2014;19:105–11. [31] Dilber D, Malcic I, Dasovic Bulievic A, Anic D, Belina D, Zovko A. Croatian clinical epidemiological study (2008–2011); the use of standardised risk scores in paediatric congenital cardiac surgery for a case complexity selection and gradual progress of cardiosurgical model in developing countries. Cardio Young 2015;25:274–80. [32] Nguyen N, Pezzella AT. Pediatric cardiac surgery in low- and middleincome countries or emerging economies: a continuing challenge. World J Podiatry Congenit Heart Surg 2015;6:274–83. [33] Akhtar MI, Hamid M, Ul-Hag A, Minai F, Rehman N. Feasibility and safety of on table extubation after corrective surgical repair of tetralogy of Fallot in a developing country: a case series. Ann Card Anaesth 2015;18:237–41. [34] Backer CL. Humanitarian congenital heart surgery: template for success. J Thorac Cardiovasc Surg 2014;148:2489–90.
eComment. Paediatric and congenital cardiac surgery in emerging economies Authors: Ho-fon Royce Law UCL Institute of Cardiovascular Science, London, UK doi: 10.1093/icvts/ivw133 © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. I read with great interest the article by Corno about establishing long-term congenital cardiac surgery services in emerging economies [1]. The article identifies impracticalities of existing programmes and suggests areas for improvement in future long-term project planning. After reading the article, I believe local institutions endorsement and medical school curriculum supplementation are as important as oversea surgical missions in the promotion of congenital cardiac surgery in the developing countries. The change should start at the undergraduate level. Medical students should be given more exposure in paediatric cardiology and cardiac surgery in order to spark their interests at the early stage of their careers. Medical school curriculum should also include basic pathophysiology and morphology of various congenital heart diseases. This can be done by using cheap and reproducible 3D models available nowadays. The university can also invite surgeons from the visiting team to give lectures and masterclasses. The local institutions should encourage trainees to pursue their surgical careers oversea. When they are qualified, they can return to the country with the knowledge and experience in the specialty and pass on to the future generations. Research fellowships can also be set up. I believe undergraduate education and local institutions participation are both vital in long-term promotion of congenital cardiac surgery. Together with the help from oversea, a sustainable programme can be created. Conflict of interest: none declared. Reference [1] Corno A. Paediatric and congenital cardiac surgery in emerging economies: surgical ‘safari’ versus educational programmes. Interact CardioVasc Thorac Surg 2016;23:163–7.
STATE-OF-THE-ART
[5] Boneva RS, Botto LD, Moore CA, Yang Q, Correa A, Erickson JD. Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979–1997. Circulation 2001;103: 2376–81. [6] Shah GS, Singh MK, Pandey TR, Kalakheti BK, Bandar GP. Incidence of congenital heart disease in tertiary care hospital. Kathmandu Unit Med J 2008;6:33–6. [7] Wickramasinghe P, Lamabadusuriya S, Narenthiran S. Prospective study of congenital heart disease in children. Ceylon Med J 2001;46:96–8. [8] Chadha S, Singh N, Shukla D. Epidemiological study of congenital heart disease. Indian J Pediatr 2001;68:507–10. [9] Abbag F. Pattern of congenital heart disease in the southwestern region of Saudi Arabia. Ann Saudi Med 1998;18:393–5. [10] Bassili A, Mokhtar SA, Dabous NI, Zaher SR, Mokhtar MM, Zaki A. Risk factors for congenital heart disease in Alexandria, Egypt. Eur J Epidemiol 2000;16:805–14. [11] Davis AJM. Pediatric heart disease in the developing world. In Lake CL, Booker PD (eds). Pediatric Cardiac Anesthesia. Ends. Philadelphia: Lippincott Williams & Wilkins, 2005, pp. 7–12. [12] Dearani JA, Neirotti R, Kohnke EJ, Sinha KK, Cabalka AK, Barnes RD et al. Improving pediatric cardiac surgical care in developing countries: matching resources to needs. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2010;13:35–43. [13] Nguyen N, Jacobs JP, Dearani JA, Weinstein S, Novick WM, Jacobs ML et al. Survey of nongovernmental organizations providing pediatric cardiovascular care in low- and middle-income countries. World J Pediatr Congenit Heart Surg 2014;5:245–55. [14] Young JN, Everett J, Simsic JM, Taggart NW, Litwin SB, Lusin N et al. A stepwise model for delivering medical humanitarian aid requiring complex interventions. J Thorac Cardiovasc Surg 2014;148:2480–9. [15] Deloche A, Babatasi G, Baron O, Roux D, Chauvaud S, Sidi D et al. Pediatric heart surgery in developing countries. Twenty years experience of ‘La chaine de l’espoir’. Bull Acad Natl Med 2011;195:305–7. [16] McKavanagh P, Booth K, Blair L, McNeilly G, Varadarajan B, Nzewi O. Addressing discrepancies: personal experience of a cardiac mission programme in Africa. Int J Cardiol 2014;177:794–9. [17] Unger F. Worldwide survey on cardiac interventions 1995. For Europium 1999;7:128–46. [18] Cox JL. Presidential address: changing boundaries. J Thorac Cardiovasc Surg 2001;122:413–8. [19] Pezzella AT. International cardiac surgery: a global perspective. Semin Thorac Cardiovasc Surg 2002;14:298–320. [20] Neirotti R. Paediatric cardiac surgery in less privileged parts of the world. Cardiol Young 2004;14:341–6. [21] Michael P. Humanitarian surgical mission. Coming home. Ann Chir Plast Esthet 2004;49:320–7. [22] Welling DR, Ryan JM, Burris DG, Rich NM. Seven sins of humanitarian medicine. World J Surg 2010;34:466–70. [23] DeCamp M. Ethical review of global short-term medical volunteerism. HEC Forum 2011;23:91–103. [24] Thiagarajan RI, Scheurer MA, Salvin JW. Great need, scarce resources, and choice: reflections on ethical issues following a medical mission. J Clin Ethics 2014;25:311–3. [25] Novick WM, Anic D, Ivancan V, DiSessa TG. International pediatric cardiac assistance in Croatia: results of the 10 year program. Croat Med J 2004;45: 389–95. [26] Balachandran R, Nair SG, Kumar RK. Establishing a pediatric cardiac intensive care unit. Special considerations in a limited resources environment. Ann Podiatry Cardiol 2010;3:40–9. [27] Walk RM, Glaser J, Marmon LM, Donahue TF, Bastien J, Safford SD. Continuing promise 2009. Assessment of a recent pediatric surgical humanitarian mission. J Pediatr Surg 2012;47:652–7.
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