Pediatric Cardiology

, Volume 34, Issue 1, pp 39–45 | Cite as

Catheter Interventions in Congenital Heart Disease Without Regular Catheterization Laboratory Equipment: The Chain of Hope Experience in Rwanda

  • John Senga
  • Emmanuel Rusingiza
  • Joseph Mucumbitsi
  • Agnès Binagwaho
  • Bert Suys
  • Christine Lys
  • Karlien Carbonez
  • Caroline Ovaert
  • Thierry SluysmansEmail author
Original Article


This report describes the feasibility and safety of cardiac catheterization in a developing country without access to a regular cardiac catheterization laboratory. The equipment used for imaging consisted of a monoplane conventional C-arm X-ray system and a portable ultrasound machine using the usual guidewires and catheters for cardiovascular access. In this study, 30 patients, including 17 children younger than 2 years and 2 adults, underwent catheterization of the following cardiac anomalies: patent ductus arteriosus (20 patients) and pulmonary valve stenosis (9 patients, including 2 patients with critical stenosis and 3 patients with a secundum atrial septal defect). Except for two cases requiring surgery, the patients were treated successfully without complications. They all were discharged from hospital, usually the day after cardiac catheterization, and showed significant clinical improvement in the follow-up evaluation. Cardiac catheterization can be performed safely and very effectively in a country with limited resources. If patients are well selected, this mode of treatment is possible without the support of a sophisticated catheterization laboratory.


Cardiac catheterization Cardiac heart diseases Developing country 



The authors thank AGA Medical, Ltd. and Cook Medical and Medicor Medical Supplies for their help and continued support for all the missions of Chaîne de l’Espoir realized in Rwanda.


  1. 1.
    Allen HD, Beekman RH, Garson A Jr, Hijazi ZM, Mullins C, O’Laughlin MP, Taubert KA (1998) Pediatric therapeutic cardiac catheterization: A Statement for Healthcare Professionals from the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 97:609–625PubMedCrossRefGoogle Scholar
  2. 2.
    Amarante J, Toscano C, Pearson M, Roth V, Jarvis W, Levin A (2008) Reprocessing and reuse of single-use medical devices used during hemodynamic procedures in Brazil: a widespread and largely overlooked problem. Infect Control Hosp Epidemiol 29:854–858PubMedCrossRefGoogle Scholar
  3. 3.
    Aryampur-Kashani I, Mehrampur M, Paydar P, Yazdanyar A, Siassi B, Shakibi JG (1981) A profile of heart diseases in children in a developing country. Ann Trop Paediatr 1:221–227Google Scholar
  4. 4.
    Berdat PA, Chatterjee T, Pfammatter JP, Windecker S, Meier B, Carrel T (2000) Surgical management of complications after closure of an atrial septal defect or patent foramen ovale. J Thorac Cardiovasc Surg 120:1034–1039PubMedCrossRefGoogle Scholar
  5. 5.
    Bergersen L, Foerster S, Marshall AC, Meadows J (2009) Congenital heart disease: the catheterization manual. Springer, Berlin pp 70–125Google Scholar
  6. 6.
    Bösenberg AT (2007) Pediatric anesthesia in developing countries. Curr Opin Anaesthesiol 20:204–210PubMedCrossRefGoogle Scholar
  7. 7.
    Chen CR, Cheng T, Huang T, Zhou YL, Chen JY, Huang Y-G, Li H-J (1996) Percutaneous balloon valvuloplasty for stenosis in adolescents and adults. N Engl J Med 335:21–25PubMedCrossRefGoogle Scholar
  8. 8.
    Cohen AJ, Tamir A, Houri S, Abegaz B, Gilad E, Omohkdion S, Zabeeda D, Khazin V, Ciubotaru A, Schachner A (2001) Save a child’s heart: we can and we should. Ann Thorac Surg 71:462–468PubMedCrossRefGoogle Scholar
  9. 9.
    Dessy H, Hermus JPS, van den Heuvel F, Oei HY, Krenning EP, Hess J (1996) Echocardiographic and radionuclide pulmonary blood flow pattern after transcatheter closure of patent ductus arteriosus. Circulation 94:126–129PubMedCrossRefGoogle Scholar
  10. 10.
    Dilawar M, El Said HG, El-Sisi A, Ahmad Z (2009) Safety and efficacy of low-profile balloon in native caorctation and recoarctation balloon angioplasty for infants. Pediatr Cardiol 30:404–408PubMedCrossRefGoogle Scholar
  11. 11.
    Druce JD, Russell JS, Birch CJ, Yates LA, Harper RW, Smolich JJ (2003) A decontamination and sterilization protocol employed during reuse of cardiac electrophysiology catheters inactivates human immunodeficiency virus. Infect Control Hosp Epidemiol 24:184–190PubMedCrossRefGoogle Scholar
  12. 12.
    Edwin F, Sereboe LA, Tettey MM, Aniteye EA, Kotei DA, Tamatey MM, Entsua-Mensah K, Frimpong-Boateng K (2010) Experience from a single centre concerning the surgical spectrum and outcome of adolescents and adults with congenitally malformed hearts in West Africa. Cardiol Young 20:159–164PubMedCrossRefGoogle Scholar
  13. 13.
    Feldman T, Leon MB (2007) Prospects for percutaneous valve therapies. Circulation 116:2866–2877PubMedCrossRefGoogle Scholar
  14. 14.
    Frank U, Herz L, Daschner FD (1988) Infection risk of cardiac catheterization and arterial angiography with single- and multiple-use disposable catheters. Clin Cardiol 11:785–787PubMedCrossRefGoogle Scholar
  15. 15.
    Giamberti A, Mele M, Di Terlizzi M, Abella R, Carminati M, Cirri S, Frigiola A (2004) Association of children with heart disease in the world: 10-year experience. Pediatr Cardiol 25:492–494PubMedCrossRefGoogle Scholar
  16. 16.
    Gowda ST, Kutty S, Ebeid M, Qureshi AM, Worley S, Latson LA (2009) Preclosure pressure gradients patent ductus arteriosus patients at risk for later pulmonary artery stenosis. Pediatr Cardiol 30:883–887PubMedCrossRefGoogle Scholar
  17. 17.
    Grifka RG, Jones TK (2000) Transcatheter closure of large PDA using 0.052-inch Gianturco coils: controlled delivery using a bioptome catheter through a 4-French sheath. Catheter Cardiovasc Interv 49:301–306CrossRefGoogle Scholar
  18. 18.
    Grossfeld P, Greenberg M, Saw S, Cheng G, Stanzi A, Mathewson J, Pises N, Lyda L, Vuthy S, Elias W, Moriarty S, Levy S, Walter D, Panzarella P, Grossfeld S, Kriett J, Madani M (2010) Successful surgical closure of an arterial duct in 18 children in a third world country. Cardiol Young 20:367–372PubMedCrossRefGoogle Scholar
  19. 19.
    Hawkins JA, Minich LLA, Tani LY, Sturtevant JE, Orsmond GS, Mc Gough EC (1996) Cost and efficacy of surgical ligation versus transcatheter coil occlusion of patent ductus arteriosus. J Thorac Cardiovasc Surg 112:1634–1639PubMedCrossRefGoogle Scholar
  20. 20.
    Hewitson J, Brink J, Zilla P (2002) The challenge of pediatric cardiac services in the developing world. Semin Thorac Cardiovasc Surg 14:340–345PubMedCrossRefGoogle Scholar
  21. 21.
    Kaya MG, Baykan A, Dogan A, Inanc T, Gunebakmaz O, Dogdu O, Uzum K, Eryol NK, Narin N (2010) Intermediate-term effects of transcatheter secundum atrial septal defect closure on cardiac remodeling in children and adults. Pediatr Cardiol 31:474–482PubMedCrossRefGoogle Scholar
  22. 22.
    Kumar KR, Tynan MJ (2005) Catheter Interventions for congenital heart disease in third world countries. Pediatr Cardiol 26:241–249PubMedCrossRefGoogle Scholar
  23. 23.
    Kumar KR, Anil SR, Philip A, Sivakumar K (2004) Bioptome-assisted coil occlusion of moderate–large patent arterial ducts in infants and small children. Catheter Cardiovasc Interv 62:266–271PubMedCrossRefGoogle Scholar
  24. 24.
    Lock JE, Castameda Zuniga WR, Fuhrman BP, Bass JL (1983) Balloon dilation angioplasty of hypoplastic and stenotic pulmonary arteries. Circulation 67:962–967PubMedCrossRefGoogle Scholar
  25. 25.
    Noonan JA (2004) A history of pediatric specialties: the development of pediatric cardiology. Pediatr Res 56:298–306PubMedCrossRefGoogle Scholar
  26. 26.
    Rao SG (2007) Pediatric cardiac surgery in developing countries. Pediatr Cardiol 28:144–148PubMedCrossRefGoogle Scholar
  27. 27.
    Rashkind WJ, Cuaso CC (1979) Transcatheter closure of a patent ductus arteriosus: successful use in a 3.5-kg infant. Pediatr Cardiol 1:3–7CrossRefGoogle Scholar
  28. 28.
    Rashkind WJ, Miller WW (1966) Creation of an atrial septal defect without thoracotomy: palliative approach to complete transposition of the great arteries. J Am Med Assoc 196:991–992CrossRefGoogle Scholar
  29. 29.
    Rashkind WJ, Mullins CE, Hellenbrand WE, Tait MA (1987) Nonsurgical closure of patent ductus arteriosus: clinical application of Rashkind PDA pccluder system. Circulation 75:583–592PubMedCrossRefGoogle Scholar
  30. 30.
    Rastogi N, Smeeton NC, Qureshi SA (2009) Factors related to successful transcatheter closure of atrial septal defect using the Amplater septal occluder. Pediatr Cardiol 30:888–892PubMedCrossRefGoogle Scholar
  31. 31.
    Sadiq M, Khan A (2009) Difficulties and possible solutions in establishing pediatric cardiac care in developing country. 5th World Congress of Pediatric Cardiology and Cardiac SurgeryGoogle Scholar
  32. 32.
    Soares AM, Aiello VD, Andrade JL, Kajita LJ, Soares JJr, Morhy SS, Mathias W Jr, Lopes AAB, Ramires JAF (2004) Doppler flow evaluation can anticipate abnormal left lung perfusion after transcatheter closure of patent ductus arteriosus. Eur Heart J 25:1927–1933PubMedCrossRefGoogle Scholar
  33. 33.
    Song J-K, Kim M-J, Yun S-C, Choo SJ, Song JM, Song H, Kang DH, Chung CH, Park DW, Lee SW, Kim Y-H, Lee CW, Hong M-K, Kim J-J, Lee JW, Park S-W, Park S-J (2010) Long-term outcomes of percutaneous mitral balloon valvuloplasty versus open cardiac surgery. J Thorac Cardiovasc surg 139:103–110PubMedCrossRefGoogle Scholar
  34. 34.
    Tan CA, Levi DS, Moore JW (2005) Embolization and transcatheter retrieval of coils and devices. Pediatr Cardiol 26:267–274PubMedCrossRefGoogle Scholar
  35. 35.
    Vaidyanathan B, Radhakrishnan R, Sarala DA, Sundaram KR, Kumar KR (2009) What determines nutritional recovery in malnourished children after correction of congenital heart defect? Pediatrics 124:294–299CrossRefGoogle Scholar
  36. 36.
    Weidenbach M, Franklin R, Gedlu E, Woerner C, Janousek J, Kostelka M (2009) Cardiac surgery for children from developing countries: program evaluation and outcomes. 5th World Congress of Pediatric Cardiology and Cardiac SurgeryGoogle Scholar
  37. 37.
    Willcoxson FE, Viswanathan S, Thomson JDR, Gibbs J (2010) Transcatheter closure of the arterial duct without arterial access. Cardiol Young 20:39–43PubMedCrossRefGoogle Scholar
  38. 38.
    Zaqout M, Suys B, De Wilde H, De Wolf D (2009) Transthoracic echocardiography guidance of transcatheter atrial septal defect closure in children. Pediatr Cardiol 30:992–994PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • John Senga
    • 1
  • Emmanuel Rusingiza
    • 2
  • Joseph Mucumbitsi
    • 3
  • Agnès Binagwaho
    • 4
  • Bert Suys
    • 5
  • Christine Lys
    • 7
  • Karlien Carbonez
    • 6
  • Caroline Ovaert
    • 6
  • Thierry Sluysmans
    • 6
    Email author
  1. 1.Cliniques Universitaires de KinshasaKinshasaDemocratic Republic of Congo
  2. 2.CHU, National University of RwandaButareRwanda
  3. 3.King Faisal Hospital (KFH)KigaliRwanda
  4. 4.Minister of HealthKigaliRwanda
  5. 5.Pediatric CardiologyRUG, Ghent University HospitalGentBelgium
  6. 6.Pediatric Cardiology, Chain of Hope BelgiumBrusselsBelgium
  7. 7.BrusselsBelgium

Personalised recommendations