Surgical Management of Congenital Heart Disease at Soavinandriana Hospital

Introduction: Access to cardiac surgery is usually limited in sub-Saharan African countries despite the high prevalence of congenital heart disease (CHD). The aim of this study was to describe the surgical management of CHD in Malagasy children at Soavinandriana Hospital (Cenhosoa). Methods: We conducted a retrospective descriptive study during a 3 years period (April 1, 2022–March 31, 2025) performed in the Cardiac Surgery Unit of Cenhosoa, including all children with CHD who underwent surgical repair. Demographics, type of CHD, diagnosis, procedures, outcomes were analyzed. Results: Eighty-seven children, including 38 boys (43%) and 49 girls (56%) were recorded. The average age was 3.17 years. Surgical indications were 76 Patent Ductus Arteriosus (87%), 6 Atrial Septal Defects (6%), and 5 Ventricular Septal Defects (5%). Symptomatic CHD was present in 82%. The circumstances of discovery of CHD were recurrent lung infections (63%), cardiac murmur (17%), and failure to thrive (16%). Echocardiography showed a large ductus (84%) with mean diameter of 4.66 mm. Pulmonary hypertension discovered in 29%. All children underwent conventional surgery. PDA were most common closed with sectioning and suturing of the ductus (88.15%). ASD and VSD were closed by using a pericardial or Dacron patch and cardiopulmonary bypass. The postoperative success rate was 97.36%. Conclusion: Surgical closures of PDA were the most common surgical procedures for CHD performed at Soavinandriana Hospital. Despite the challenge in practice of CHD surgery, the result is satisfied.