We present a rare and first case of Cor triatriatum sinistrum (CT) in a patient who presents with dyspnoea, easy fatigability, chest pain, murmurs and typical ECG and 2D-echo findings.The purpose of presenting this case report is to highlight the distinctive manifestation of Cor triatriatum sinistrum and to provide a concise report of this disease with the hope that such information will help identify patients earlier in the course of their disease.Surgical correction offers good and long term results for both classic and atypical types.In a resource poor country like ours, high index of suspicion, early diagnosis and timely referral are warranted so as to avert death.

Background: Traumatic Arteriovenous Fistula (TAVF) and traumatic artery aneurysms are the late complications of vascular injuries. Complications arise from neglected or undetected cases of TAVF, hence the need to promptly diagnose and manage them. Aims/Objective: this is to highlight the principles and challenges of managing traumatic recurrent AVF of the lower extremities in a low-income setting like ours. We present a 43- year man with traumatic recurrent AVF of the lower extremity, associated with chronic venous disease and ankle ulcer dating 17 years, who underwent successful treatment via open repair, in our facility, through the combined efforts of a multidisciplinary team involving vascular and plastic surgeons as well as a physiotherapist.

Introduction: Immunization has been shown to be the most successful and cost-effective public health intervention in the 20th century. In the developing world, it does not only prevent about three million child deaths annually, but also has the potential to prevent additional two million deaths if coverage improves. However, immunization coverage has remained low in Nigeria although vaccines are provided relatively free by the government. Efforts have focused on the health worker, health system and logistics with little attention being paid tomaternal factors like knowledge, perception, beliefs and practice. Objectives: To assss mothers’ knowledge, perception and practice of routine and campaign immunization in Enugu. Methods: A structured questionnaire was administered to 207 mothers who have at least one child less than 5 years of age, attending children outpatient and immunization clinics at the University of Nigeria Teaching Hospital, Enugu. Results: Forty-eight per cent of the mothers had tertiary education, 42% had secondary education, and 9% had primary education while 1% had no formal education. Eighty-two per cent knew that children are immunized to prevent major killer diseases, 14% and 3.4% believed it was to prevent all diseases, and to treat diseases respectively. Most mothers took their children to health facilities for routine immunization (95.2%) and also accepted immunization on immunization campaign days (75.4%). However, 23.6% had never immunized their children during campaigns. On the other hand, 13% (27) of mothers had out-rightly rejected immunization during campaign while 85% (177) had never rejected immunization. The remaining 2% were not immunized due to reasons other than rejection. More mothers significantly rejected campaign immunization than the number that did not go for routine immunization (p=0.000). Maternal highest educational level was significantly associated with knowledge of reason for immunization and acceptance of immunization (p=0.000). Religious denomination was not significantly associated with rejection of campaign immunization (p=0.056). Conclusion: Most mothers studied had good knowledge and positive perception and practice of immunization. However, the Campaign immunization rejection rate was relatively high for the south eastern Nigeria where it is often assumed that non-compliance is not a problem. Similarly, the proportions of mothers with wrong knowledge and poor perception of immunization require policy attention. Maternal education was significantly associated with knowledge and acceptance of immunization. These findings are important in the design and implementation of childhood immunization programmes.

Diaphragmatic eventration, is a rare pathology that is characterized by abnormal elevation of the diaphragm and abdominal contents residing within thoracic cavity, though separated from the lungs by the thin or membraneous diaphragm. It may be asymptomatic but may result in dyspnoea, heaviness in the chest and hearing of bowel sounds in the chest. We report a 63 year old man who presented to our service, 10 years history prior, of heaviness in the left hemithorax and whose chest x-ray revealed an abnormally elevated dome of the left hemidiaphragm in the chest (eventration). He was worked up for left thoracotomy, plication of the diaphragm with uneventful recovery postoperatively and disappearance of symptoms.

Unlike in the Western world, the delivery of cardiovascular services to children and adults born with congenital heart defects (CHDs) in Nigeria is grossly inadequate. There are problems all through the ages of these unfortunate patients. Accurate statistical data of CHD in Nigeria is lacking, but it is comparable to 8 per 1000 live births as seen in other countries. The burden is presently being ameliorated by medical tourisms and foreign cardiac surgery missions, but such services are still inadequate. There is a need for the government to share resources between this noncommunicable (CHD) and communicable diseases. When this is done with assistance of international partners and humanitarian organizations, a sustainable pediatric cardiac surgery program will be established that will definitely enhance the care of these patients at childhood, adolescent, and adult stages of their lives.

Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech.One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass effect of a neighbouring structure.We report a rare case of vocal cord paralysis secondary to internal carotid artery dissection.Method: The diagnosis was based on clinical history, physical examination and imaging studies.Literature review was done.Case Report: This was a 53-year-old female with a history of unremitting, progressive hoarseness and mild dysphagia to liquid, who was clinically found to have impaired left vocal cord mobility, a left-sided pulsatile neck mass and left carotid artery dissection based on imaging studies.Symptoms abated after conservative treatment with Aspirin and she has remained symptom free since two years of follow-up.Conclusion: Vocal cord paralysis can be a consequence of carotid artery dissection causing mass effect on the vagus nerve.Thus, carotid artery dissection should not be forgotten as a possible cause of vocal cord paralysis in some cases of vocal cord paralysis of uncertain etiology.Treatment with anti-platelet drug can bring about resolution of symptoms and return of vocal cord mobility.

Unlike in the Western world, the delivery of cardiovascular services to children and adults born with congenital heart defects (CHDs) in Nigeria is grossly inadequate. There are problems all through the ages of these unfortunate patients. Accurate statistical data of CHD in Nigeria is lacking, but it is comparable to 8 per 1000 live births as seen in other countries. The burden is presently being ameliorated by medical tourisms and foreign cardiac surgery missions, but such services are still inadequate. There is a need for the government to share resources between this noncommunicable (CHD) and communicable diseases. When this is done with assistance of international partners and humanitarian organizations, a sustainable pediatric cardiac surgery program will be established that will definitely enhance the care of these patients at childhood, adolescent, and adult stages of their lives.

Carotid artery injuries with pseudo-aneurysm are uncommon but associated with central neurologic dysfunction. We present a 26-year-old man with a giant bleeding pseudo-aneurysm of right common carotid artery managed by emergency sternotomy, neck exploration and repair of the aneurysm. On the right side of the neck was a 10 × 8 cm mass occupying almost the entire posterior triangle. It was pulsatile, tender with sinus discharging serosanguinous fluid. Positive thrill and bruit were demonstrable over the mass. Conventional Computerized Angiography (CTA) and Distal Subtraction Angiography (DSA) showed a 1 cm defect in the lateral wall of the distal right common carotid artery (RCCA), complete circle of Willis and massive blood clot at the site of the defect. In middle-and low-income settings where the technical know-how and resources for stenting including cerebral oximeter are not available, expertise in open surgical approach becomes the only way to save life. Key words: Diagnosis, equipment, surgery, treatment, pseudoaneurysm, carotid artery, rupture.

Background: Current management of empyema thoracis requires that patients receive appropriate empiric antibiotics targeted to treat the bacterial profile of modern pleural infection and based on local antibiotic policies and resistance patterns until results of cultures are available. There are few studies on the local microbial patterns of empyema in most regions of Africa. Objectives: To determine the common aetiologic organisms and antimicrobial resistance pattern of pleural empyema Methods: We conducted a retrospective review of 105 pleural empyema culture and sensitivity reports. Results: Out of the 105 pleural aspirate samples, 46(43.81%) were positive on culture. Of the 46, Gram-negative bacilli (n=43) were the predominant isolates, the commonest of which were Klebsiella pneumoniae (32.56%, 14/43), Pseudomonas aeruginosa (25.58%, 11/43) and E. coli (20.93%, 9/43). The Gram positive isolates (n=17) were Staphylococcus aureus (47.06%, 8/17), Coagulase Negative Staphylococcus (29.41%, 5/17), and Streptococcus pneumoniae (23.53%, 4/17). The other isolates were Mycobacterium tuberculosis (n=13) and non albicans Candida (n=2). Klebsiella pneumoniae (n=14, 32.56%) was the most common isolate and showed high sensitivity to levofloxacin (71.43%), Ciprofloxacin (69.23%), Imipenem (57.14%) and Cefepime (57.14%) but was resistant to Cefuroxime (92.86%), Amoxicillin/ Clavulanic acid (66.67%), Ceftriaxone (64.29%) and Ceftazidime (57.14%). Conclusion: Our finding differ from most studies locally and globally. Local protocols on initiation of empirical therapy should be based on the resistance profile of aetiological agents prevalent in a locality and should be reviewed from time to time.

Spontaneous pneumothorax is a rare and life-threatening emergency. When it occurs in pregnancy, it poses a serious danger for both the mother and the fetus. A high index of suspicion, early diagnosis, and proper management are recommended. We present the case of a 35-year-old pregnant woman at the 34th week of gestation who presented via the emergency department complaining of sudden onset of dyspnea and chest pain. The clinical and radiologic evaluation confirmed the right-sided pneumothorax. She had a closed tube thoracostomy drainage (CTTD) following which the patient's condition improved. She subsequently had chest tube removal with no recurrence beyond delivery as she had a good outcome.

Patient satisfaction may be regarded as a subjective idea which helps patient assess and rate the quality of care they obtain from healthcare providers. This study was aimed to assessing patients’ satisfaction level with radio-diagnostic services in National Orthopaedic Hospital, Igbobi Lagos (NOHIL), Nigeria. A cross-sectional study was conducted on 194 patients that visited the General Outpatient Department (GOPD) clinic twice or more from July 2019 to August 2019. Convenience sampling technique was used for sample collection. Ethical approval was obtained from the Human Research and Ethics Committee of NOHIL and participants’ consent was also obtained. Data were collected by the use of questionnaires. Descriptive and inferential statistics were used for data analysis. Findings were significant at P < 0.05. The findings from the study showed that majority of the patients (92.3%) were satisfied with the quality of the x rays produced and the friendly nature of the radiographers (77.8%).The patients’ satisfaction with radio diagnostic services in this center could be said to be very low as patients opined that they were dissatisfied with most of the services rendered. There is a need for the radiographers to be punctual to duty as this will help reduce the long waiting time experienced by the respondents.

Subclavian artery pseudoaneurysms are rare and occur mostly as a consequence of an inadvertent arterial puncture during central venous catheterization, endovascular therapeutic procedures or after penetrating or blunt trauma. They usually have a late clinical presentation, with pain, swelling or other compressive symptoms. We present a 40-year old man farmer who presented to our service with prior 14 days and 12 days history of left chest upper chest swelling and inability to use the left upper limb respectively, all on account of injury. He went on a night alcohol binge, got drunk and while getting to his sitting room slipped and fell on a nearby glass center table. He had a deep cut on the left upper anterior chest wall. There was immediate profuse spurting bleeding with estimated blood loss of 800 ml. After delay in definitive treatment due to financial constraint the aneurysm increased in size, ruptured and rebled profusely leading to syncope. He was managed by Doppler ultrasound, median sternotomy and subclavian artery exploration to achieve proximal and distal vascular control. Sac was entered into via an infraclavicular transverse incision, heamatoma manually evacuated, bleeding site isolated and secured. He received 5 units of blood. Postoperative course was uneventful as he was managed with analgesics, antibiotics, haematinics and physiotherapy. Power in the upper limb has improved to 3 around the shoulder, 2 around the elbow and 1 around the wrist.

Background: The diaphragm is a fibro-muscular partition that separates the relatively low-pressure thoracic cavity from the relatively high-pressure abdominal cavity. This difference in pressure causes transmigration of abdominal contents into the thoracic cavity whenever there is a defect, often resulting in cardio-respiratory disturbances.Objective: To describe the profile of diaphragmatic hernias managed in three tertiary hospitals in, South-East Nigeria and compare same with global outcomes.Methodology: Retrospective study of patients with different types of diaphragmatic hernias managed in three centre over a 13-year period was done. Data on demography, types of hernias, mode of presentation, diagnostic methodology, treatment offered and prognosis including complications were obtained from Record Departments of each hospital.Results: There were a total of 44 patients with male to female ratio of 9:2. The ages ranged from 21 days to 840 months. The profile of the hernias was congenital (n=8, 18.2%), acquired traumatic (n= 30, 68.2%) and acquired non-traumatic (n=6, 13.6%). Among the congenital types-four (50%) were central, three (37.5%) were posterior while one (12.5%) was anterior. In the acquired traumatic types, left side was dominant. In the hiatal hernia (acquired non-traumatic), types 1 has the highest occurrence followed by type IV. Associated injuries in traumatic diaphragmatic hernias were the determinants of morbidity.Conclusion: Thoraco-abdominal hernias as described are not uncommon in our centre. Multidisciplinary approach and functional Intensive care unit (ICU) played significant role in the outcome of congenital diaphragmatic hernias. Keywords: Profile, Diaphragm, Hernias, Enugu

Background: Post-operative fever (POF) after cardiac surgery in a developing country is of great concern because of the associated morbidity and mortality. In our country, we experience this complication more because of a high rate of malaria infestations, gastroenteritis, and malnutrition. We also experience a low yield of positive diagnostic tests when POF develops; this is partly due to expense and the prioritisation of other essential items in our poorly equipped cardiac ICU. Aims/Objective: To assess the causes of POF after cardiac surgery and determine its impact on the outcome on patients. Materials and methods: International Cardiac Surgery Mission teams visited our centre for 7 years (2013-2019). During this period, a significant number of cardiac surgeries were performed. A retrospective study of patients with POF was performed with data from our hospital's database, and included standard demographics; types of surgery performed, and management protocols being used in the peri-operative care. Results: A total of 242 patients were treated during the study period and underwent 266 surgeries. Of these, 151 (56.8%) and 115 (43.2%) were adult and paediatric cases respectively. Ages ranged between 0 and 90 years; 34 (14.1%) had POF. When we evaluated the clinical and associated laboratory findings, pyrexia (temp >38.0 degrees C) and elevated white blood cell count with differential neutrophilia were present in 10 patients (29.4%). The time of onset and duration of POF were between 144 hours. In the invasive procedure related to POF, sternotomy infections were present in seven patients (18.4%). Malaria infestations and breach in sterility protocol were predominant. Conclusion: The management of POF in the cardiac ICU was complicated by the requirement of co-operation from a larger number of specialties than is usually required in advanced centres with special expertise in malaria confirmation. We, therefore, introduced structured clinical, laboratory, and appropriate interventions to treat POF more aggressively. We found that more careful attention to peri-operative details to ensure strict observation of sterility protocol with anti-malaria prophylaxis led to improvements in our centre's outcomes.

Background: Unlike in developed countries, the delivery of cardiovascular services to patients born with CHD in Nigeria is grossly inadequate. There are problems at both pediatric and adult ages with high morbidity and mortality. We aim to highlight the status of the patients born with CHD, and the challenges of their surgical management. Materials and Methods: In the last 6 years, Foreign Cardiac Surgery missions were reinstituted at NCTCE/UNTH, Enugu, Nigeria. The participants performed cardiac interventions on a variety of patients with CHD. We performed a retrospective review of this endeavor. Patient demographics, number of patients, age ranges, types of CHD and clinical evaluation methodology were obtained from our hospital information technology department. We assessed the types of cardiac interventions, the outcome and the challenges including the impacts of the foreign cardiac surgery missions. Results: During the study period, a total of 113 patients with CHD were evaluated. They were 61 males and 52 females with a ratio of 1.2:1. We studied both simple and complex anomalies. The highest age range affected was 1.1- 2 years followed by 2.1-3 years. A VSD was the commonest anomaly (n=32, 24.6%), followed by tetraology of Fallot (n=25, 19.2%). One of the commonest challenges is inadequate educational program for the local team. Conclusion: Large burden of diseases on limited health care resources and lack of trained personnel have made Nigeria to rely on Foreign Cardiac Missions. However inadequate educational program for the local team has created lack of independence of the local to treat CHD after 6 years.

Surgical treatment of valvular heart disease in Nigeria, the most populous country in sub-Saharan Africa, is adversely affected by socioeconomic factors such as poverty and ignorance. To evaluate our experience in this context, we identified all patients who underwent surgery for acquired or congenital valvular heart disease at our Nigerian center from February 2013 through January 2019. We collected data from their medical records, including patient age and sex, pathophysiologic causes and types of valvular disease, surgical treatment, and outcomes. Ninety-three patients (43 males [46.2%]; mean age, 38.9 ± 10.0 yr [range, 11-80 yr]) underwent surgical treatment of a total of 122 diseased valves, including 72 (59.0%) mitral, 26 (21.3%) aortic, 21 (17.2%) tricuspid, and 3 (2.5%) pulmonary. The most prevalent pathophysiologic cause of disease was rheumatic (87 valves [71.3%]), followed by functional (20 [16.4%]), congenital (8 [6.6%]), degenerative (5 [4.1%]), and endocarditic (2 [1.6%]). All 3 diseased pulmonary valves had annular defects associated with congenital disease. Surgical treatment included mechanical prosthetic replacement of 92 valves (75.4%), surgical repair of 29 (23.8%), and bioprosthetic replacement of 1 (0.8%). We conclude that, in Nigeria, valvular disease is mainly rheumatic, affects mostly younger to middle-aged individuals, and is usually treated with prosthetic replacement.

Background: Civilian vascular injury is relatively common in the West African subregion, but it is highly underreported. Aim/Objective: The aim of the study was to evaluate the patients managed for civilian vascular surgeries and to determine the factors causing morbidity and mortality in low-income countries. Materials and Methods: This is a retrospective study spanning a period of 13 years (2007–2019) of civilian vascular injuries managed in a tertiary hospital in a low-income country. We obtained data from our hospital record department. Data obtained and analyzed were demography, etiology, vessels affected, pattern of presentation, stratification, and treatment. Results: Within the envisaged period, 58 patients were affected in civilian vascular trauma with a mean of 4.5 cases per year. The male-to-female ratio was 0.9:0.1. The age range of patients affected was from 0–10 to 71–80, with the age group of 21–30 years being the most affected. Male was more affected (87.9%). Motor vehicle crashes were the most common etiology agent (42.0%). The femoral artery was the most commonly injured vessel (31.3%). In the pattern of presentation, bleeding with shock was dominant (49.8%). Lateral tarsorrhaphy accounted for the major vascular treatment interventions (30.2%). Conclusion: The outcome was very variable and depended on warm ischemic time, type and/or mechanism of injury, collateral blood supply at the site of injury, and comorbidity.

Background: In the West African sub-region, significant morbidity and mortality are known to affect patients with malignant pleural effusion (MPE) but are highly under reported unlike USA, Europe or South Africa.Aim/Objective: To review cases of MPE in our tertiary hospital in the last 13 years with a view to determining the challenges and prospects.Materials and Method: This is a retrospective study spanning over a decade from January, 2007 to December, 2019. Malignant pleural effusion from various neoplasms constitutes the commonest thoracic malignancy in our tertiary hospital. After 13 years of management of such patients, we reviewed the data from the hospital record’s department. The data obtained were demography, aetiology, total number of pleural fluid specimens for cytology and pleural biopsies submitted for histology, pleurodesis and other treatment modalities.Result: 211 patients with MPE were admitted and managed during the period under review. Of these numbers, 135(64.0%) were confirmed cytologically positive (MPE). 76(36.0%) tested falsely negative and were initially regarded as paramalignant, later confirmed MPE. The age affected was from 7 to 81 years with a mean of 44 years. Of 211 patients with MPE, 94 were males while 117 were females, with a male to female ratio of 4:5. Aetiologically, metastatic breast cancer was the highest followed by advance lung cancer.Conclusion: Submission of insufficient samples resulted in false negative cytology. Review of recurrent pleural effusion and exophytic tumour at the sites of CTTD resulted in late diagnosis of MPE. Additionally, prolonged hospital stay awaiting CTTD and cytology results are among the challenges.