Non-communicable Diseases

When all the trouble begins with a sore throat

Friday morning.

It’s drizzling and it threatens to pour in the next hour. Welcome to the unpredictable Nairobi weather.

The rain aside, I am excited to be at the cardiology department at the Kenyatta National Hospital where a heart procedure to widen a damaged heart valve will take place.

This specialised heart theatre is known as a catheterization lab.  The procedure of the day involves inserting an hour glass-shaped balloon from the groin area, to the heart.

Where is the groin area? Biology 101! This is the area of your hip between your stomach and thigh. Long story short, it is located where your abdomen ends and your legs begin.

The team today comprises eminent doctors from Kenya and Japan. We will also meet the inventor of the heart balloon that will be used to treat the heart condition.

Prof Kanji Inoue is the inventor of the Inoue balloon that widens the defective heart section known as the mitral valve. Interestingly, the balloon is named after him hence we are fortunate to be in the precincts of the visionary of this procedure.

He is accompanied by Dr Narisatu Saito, from the Department of Cardiovascular Medicine at the Graduate School of Medicine at Kyoyo University in Japan and another colleague, Atsushi Yamazaki.



How are you, nice to meet you.

We exchange a few more pleasantries from the basic Japanese language I picked at  Kenyatta university a couple of years back.

The local  operating team is drawn from the top cardiologists in Kenya, all keen to be part of this ground-breaking heart surgery.

The medical team from Kenya is led by Dr Martin Murage, the head of KNH cardiology department and also comprises great cardiologists including Dr Bernard Gitura, Dr Prof Christine Jowi, Dr. Robert Mathenge, paediatric cardiologist Dr Naomi Gachara and a fantastic KNH nursing and radiology team.

As we change into our theatre scrubs, I am particularly excited about this surgery for the following reasons;

  • The patient will be awake, save for local anaesthesia at the groin area where the balloon will be introduced.
  • There will be no major scar after the procedure. They call this known as a minimally invasive procedure.
  • The procedure will be done in under two hours to resolve the structural issue in the heart.
  • The transfer of knowledge from the inventor, Prof Inoue is bound to exude interesting insights.

Today’s surgery is known as the Percutaneous Balloon Mitral Valvuloplasty.

The damage to the heart is caused by a sore throat that was not treated early enough. Rheumatic Heart Disease is the main culprit that causes the mitral valve to narrow hence blood flow is not efficient. It is a common heart disease in Kenya and presents a significant health problem largely due to its silent nature.

Dr Bernard Gitura a consultant cardiologist

Dr Bernard Gitura a consultant cardiologist describes Rheumatic Heart Disease as a condition that is common in developing countries like Kenya and causes most illnesses, and sometimes deaths in children and young adults.

‘Rheumatic Heart Disease is a condition that causes permanent damage to heart valves. It starts as a sore throat that if not treated early and properly, affects the mitral valve,’ This forces  the heart to work harder to pump blood and may eventually cause congestive heart failure.

Photo by camilo jimenez on Unsplash

Dr Gitura notes that in some cases, the damage may resolve on its own, or it may be permanent, eventually causing congestive heart failure which describes a condition in which the heart cannot pump out all of the blood that enters it.

Prevention is always the best option to treating the strep throats using antibiotics. In cases where this doesn’t happen, the damage of the mitral heart valve causes symptoms like fatigue in the patient as they perform simple chores, which calls for an intervention, including this surgery.

Let us learn more about Rheumatic Heart Disease. These most common symptoms of rheumatic fever include;

  • Fever
  • Swollen, tender, red and extremely painful joints — particularly the knees and ankles
  • Nodules (lumps under the skin)
  • Red, raised rash, usually on the chest, back, and abdomen
  • Shortness of breath and chest discomfort
  • Uncontrolled movements of arms, legs, or facial muscles
  • General body weakness

Rheumatic Fever later progresses to Rheumatic heart disease which occurs when the mitral valve and the aortic valve are damaged by the disease.

If left untreated some of the complications of rheumatic heart disease include:

  • Heart failure. This can occur from either a severely narrowed or leaking heart valve.
  • Bacterial endocarditis is an infection of the inner lining of the heart. In most cases, it damages the heart valves too.
  • Complications of pregnancy and delivery due to heart damage. Women with rheumatic heart disease should be closely followed.
  • Ruptured heart valve. This is a medical emergency. It must be treated with surgery to replace or fix the heart valve

What treatment is available?

The main form of treatment is antibiotics to treat the strep infection and additional medications to ease the inflammation of the heart and other symptoms. In other cases surgery is needed to repair of the damaged valves. This procedure is known as Percutaneous Balloon Mitral Valvuloplasty..

Next week in part two of this article, we meet the inventor of the balloon used to treat this heart procedure, Prof Kanji Inoue. We also talk to the local cardiologists who perform this heart procedure.






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