As a result of heart disease, diagnosed for the first time at the age of nine, in the province of Huambo, where she was born and lives with her family, the 15-year-old weighs, despite her age, only 28 kilos.
Verónica is the first of five brothers and the daughter of Adelina Brito and João Tchilombo, two family farmers, who make this profession their source of family income, to cover their children’s expenses, from food, school and health.
Based on information from her mother, Adelina Brito, Verónica was born healthy, weighing 3,500 kilos. Despite her parents’ financial difficulties, she lived well and without major problems. But at the age of eight, the first symptoms of the disease began to appear. “She started to lose her appetite. She had high fevers, started to lose weight and got tired easily when doing small physical efforts, or walking distances, previously done normally”, she explained.
Worried, her parents took her to a general clinic appointment at the Hospital do Huambo. The doctor who attended to them noticed irregularities in the girl’s body, without having to be in the lungs or heart. “The tests carried out at the time, those for thick blood smears, typhoid fever and tuberculosis, were negative. Due to growing tiredness, she was referred, a year later, to a cardiologist, who, through electrocardiogram and echocardiogram tests, detected the anomaly in the girl’s heart.
The cardiologist, said the mother, said that the girl had Rheumatic Mitral Insufficiency, a very serious heart disease, whose improvement required a surgical operation. “I had never heard of the disease. I don’t even know how my daughter contracted this disease. No one in the family suffers from this disease”, she recalls, still with tears in her eyes.
Delfina Brito, 33, took a cloth to wipe away her tears. After calming down, she said, the doctor explained that Veronica’s pathology affected the mitral valve of the heart, causing the loss of competence and function of closing this organ, that is, there were blood leaks (regurgitation) from the ventricle to the atrium ( against the normal flow of blood).
As we didn’t understand anything he said, he said, they just wanted to know when the girl would have the operation. “The doctor said that Hospital do Huambo does not perform cardiac surgeries and it was necessary to go to Luanda, to Hospital Josina Machel, as it is the reference place for this type of operation”, he reveals, adding that since that date he began to have “peaks ” of high blood pressure.
When they arrived at Josina Machel, Verónica’s parents were informed that cardiac surgeries were temporarily suspended, but that the patient would be transferred to Clínica Girassol, through a medical board, fully funded by the Angolan state.
“A light at the end of the tunnel turned on”, he says. Months later, he said, the girl, then nine years old, underwent heart surgery. “It was in 2016, at Clínica Girassol. Doctors placed a short-lived valve. Only five years, at the end of which she had to be re-intervened”.
The problem, he confesses, is that after the deadline, the symptoms got worse. “The girl was referred to the Hospital Complex for Cardio-Pulmonary Diseases Cardeal Dom Alexandre do Nascimento, where it was found that in addition to the valve, Verónica had a pulmonary pressure of 110 mmHg, when the normal for her age would be less than 35 mmHg”.
In addition to this, the mother recalls, the medical team who accompanied her noticed several thrombi and clots inside the girl’s heart. “They said that the cavities were very dilated and that made her situation very serious, to the point that a second surgery was very complex. But they argued that it had to be done, because otherwise, she would die”, she recalled.
With everything in the hands of God and the surgeons, he confessed, the girl entered the operating room at 8:00 am on Wednesday of last week, the 23rd. The surgery lasted almost five hours and it was possible to replace the valve and treat the other heart anomalies successfully. “Today, she is still in one of the wards of the Hospital Complex waiting for a medical discharge”, she says, more relieved.
Like Verónica Tchilombo, several other patients undergo heart surgery or have other pathologies that significantly affect the normal functioning of this organ, one of the most important in the human body.
The head of Cardiovascular and Thorax Services at the Dom Alexandre do Nascimento Hospital Complex, surgeon Valdano Manuel, defines the heart as a hollow, cone-shaped muscular organ that weighs between 250 grams in children and 300 grams in adults. .
The heart, he explained, has the function of pumping blood throughout the body. “It works as a double pump. The left side pumps oxygenated blood (arterial) to different parts of the body, while the right side pumps venous blood to the lungs. This whole process is done continuously”, he clarified.
The doctor informed that there are several cardiac pathologies, both clinical and surgical, capable of affecting the proper functioning of the heart, among which are arterial hypotension, intra-auricular fibrillation, arterial hypertension, ventricular hypertrophy and cardiac arrhythmias.
As for surgical cardiac pathologies, he explained that the most common are rheumatic fevers, due to mitral valve diseases, aortic diseases, heart tumors, myocardial revascularization, endocarditis, cardiac arrhythmias, coronary atherosclerosis and congenital diseases of the heart.
Among the congenital heart diseases, he stressed, the most frequent are Interventricular and Intra-Atrial Communication, Tetralogy of Fallot, atrioventricular septal defect, more frequent in patients with Down Syndrome.
More than 120 surgeries are performed in nine months
The head of Cardiovascular and Thorax Services at the Hospital Complex informed that, since its opening until today, the Hospital Complex for Cardio-Pulmonary Diseases Cardeal Dom Alexandre do Nascimento has performed a total of 129 surgeries, of which 27 in children.
In the same period, he said, a total of 56 pacemaker devices were placed in patients with cardiac arrhythmia problems, in this case slower, and 200 catheterizations were performed, a procedure that makes it possible to accurately diagnose obstructions in the blood vessels connected to the heart. .
Valdano Manuel added that, on average, 400 patients are seen in outpatient consultations. The demand, he explained, is because many of these patients have been waiting five or more years for heart surgery. “This wait has greatly worsened the clinical condition of some”.
“Many arrive at the operating room in a very advanced state of the disease, a situation that significantly influences the results in heart surgeries. Therefore, the complex has recorded, since its opening until today, a total of nine deaths”, he stressed.
The degree of mortality in the complex, he justified, is within the expected, taking into account that the World Health Organization (WHO) establishes as a reference rate in mortality a rate below 10 percent. “The complex’s rate is 7 percent, however, even so, the goal is to reduce mortality as much as possible. Another objective of the institution is to perform, on a regular basis, 300 surgeries a year”, he revealed.
Previously, the only units in the country that performed cardiovascular surgeries were Hospital Josina Machel and Clínica a Girassol. But, over the years, the public hospital unit stopped performing the surgeries in 2018. Girassol was the only one to attend to patients.
With the creation of the Cardeal Dom Alexandre do Nascimento Hospital Complex for Cardio-Pulmonary Diseases, in December 2021, several people were successfully operated on, at zero cost, by a team of young doctors, mostly Angolans.
The cardiovascular surgeon considers it urgent to carry out organ transplants, in particular of the heart, at the country level. “We have had cases, sometimes, of patients who urgently need this procedure. They are people with a very low cardiac injection fraction, for whom a transplant would be the solution”, he defended.
For Valdano Manuel, heart transplantation should always be the last option for patients with heart disease, because the process is time-consuming and very complex. “It requires a lot of logistics, as well as expensive medication that must be taken regularly for the rest of your life, to avoid rejection of the new organ.”
Only medication, he explained, is very difficult to appear in the country. “When it appears, it is extremely expensive. Therefore, if the performance of transplants becomes a reality, it is necessary to create a strong organizational structure, a committee with several specialists and regulate who should donate and under what circumstances”, he stressed.
The team of doctors specializing in heart surgery, he continued, should also be broader. “The process of organ removal, transport and implantation needs to be well defined, so that there are no failures during the process, whose maximum duration is four hours”.
At the same time, he continues, the country must also have state-of-the-art laboratories capable of carrying out monthly, semi-annual and annual organ compatibility tests, biopsies, to avoid possible organ rejection.
Country lacks cardiologists
The country has 300 specialists in cardiology, registered with the Ordem dos Médicos, an insufficient number to serve the more than 30 million inhabitants, many of whom have serious problems with arterial hypertension, informed yesterday the president of the Angolan Society of Cardiovascular Diseases and Hypertension.
For Gade Miguel, who was speaking to the press on the occasion of World Heart Day, celebrated today, it is important to have at least one cardiologist for every thousand inhabitants. “In this way, it would be possible to improve care. Through screening consultations it would be possible to have a better idea of the incidence of arterial hypertension among the population, “he said.
Before, he underlined, the country already had problems of lack of cardiologists, but today, with the training, several specialized doctors are already working in central hospitals in all provinces. “Today, there are three cardiology boarding schools in the country, in Luanda, Benguela and Huambo”.
Regarding World Heart Day, Gade Manuel said that the date should serve for reflection. “The country already has a Law for Organ Transplantation, in particular of the heart, a positive sign, as there are patients whose survival depends on this procedure”, he said.
The 29th of September was established by the World Heart Federation, in 2000, with the aim of publicizing the dangers of diseases of this organ and preventing possible attacks. Heart disease and stroke are the leading causes of death worldwide, with 17.3 million lives claimed each year.
This year, the date is celebrated under the motto “Use the heart for every heart”. With this theme, the World Heart Federation intends to draw people’s attention to the best way to use the heart.