[Results of 17 months' surgical experience in the Cardiological Centre of Phnom-Penh (CCPP). The challenge of sanitation in a developing country].

The authors report the preliminary results of the first 17 months' experience at the Cardiological Centre of Phnom-Penh (CCPP), set up by the initiative of the "Chaîne de l'Espoir" organisation. The CCPP has only two operative theatres, 8 intensive care beds and 32 hospital beds. During the 17 months, 1193 patients under 30 years of age were examined. Nine hundred and five had cardiac disease. Three hundred and twenty-two patients underwent surgery for congenital and valvular heart disease. The commonest operated congenital lesions were left-to-right shunts (71%) and tetralogy of Fallot (24%). In the valvular group, 53% had mitral insufficiency, 40% had mitral stenosis and 7% had aortic insufficiency. The selection of patients and surgical strategy depended on the economic constraints specific to developing countries: --strict selection of operable patients: exclusion of severe pulmonary hypertension, left ventricular dysfunction or cachexia and neonates with complex congenital heart disease; --simple, effective and low cost surgical procedures are preferred, repair in the majority of cases, preference given to valvuloplasty over valve replacement. The quality of the results with low morbid-mortality, justifies the creation of such cardiac surgical centres; surgery must be accompanied by strict measures of prevention of endemic rheumatic fever which remains a major public health problem.