Homograft aortic valve replacement, 1971-1978

Twenty-two patients were subjected to Homograft Aortic Valve Replacement (HAVR) at the University Hospital between 1971 and 1978. The clinical and investigative data, operative morbidity and mortality, and the results in the survivors have been presented. It is concluded that HAVR is a satisfactory operation with acceptable operative morbidity and mortality. (AU)

Effect of triamterene on leucocyte sodium and potassium levels in heart disease

Sodium and potassium levels in plasma and leucocytes and the sodium efflux rate constants of leucocytes were measured in patients with congenital heart disease not on treatment, patients with valvular heart disease being treated with digoxin and conventional diuretics showed low cellular potassium levels, low sodium levels. Patients given triamterene showed a rise in potassium levels in plasma and cells and in the sodium efflux rate constant (AU)

Rheumatic fever prophylaxis: a three-year study

An effective programme of secondary prophylaxis against rheumatic fever has been established in Barbados over the last three years. Relatively unsophisticated patients collaborated well over prolonged periods. Adequate secondary prophylaxis was acheived with monthly injections of benzathine penicillin, with a resultant decrease in the complication rate. A total of 84 admissions over 32 months from a population of some 60 000 children under the age 12 emphasises the need for registration and prophylactic treatment of children with rheumatic fever. The low yield in the survey schoolchildren between the ages of 5 and 11 and the large number of personnel required for the survey suggest that it might be extended to include older age groups. Automatic screening devices should be used when possible so that more may be screened. (AU)

Rheumatic fever and rheumatic heart disease in Barbados: detection and prophylaxis

The objectives of this study were to improve our methods of secondary prophylaxis of rheumatic fever and rheumatic heart disease in Barbados, to estimate the overall prevalence of these diseases and the relative load imposed by them on available health services, and to measure the yield, feasibility, and effectiveness of mass programmes for the detection and prophylactic management of rheumatic heart disease in schoolchildren. Improved methods of surveillance and follow up resulted in 97 percent adherence to therapy by patients on prophylactic penicillin. Thirty-four children, 27 with a first attack, were admitted with acute rheumatic fever, representing a 7 percent occupancy of children's medical beds during a twelve month period of the study. Out of a possible 3,942 schoolchildren aged 5-11 years, 3,882 (98 percent) were screened for rheumatic heart disease. Four cases (about 1 per 1,000) were discovered. (Summary)

Echocardiographic findings in a Afro-Caribbean population reffered for evaluation of atrial fibrillation or flutter

Atrial fibrillation and/or flutter is the most common and the most significant cardiac arrhythmia in the Caribbean. This study is an attempt to determine the echocardiographic findings in a current, consecutive series of Afro-Caribbean patients referred for evaluation of atrial fibrillation and flutter. Between May 1998 and June 2000, 50 patients (mean age 67 years, 58 percent male) had echocardiograms done. Measurements include left atrial dimension (LA), left ventricular end-systolic dimension (LVESD), LV end-diastolic dimension (LVEDD), LV posterior wall thickness (LVPWT) and ventricular septal thickness (VST). Left ventricular ejection fraction (EF) was calculated. LA>4 cm, LVPWT or VST>13 mm, and LVEF<50 percent were considered abnormal. Atrial fibrillation was seen in 92 percent, atrial flutter in 8 percent; 60 percent were chronic, 40 percent paroxysmal; 56 percent had congestive heart failure. The most frequent echocardiographic finding was LV hypertrophy (19/50, 38 percent). Left ventricular systolic dysfonction was present in 12/50, 24 percent with LV hypertrophy also). Valvular disease (abnormal appearing valve, no Doppler study), was seen in 9/50, 18 percent. Normal findings ("lone atrial fibrillation") were seen in 10/50, 20 percent. Increased LA dimension was seen in 39/50, 78 percent. Patients with lone atrial fibrillation were younger (mean 56 years) than those with valvular disease (mean 64 years), LV systolic dysfunction (mean 69 years) and those with LV hypertrophy (mean 72 years). Thus, LV hypertrophy, probably secondary to hypertension, is the most frequent echocardiographic finding, with LV dysfunction (such as seen in coronary artery disease) seen less often. Valvular disease and lone atrial fibrillation rates are similar to rates in developed countries. (AU)