Cardiology practice in Grenada, West Indies: a unique collaborative approach

This paper describes a unique programme, recently developed in Grenada, where no cardiological services have previously existed. In addition to becoming clinically important, the visiting cardiology programme has evolved into what has proven to be a conceptually interesting model for soliciting donations and attracting medical expertise to the Caribbean region. The programme was conceived and is directed by the University Vice Chancellor. A cardiovascular nurse coordinates and manages the programme with the aid and support of Mr. Alexander P Ross, Dean of the Caribbean Clinical Programmes at St. George's University, in collaboration with Dr. Phillip Finlay, Director of Medical Education and Dr. Garth George, Medical Director, Grenada General Hospital. The programme is fully linked to the Barbados Cardiology Programme, where services not included in our programme are available to our patients at a fraction of the cost charged in the United States (AU)

Surgery for patent ductus arteriosus

The surgical treatment of Patent Ductus Arteriosus (PDA) at the University Hospital of the West Indies, Kingston, Jamaica was examined over an eight-year period. The results of standard surgical modalities were comparable to large published series. A review of the literature regarding the treatment options for PDA does not support a change in management strategy in favour of non-surgical methods. The treatment of PDA at this centre has shown excellent long-term results, with miminal mortality and morbidity.(Au)

The development of invasive cardiology at the University of the West Indies

The development of invasive cardiology at the University of the West Indies encompasses four relatively distinct periods: the early years (1961-1975), the period of development (1975-1988), the period of absence (1988-93) and the modern era (1994 to the present). During the early years, invasive procedures were carried out in the general X-Ray Department using a Phillips 6 Channel Cardioscope and a Single Plane Angiographic Machine. The period of development was heralded by the completion of a new, separate cardiac laboratory within the X-Ray Department. In addition, it was characterised by an increase in the number of patients studied, and the availability of BiPlane Angiography. Equipment failure in the late 1980s precipitated the cessation of cardiac catheterisation at the University of the West Indies in 1988 and no invasive procedures were performed in the period 1988-1993. (The availability of up to date colour flow doppler echocardiographic facilities during this period greatly facilitated pre-operative diagnosis of congenital and valvular heart disease.) The re-opening of a cardiac catheterisation facility in early 1994 was accompanied by major advances with the availability of cine-angiography. Additionally, during this period, interventional cardiology was introduces with balloon percutaneous transluminal coronary angioplasty, and balloon valvuloplasty (mitral and pulmonary) being successfully performed on several patients. Future development of invasive cardiology at UWI will see an increase in efficiency of the operation of the cardiac laboratory and expansion of the therapeutic armamentarium in interventional cardiology.(AU)

Severe Neurological complications post-open heart surgery: the Jamacian experience

During the period January 1994 to December 1999, a total of 395 patients - adults and children - underwent various types of open heart surgical (OHS) procedures. The range of these patients was 10 days to 77 years. Most (43.5 percent) of these patients underwent valve replacement - first time and "redo" - as a result of rheumatic heart disease of varying duration and severity. The other large group was the complex congenital heart abnormalities (16 percent), followed by the group that underwent repair of atrial septal defect (13 percent), coronary artery bypass graft (13 percent) and repair of the ventricular septal defect (12 percent). Open valve repair (2 percent) developed severe neurological complications (NCs) post-OHS. These included: a short period (< 48 hours) of irritability and fluctuating consiousness level; seizure activity associated with hemiparesis and/or blindness; severe encephalopathy and vegetative state. Four patients showed complete recovery, but one died as a result of complications of the anti-seizure medication. Of the five, four died as a result of the NCs, and one was discharged in a vegetative state. Such severe neurological complications after an otherwise successful cardiac surgery represented a devastating outcome for patients and their families, and the social and economic impacts are enormous. Several factors were identified. The main ones being mitral valve replacement (MVR), especially "redo" surgery, female gender, age over 60 years, high New York Association functional class and post-operative hypotension. However, the true incidence of NCs (gross and subtle) in the study group cannot be ascertained. A detailed, structured neurological and neuropsychiatric assessment, both pre-and post-operatively, is therefore needed to document the true incidence of this complication. There is also the need for public education, especially for those with valvular disease, in order to encourage changes in attitude and behaviour towards continued follow-up care and valve surgery, both first and `redo'. (AU)