Coronary artery bypass graft outcome: the Trinidad and Tobago experience

The study is a retrospective review of the demographic, clinical, angiographic, and operative data of the first 205 consecutive CABG operations performed by Caribbean Heart Care at the Eric Williams Medical Sciences Complex (EWMSC), Trinidad and Tobago, between November 1993 and December 1997. The aim of the study was to determine the in hospital and intermediate term follow up results. The mean age of patients was 59 ñ 10 years and 78 percent male. Sixty-four percent were of East Indian descent, whereas, 16 percnt were of Africian descent. Forty-eight percent of the patients were hypertensive, 46 percent were diabetic, 33 percent had hyperlipidaemia, 20 percent had a recent history of cigarette smoking and 16 percent were obese. Sixty-five percent had a positive family history of ischaemic heart disease. The average time interval between angiography and surgery was 2.3 months. At the time of angiography, 63.5 percent of patients had Canadian Cardiac Society (CCS) class 3 or 4 angina. The mean ejection fraction was 61 ñ 15 percent. Wall motion abnormalities were seen in 67 pecent of patients. Significant stenoses of the left anterior descending artery, right circumflex artery, circumflex and ramus coronary arteries were present in 91 percent, 78 percent, 54 percent and 5 percent, respectively. Many patients (67 percent) had severe diffuse disease on angiography. The mean intensive care stay was 2.2 ñ 0.8 days. In hospital mortality was 3.9 percent (8/205). THe most frequent post operative complicaton was haemorrhage (2.6 percent). Acute renal failure occurred in 2.1 percent; pulmonary collapse, 1.6 percent; 1 percent and cardiac arrest , 1 percent. Both sternal wound infections and systemic sepsis occurred in 0.5 percent. Intermediate term follow-up data were obtained for 92 percent (189/205). The duration of follow-up ranged from 1 to 5 years (mean 3.7 years). During the follow up period, 7 patients (3.4 percent) died. Angina severity was reduced from a mean CCS score of 2.61 ñ 0.95 before CABG ot 1.22 ñ 0.55 at the time of follow up (p<0.0001). Overall 4-year mortality compared favourably with data from international studies. Among survivors, quality of life improved as evidenced by the reduction in the mean angina score.(Au)

Methodology and cost of cardiopulmonary by-pass for open-heart surgery at the University Hospital of the West Indies: review of a 14-year experience (1968-1982)

A 14-year microcomputer-assisted review of cardiopulmonary by-pass at the University Hospital of the West Indies is presented. A total of 436 cardiopulmonary by-pass operations was used for open-heart surgery in 417 patients. The results indicate that the by-pass methodology used was relatively uneventful and easy to manage. The costs of cardiopulmonary by-pass have been low. This procedure which is a necessary adjunct for open-heart surgery at the University Hospital is relatively cheap and safe and its methodology presents no problems in management (AU)

Pericardial constriction after open-heart surgery

A case of pericardial constriction developing after open-heart surgery is described. As far as we are aware, this is the first such case to be reported in the West Indian medical literature. Possible aetiological influences are discussed, important differences from the clinical features of idiopathic constrictive pericarditis are stressed, and the great importance of considering this diagnosis in any post-operative cardiac surgical patient who develops apparent heart failure is emphasized (AU)

Atrial septal defect, 1968 - 1978

The clinical, radiological, electrocardiographic and haemodynamic features of the 45 patients undergoing closure of atrial septal defects at the University Hospital of the West Indies from 1968 to 1978 were reviewed and found to be similar to those reported from other centres. Surgical treatment was effected with acceptable operative mortality and morbidity and good long-term functional results (AU)

Pulmonary stenosis with intact ventricular septum, 1968 - 1978

Twelve cases of pulmonary stenosis with intact ventricular septum had correction of their defects using cardiopulmonary bypass. One patient of acute cardiac failure in the early postoperative period. There were no late deaths. The 11 late survivors are well. The majority (10 patients) were in NYHA grade 1 and there has been a significant reduction in right ventricular size as determined electrocardiographically (AU)

The prediction of postoperative potassium excretion after cardiopulmonary bypass

Potassium excretion following cardiopulmonary bypass has been studied in 11 patients. After an initial period of 4 to 5 hours, potassium excretion was found to be directly related to urine flow provided diuretics had not been administered. Triamterene altered the slope of the regression line so that, for any given urine flow rate, less potassium was excreted. A simple program for postoperative potassium therapy is described (AU)

Closure of aorto-pulmonary window in infancy using cardiopulmonary bypass

A case is described of a Jamaican Negro female infant with resistant cardiac failure due to an aorta-pulmonary window which was successfully closed using a cardio-pulmonary bypass operation (AU)

Pre and post-operative findings in 18 cases of congenital heart disease treated by open heart surgery and cardiopulmonary bypass - abstract

The main purpose of this paper is to review the results of open heart surgery at the University Hospital of the West Indies in the past three years. 18 patients with congenital heart disease have had corrective surgery performed. The mean age at operation was 14.8 years ranging from 6.8 to 28 years. Seven of the patients were under 12 years and all but two 18 years or under at the same time of surgery: Five patients have had total correction of the Tetralogy of Fallot. Four of them, including a girls of 12 1/2 years who had pulmonary embolus one month after operation, are well at follow-up. One patient, a girl of 11 years, who was operated on in June, 1970, had evidence of right ventricular failure for six months, but when last seen was well although signs of tricuspid incompetence persist. Four patients with atrial septal defect, including one with an ostium primum defect and mitral incompetence, are well at follow-up with no evidence of heart disease. Four patients with ventricular septal defect have had their defect repaired. Two of these had significant pulmonary hypertension pre-operatively and one of these developed a leak post-operatively and has required a second operation. Four cases of pulmonary stenosis (two valvular, one infundibular and one both valvular and infundibular) have been corrected and all these patients are now well and active. A young woman of 27 who was thought on cardiac catheterization to have pulmonary stenosis, was found at operation to have a double outlet right ventricle and infundibular stenosis. Right and left outflow tract reconstruction carried out and although she had a stormy post-operative course was well when last seen. Pre- and post-operative electrocardiographic and radiological data will also be presented (AU)