Write a Scientific Paper (WASP): Past and anticipated trends in cardiology service requirements at Mater Dei Hospital, Malta.

INTRODUCTION: The requirement for medical services fluctuates. This study was carried out in order to attempt to extrapolate the service requirements for various cardiology services at Mater Dei Hospital, Malta over the coming five years, based on service demands from previous years. METHODS: Past annual data was obtained from hospital records for various services (to 2017). Linear regression was carried out using a bespoke Excel™ spreadsheet in order to extrapolate possible services requirements up to 2022. RESULTS: All services are expected to increase, with forecasts ranging between 41 and 354%, depending on services being considered. DISCUSSION: It is easy to "get on with it" and perform the work required at the workplace but this study has shown that it is equally important to anticipate demands lest lack of planning leads to long and important waiting lists for critical diagnostics and treatments. Health care provision requirements are increasing worldwide. Even using conservative estimates and in the absence of the creation of new services, the demands for extant services are likely to continue to grow. Unless medium term plans are made for hardware, software, physical space and staffing, and the funding thereof, waiting lists for investigations in this speciality are bound to rise. This may be mitigated by novel treatments but since these cannot be predicted, it would be safer and wiser to plan ahead lest we are overwhelmed. This paper has also shown how WASP (Write a Scientific Paper) precepts can be applied to elegantly study a problem and write up a paper.

Preseptostomy myocardial infarction in a patient with complex transposition of the great arteries.

In transposition of the great arteries, systemic venous return is preferentially routed to the aorta, and any spontaneous or iatrogenic emboli may therefore cause organ infarction. We present a patient with transposition of the great arteries who developed myocardial infarction prior to balloon septostomy and, also, was later documented to have sustained brain infarction despite adequate precautionary measures. Minimal handling of venous sites in these patients is crucial.

Risk factors for QRS prolongation after repaired tetralogy of Fallot.

INTRODUCTION: Repaired tetralogy of Fallot is usually conducive to a normal and unrestricted lifestyle. However, occasionally, late sudden death occurs due to ventricular tachycardia. This is thought to be due to a combination of factors, including both left and right ventricular dilation, which may be associated with valvular incompetence and residual right ventricular outflow tract obstruction. Several studies have shown that QRS duration > 180 ms is a predictor for life-threatening ventricular arrhythmias. METHODS AND RESULTS: We recalled our tetralogy population (n = 57) to identify risk factors for prolonged QRS duration on the resting ECG. Factors examined included history, demographics, symptoms, surgery, chest X-ray, ECG and echocardiography. Extensive analysis found only a significant positive correlation between QRS duration and degree of residual right ventricular outflow tract obstruction. CONCLUSIONS: Our study suggests that residual right ventricular outflow tract gradients may be a very significant contributor to QRS prolongation. It will be interesting to see if future studies of larger cohorts confirm this finding.

Aortic stenosis after uncomplicated surgical repair of tetralogy of Fallot.

Tetralogy of Fallot is only rarely associated with aortic valvar disease. We present a child who had uncomplicated repair of tetralogy of Fallot at 16 months of age, and who developed mild aortic stenosis three years later, with mild to moderate aortic incompetence being seen two years subsequent to that event. No aortic valvar disease had been noted prior to surgery. No intervention is planned at this stage.