Clinical utility of transoesophageal echocardiography in low resource environments: the jamaican experience / Utilidad clínica de la ecocardiografía transesofágica en medios de bajos recursos: la experiencia jamaicana

OBJECTIVE: To provide the first detailed review of the indications and clinical utility of transoesophageal echocardiogram (TEE) in the Caribbean. DESIGN AND METHODS: Data for patients who had TEE performed at the Heart Institute of the Caribbean over a three-year period were abstracted and reviewed. Information gathered included demographic data, indications for the procedure, findings and clinical recommendations. The effect of age and sex on these variables was assessed using the Chisquare or Fishers Exact tests. Significance was set at a p < 0.05. RESULTS: Of the 116 procedures performed between 2005 and 2008, medical records were reviewed for 107 (50 male, 57 female) patients. The patients ranged in age from 15-86 years with a mean age of 45.4 ± 18.5 years. With the exception of four patients, all attempted TEE were completed. The most common indications for the procedure were valvular heart disease (41.1%), strokes (17.8%), shunts (10.3%) and infective endocarditis (11.2%). Less common indications included arrhythmias, cardiac masses, aortic dissection and shortness of breath. Transoesophageal echocardiogram altered the treatment course in about 30% of all patients including 66.6% of patients referred for suspected infective endocarditis. Furthermore, TEE resulted in recommendation for surgery in 43% of patients referred for evaluation of severity of valvular disease. Minor complications occurred in two persons. No severe complications or deaths occurred as a result of the procedure. CONCLUSIONS: Transoesophageal echocardiogram has been most commonly performed to evaluate valvular heart disease in Jamaica without any major complications resulting from the procedure. It provides additional information that supplements transthoracic echocardiography in a wide range of clinical conditions. Measures should be put in place to make TEE more widely available and accessible in Jamaica.

OBJETIVO: Ofrecer un primer examen detallado de las indicaciones y utilidad clínica del ecocar-diograma transesofágico (ETE) en el Caribe. DISEÑO Y MÉTODOS: Por un período de tres años, se examinaron y resumieron datos de pacientes a los cuales se les realizó un ETE en el Instituto de Cardiología del Caribe. La información recogida incluyó datos demográficos, indicaciones para el procedimiento, hallazgos y recomendaciones clínicas. Se evaluó el efecto de la edad y el género en estas variables usando las pruebas Chicuadrado y el test exacto de Fisher. La significatividad fue establecida en p < 0.05. RESULTADOS: De los 116 procedimientos realizados entre 2005 y 2008, se revisaron las historias clínicas de 107 pacientes (50 varones, 57 hembras). La edad de los pacientes fluctuó de 15 a 86 años para una edad promedio de 45.4 ± 18.5 años. Con la excepción de cuatro pacientes, todos los ETE planificados fueron realizados. Las indicaciones más comunes para el procedimiento fueron los casos de enfermedad valvular cardíaca (41.1%), accidente cerebrovascular (17.8%), shunts o desviaciones (10.3%) y endocarditis infecciosa (11.2%). Las indicaciones menos comunes incluyeron las arritmias, las masas cardíacas, la disección aórtica y la disnea. El ecocardiograma transesofágico alteró el curso del tratamiento en aproximadamente el 30% de todos los pacientes, incluyendo el 66.6% de los pacientes remitidos por sospecha de endocarditis infecciosa. Además, a partir del ETE se derivaron recomendaciones de cirugía para 43% de los pacientes remitidos para evaluación de la severidad de la enfermedad valvular. Se presentaron complicaciones menores en dos personas. No se produjeron complicaciones severas o muertes como resultado del procedimiento. CONCLUSIONES: El ecocardiograma transesofágico se ha realizado más frecuentemente con el propósito de evaluar la enfermedad valvular cardíaca en Jamaica, sin que se hayan presentado mayores complicaciones como resultado de su empleo. Por otra parte, este procedimiento ofrece información adicional que sirve de complemento a la ecocardiografía transtorácica en una amplia gama de condiciones clínicas. Deben tomarse medidas para que el ETE tenga una mayor disponibilidad y accesibilidad en Jamaica.

Persistent hypokalaemia in a jamaican hypertensive patient / Hipocalemia persistente en un paciente hipertenso jamaicano

We report the case of a 48-year old man with uncontrolled hypertension and persistent hypokalaemia from an aldosterone producing adrenal adenoma treated by laparoscopic adrenalectomy. Clinicians' identification of primary hyperaldosteronism is critical as the correct treatment results in improved blood pressure control and reduced risk of complications.

Reportamos el caso de un hombre de 48 años de edad con hipertensión descontrolada e hipocalemia persistente a partir de un adenoma suprarrenal productor de aldosterona, tratado mediante adena-lectomía laparoscópica. La identificación de hiperaldosteronismo primario por parte de los clínicos es fundamental, ya que el tratamiento correcto trae como resultado un mejor control de la presión sanguínea a la par que reduce el riesgo de complicaciones.

Clinical utility of transoesophageal echocardiography in low resource environments: the Jamaican experience.

OBJECTIVE: To provide the first detailed review of the indications and clinical utility of transoesophageal echocardiogram (TEE) in the Caribbean. DESIGN AND METHODS: Data for patients who had TEE performed at the Heart Institute of the Caribbean over a three-year period were abstracted and reviewed. Information gathered included demographic data, indications for the procedure, findings and clinical recommendations. The effect of age and sex on these variables was assessed using the Chi-square or Fishers Exact tests. Significance was set at a p < or = 0.05. RESULTS: Of the 116 procedures performed between 2005 and 2008, medical records were reviewed for 107 (50 male, 57 female) patients. The patients ranged in age from 15-86 years with a mean age of 45.4 +/- 18.5 years. With the exception of four patients, all attempted TEE were completed. The most common indications for the procedure were valvular heart disease (41.1%), strokes (17.8%), shunts (10.3%) and infective endocarditis (11.2%). Less common indications included arrhythmias, cardiac masses, aortic dissection and shortness of breath. Transoesophageal echocardiogram altered the treatment course in about 30% of all patients including 66.6% of patients referred for suspected infective endocarditis. Furthermore, TEE resulted in recommendation for surgery in 43% of patients referred for evaluation of severity of valvular disease. Minor complications occurred in two persons. No severe complications or deaths occurred as a result of the procedure. CONCLUSIONS: Transoesophageal echocardiogram has been most commonly performed to evaluate valvular heart disease in Jamaica without any major complications resulting from the procedure. It provides additional information that supplements transthoracic echocardiography in a wide range of clinical conditions. Measures should be put in place to make TEE more widely available and accessible in Jamaica.

Persistent hypokalaemia in a Jamaican hypertensive patient.

We report the case of a 48-year old man with uncontrolled hypertension and persistent hypokalaemia from an aldosterone producing adrenal adenoma treated by laparoscopic adrenalectomy. Clinicians' identification of primary hyperaldosteronism is critical as the correct treatment results in improved blood pressure control and reduced risk of complications.