Cardiothoracic surgical problems in Jamaica - abstract

ABSTRACT

Statistics of the incidence of cardiothoracic surgical problems in Jamaica are incomplete. An attempt is made to compile currently available data. The potential sources of data are the records of the University Hospital, Kingston Public Hospital, George V Sanatorium, the Registrar General's office and private practitioners. Some published data also exist. Most of the records are incomplete and the information is not available in a way which would highlight the major cardiothoracic surgical problems of Jamaica. Because of this, the author, as the person most engaged to any significant degree in the practice of cardiothoracic surgery in Jamaica, reports in this preliminary communication on his own experience at the University Hospital during the past two years. Thirty-seven major chest injuries were seen and 18 of these required admission to the Intensive Care Unit. Only a small percentage of all chest trauma comes under the author's care. One hundred and twenty diagnostic bronchoscopies were performed. For bronchogenic carcinoma only 6 lung resections were performed from a total of 52 cases. The incidence of this disease in Jamaica rose from 7.2 to 12.8 per 100,000 moles during the two 5-year periods ending in 1969 and it now rivals carcinoma of the oesophagus for a second place as a cause of death from malignant disease in the male. In the case of bronchiectasis, 8 lung resections were done frome amongst 17 cases seen by the author and proved by bronchography. In cardiac surgery, 24 closed and 24 open open-heart operations were performed. In the closed group, 13 patent ductuses were treated by division and suture, there were 2 shunt operations for Tetralogy at Fallot, 2 coarctations were relieved and 7 commissurotomies performed for rheumatic mitral stenosis. In the open-heart group requiring cardiopulmonary bypass, the following congenital cases were corrected without mortality 4 V.S.D., 6 Tetralogy of Fallot, 3 pulmonary valve stenosis, 1 infundibular stenosis, 2 ostium secundum, 1 ostium primum primum, and 1 double outflow right ventricle. Only a small percentage of the potentially curable congenital cases have had the benefit of surgery. It is estimated that at least 150 of the 400 new cases born annually with congenital heart disease can be cured by surgery. For rheumatic heart disease, the following operations were performed 3 mitral valve replacements, 1 aortic valve replacement, 1 aortic and mitral valve replacement and 1 mitral valveannulaplasty. Rheumatic heart disease is not uncommon and was present in 7.3 percent of 738 disease hearts examined at autopsy in adults over 17 years of age at U.H.W.I. In a miscellaneous group requiring major surgery, the following opertions were performed; 3 thymectomies for myasthenia gravis, 3 lung resections, 5 decortications, 9 mediastinal tumours were removed, 2 oesophagectomies, 4 colon bypass operations for oesophageal obstruction, and 11 operations on major vessels. In a miscellaneous number of surgical investigations, the following procedures were performed; 9 scalene node clearances, 7 anterior mediastinoscopies, 11 thorascopies and 33 oesophagoscopies. Carcinoma of the oesophagus is regarded as a general surgical problem. Recent rapid strides in the surgery of coronary artery disease suggest that this common condition, which is present in 14.2 percent of adult diseased hearts, will be a major surgical service problem. Only a small percentage of the vast number of cases are seen at the University Hospital. The precise incidence of the various cardiothoracic surgical conditions require urgent investigation (AU)