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Teaching Trans-Thoracic Echocardiography In Developing Countries: A Tale Of Two Cases
Abstract Number: T4D-5
Abstract Type: Case Report/Case Series
Introduction: Recently, during a global health trip to Rwanda, we found that teaching residents the FOCUS-transthoracic (TTE) exam when ultrasound machines are available can be a valuable tool to improve treatment strategies and patient outcomes. We report the use of the FOCUS-TTE ultrasound exam at the University Teaching Hospital in Kigali, Rwanda (CHUK) in the perioperative care of two obstetric patients.
Case one: A 28-year-old G2P1 female at 35 weeks gestation presented to the obstetric ward for a scheduled cesarean section. Her pregnancy was complicated by a previous tissue mitral valve replacement secondary to rheumatic heart disease at the age of 24. On TTE she was noted to have mitral stenosis with a peak gradient of 11mmHg, mitral regurgitation, dilated left ventricle with mildly reduced function, and fixed left ventricular outflow track (LVOT) obstruction caused by a part of the valve apparatus in the LVOT. An epidural was placed at the L2-L3 interspace and gradually dosed with 0.25% bupivicaine till a T4 surgical block was reached. Standard ASA monitors were used as well as intraoperative TTE. TTE was used to assess volume status via IVC collapsibility index and visual assessment of ventricular filling. The case proceeded uneventfully. The patient developed pulmonary edema postoperatively which responded well to intravenous diuresis. She was discharged on post operative day seven.
Case two: A 42-year-old G6P6 female presented to the CHUK emergency department with dyspnea, orthopnea, hemoptysis, and anasarca. Her symptoms began 4 days post-spontaneous vaginal delivery at an outside district hospital. Upon evaluation at CHUK, she was noted to be tachycardic, dyspneic, and hypotensive with cool extremities. She was intubated in the emergency department for respiratory failure. A FOCUS-TTE exam was preformed which showed a dilated left ventricle with severely reduced ejection fraction, dilated right ventricle, and mitral regurgitation. She was diagnosed with peripartum cardiomyopathy and admitted to the intensive care unit. She was treated with inotropic and vasopressor support with dobutamine and norepinephrine and aggressive diuresis. After six days of treatment, she developed ventricular tachycardia and unfortunately passed away shortly there after.