CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
101
HEALTH SYSTEMS AND HEART DISEASE
consultations with university departments and operating centres.
Echocardiographic examinations are presented and discussed.
Decisions are made on acute treatment, time and mode of transporta-
tion and information given to referring paediatricians and parents.
Life-saving decisions have been made using the system. Follow-up
out-patient visits have been made with the patient, parents and paedi-
atrician in the remote local hospital and the paediatric cardiologist or
cardiac surgeon in the university centre. The system is also used for
training, clinical rounds, research and business meetings.
This telemedicine video conference system and network facilitates
improvement of diagnostic skills and enhances knowledge about
heart disease in infants and children, especially in the small hospitals.
It gives patients and local paediatricians access to instant specialist
knowledge and operating centres improved information about patients
to be referred for treatment. Infants with critical heart disease arrive in
a better condition and results are likely to be improved.
68: PATTERN OF CARDIAC DISEASEAMONG PATIENTS IN
A PAEDIATRIC CARDIAC CLINIC, JUSH, 2012
Demeke Mekonnen Mengistie
Jimma University Specialised Hospital, Ethiopia
Background:
JUSH is the only specialised referral hospital in south-
western Ethiopia. Paediatric care is given by specialist and subspecial-
ist doctors. Cardiac diseases are one of the leading causes of morbid-
ity and mortality in children. Both congenital and acquired heart
diseases are common in children. The paediatric cardiac clinic gives
regular follow up for these groups of patients every Friday afternoon.
Methods:
A retrospective chart revision was made in those paediat-
ric patients who came to JUSH and were diagnosed to have cardiac
illnesses and were on follow up. Data collected from a structured
questionnaire was filled in by the physician at the time of chart
review. Analysis using SPSS version 16 was made after clearing the
data.
Result:
Mean age of patients was 3.8 years with 51% females, and
mean duration of follow up was 1.3 years. Echocardiography was
done for 89% of patients who were on follow up in the paediatric
cardiac clinic. Acquired heart disease scored the highest value, with a
predominance of CRVHD. Among congenital heart disease patients,
ventricular septal defect (VSD) was the leader, followed by patent
ductus arteriosus (PDA) with 50 and 21% prevalence, respectively.
Conclusion:
The majority of patients were receiving echocardiogra-
phy at the time of follow up. The leading cause of cardiac illness in
our children is still CRVHD from acquired, and VSD from congenital
heart diseases. A more detailed study needs to be done to find further
management options.
189: THE DEVELOPMENT OF PAEDIATRIC CARDIAC
SURGICAL NURSING IN MONGOLIA
Cathy Woodward
1
, Minnette Son
1
, Kirk Milhoan
1
, Khulan Gaalan
2
,
Tsermaa Sharav
3
1
Department of Paediatrics, University of Texas Health Science
Center, San Antonio, USA
2
Department at School of Health Technology, Health Sciences
University of Mongolia
3
Shastin Medical Centre, Ulaanbataar, Mongolia
Introduction:
The mission of WSPCHS is to promote the highest
quality comprehensive care to all patients with paediatric and/or
congenital heart disease. As mission teams help developing countries
establish paediatric cardiac surgery programmes, the mission of the
WSPCHS must be extended to include nursing; realising a perfect
surgical repair is not enough to assure a successful recovery.
Methods:
Since 2005 the Mongolian Minister of Health has invited a
team from the United States to Mongolia to perform cardiac surgery
and catheterisation procedures for children with congenital and
2: CHANGING POLICY IN SCREENING LOW-RISK PREG-
NANCIES FOR FOETAL HEART DISEASE CAN IMPROVE
EARLY DETECTION OF CONGENITAL HEART DISEASE:
LESSONS LEARNT FROM AN INTEGRATED HEALTH-
CARE SYSTEM
Denis Levy
1
, Mark Sklansky
2
, Marcos Gonzales
1
, Cherie Rao
1
, Mark
Nunes
1
, Julian Bendelstein
1
, Karen Mehalek
1
, Abraham Rothman
3
,
Raoul Burchette
4
, Dolores Pretorius
5
1
Southern California Permanente Med Group, USA
2
Mattel Children, USA
3
University of Nevada, Las Vegas, USA
4
Kaiser Permanente, southern California, USA
5
University of California, San Diego, USA
Background
: A large percentage of significant congenital heart
disease (sCHD) is not detected in utero or immediately after birth.
Prenatal detection rates of sCHD of around 30% have been reported,
even in the current era. Utilising the electronic medical record (EMR)
in an integrated healthcare system, incidence, outcome and prenatal
detection rate of sCHD within a defined low-risk population was
documented. Influence of policy to document foetal cardiac outflow
tracts on screening prenatal ultrasound was explored.
Methods
: During a six-year period, patients/foetuses under one year
of age with sCHD were identified. Mother and child EMR were
used to gather data. Incidence was determined using the number
of live births within the defined population and time period. The
outcomes, prenatal detection rate and postnatal timing of detection
were documented. The prenatal detection rate of patients undergo-
ing cardiac surgery under one year of age was compared to a similar
group within the same healthcare system where there was no policy
to document foetal cardiac outflow tracts.
Results
: sCHD was identified in 101 patients/foetuses. The number
of births within the same period was 25 666, giving an incidence
of 4.0 per 1 000 live births. The overall prenatal detection rate of
these infants was 74%. Detection rate prior to discharge was 95%.
A significant difference in prenatal detection rates was found when
there was a policy in place to obtain foetal cardiac outflow tract views
in prenatal screening (58 vs 28%).
Conclusions
: Within an integrated healthcare system and use of an
EMR, a detection rate of sCHD of 95% can be demonstrated before
hospital discharge and 74% can be detected
in utero
. A concerted
programme that includes documentation of foetal cardiac outflow
tracts in pregnancy screening can result in improved prenatal detec-
tion of sCHD.
60: A NATIONAL VIDEO CONFERENCING SYSTEM FOR
PAEDIATRIC CARDIOLOGY
Bo Lundell
1
, Anders Jonzon
2
1
Karolinska University Hospital, Stockholm, Sweden
2
Uppsala University Hospital, Uppsala, Sweden
Sweden is a sparsely populated Nordic country with a population
of 10 million, with 100 000 births annually. With only 32 paediatric
cardiologists and two operating centres, all located in the major cities
and university departments, rural small hospitals must rely on local
paediatricians for primary diagnosis and early treatment of heart
disease. In order to help ensure correct diagnosis and optimal early
treatment of congenital heart disease, a national video conferenc-
ing system was installed in all 36 hospitals with delivery units and
paediatricians or paediatric cardiologists on call. A commercially
available codec was customised for high-resolution (1 080 p) and
high frame-rate (60 fps) video conferencing. Dual streaming over a
secure national broadband network allowed for part-to-part confer-
ences, or up to all 36 hospitals simultaneously participating. The
Swedish Heart–Lung Foundation financed the system that was
installed in 2011.
The system is frequently used by small hospitals for acute
