CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
115
Methods:
Patients (
n
=
15), median age at surgery of 2.6 years
(1.5–4.1 years) and 21.1 years (19.8–23.2 years) at the time of
examination, and age-matched control subjects (
n
=
10) underwent
cardiac magnetic resonance (MR) scanning using a Philips Intera,
1.5T MR scanner. Stacks of 3 contiguous long-axis and 12 short-axis
slices encompassing both ventricles were acquired. Quantitative flow
measurements were made using phase-contrast gradient imaging. For
data analyses OsiriX and Medviso Segment software was used.
Preliminary results:
Compared to controls, left ventricular ejec-
tion fraction was unaffected, median 63.2% (56.6–68.7%) vs 65.9%
(53.5–69.9%),
p
=
0.99, and so was cardiac index, median 3.6 l (min
m
2
)
-1
(3.2-4.1 l (min m
2
)
-1
) vs 4.0 l (min m
2
)
-1
(3.6–4.1 l (min m
2
)
-1
),
p
=
0.81. Ventricular mass indexes were larger in VSD patients,
p
<
0.05 in both ventricles. Left ventricular peak ejection/filling rate was
higher in patients; median 87.3 ml sec
-1
(72.5–111.3 ml sec
-1
)/145.5
ml sec
-1
(82.7–174.5 ml sec
-1
) compared to controls 69.3 ml sec
-1
(55.0–87.1 ml sec
-1
)/87.4 ml sec
-1
(76.3–126.2 ml sec
-1
),
p
<
0.05 and
p
=
0.08, respectively. In contrast, right ventricular peak ejection/
filling rate was lower in patients; median 57.7 ml sec
-1
(50.4–73.0 ml
sec
-1
)/50.4 ml sec
-1
(37.0–60.2 ml sec
-1
) as compared to controls 89.9
ml sec
-1
(48.5–131.0 ml sec
-1
)/94.5 ml sec
-1
(51.1–137.2 ml sec
-1
),
p
<
0.01 for both parameters.
Conclusion:
Twenty years after surgically closed VSDs, larger
ventricular masses combined with superior peak rates of ejection and
filling in the left ventricle are noticed. In contrast, right ventricular
peak ejection and filling velocities were inferior compared to control
subjects. The consequence for long-term outcome is unknown and
needs further studies.
134: MENSTRUAL BLEEDING AFTER OPEN HEART
SURGERY
Vibeke E Hjortdal
1
, Signe Holm Larsen
2
, Helene Wilkens
1
, Pedersen
Thais
2
1
Department of Cardiothoracic Surgery, Aarhus University Hospital,
Denmark
2
Department of Cardiology, Aarhus University Hospital, Denmark
Background
: We investigated whether open heart surgery with the
use of extracorporeal circulation has impact on menstrual bleeding
(MB).
Material and methods:
MB pattern was registered retrospectively
and MB during admission was registered prospectively in fertile
women undergoing heart surgery for congenital heart disease.
Hematocrit and 24-hour postoperative bleeding were compared with
men also undergoing congenital heart surgery in the period 2010-
2011.
Results:
Women (
n
=
22), mean age 35 years (range: 17–60) were
operated on and hospitalised for 4–5 postoperative days. Mean post-
operative bleeding in the first 24 hours was 312 ml (range 50–1442
ml). Three to four (16%) women were expected to have MB during
their hospital stay. Unplanned MB (lasting 2–5 days) was detected in
13 patients (60%). Six had expected MB and 3 had, as expected, no
MB during hospital stay. Of the 13 unexpected MB, 4 were 1–7 days
early, 4 were 8–14 days early, 3 were 1–7 days late and 2 had MB
despite having had MB within the last 2 weeks. None had unusually
severe or long-lasting MB. Ten women took oral contraceptives, 7
of whom had unexpected MB. Men (
n
=
22), mean age 35 years
(17–54) had a mean 24-hour postoperative bleeding of 331 ml (range
160–796 ml) which was not significantly different from that of the
women. The mean preoperative haematocrit was 40% (29-53%)
among men, not significantly different from that of women (mean
40% [32–60%]).
Conclusion
: MB patterns are disturbed by open heart surgery in
the majority of fertile women. Nevertheless, the unexpected MB is
neither particularly long lasting nor of excess quantity, and postoper-
ative surgical bleeding is unaffected. We recommend giving informa-
tion about irregular MB, but no special precautions when operating
on women of fertile age.
138: LIMITED KNOWLEDGE AMONG LOCAL CARDIOLO-
GISTS OF THE MANAGEMENT OF PREGNANT WOMEN
WITH MECHANICAL HEART VALVES AND MINIMAL
IMPACT OF FOCUSED EDUCATION
James Oliver, George Ballard, John Thomson, Helen Michael, Kate
English
Leeds Teaching Hospital NHS Trust, Leeds, UK
Background/hypothesis:
There are significant risks to the mother
and foetus in pregnant women with mechanical heart valves. While
these patients are frequently managed by experienced multidiscipli-
nary teams, general cardiologists should be aware of the relevant
issues. We assessed the knowledge of local cardiologists on these
issues and evaluated the impact of focused education on the subject.
Methods:
A questionnaire on the principles of management of
pregnant women with mechanical heart valves was distributed to
cardiology consultants and trainees from the UK’s Yorkshire and
Humber region at an educational meeting. A lecture was then given
and a leaflet summarising the issues circulated. At a further meeting
11 months later the participants were re-questioned.
Results:
The questionnaire was completed by 35 doctors on the
first occasion and 26 on the second. Questions included: What is
the risk of maternal death? [
Accepted answer
: 1–5%;
% correct,
1st questioned
, 48%;
% correct, re-questioned
, 69%.] What is the
risk of foetal wastage? [
Accepted answer
: 20–40%;
% correct, 1st
questioned
, 18%;
% correct, re-questioned,
31%.] What is the risk of
major bleeding? [
Accepted answer:
1–4%;
% correct, 1st questioned,
23%;
% correct, re-questioned,
23%.] What is the risk of warfarin
embryopathy? [
Accepted answer:
5–6%;
% correct, 1st questioned,
20%;
% correct, re-questioned 31%.]
By what gestation should
warfarin be stopped to avoid embryopathy? [
Accepted answer:
6
weeks;
% correct, 1st questioned,
3%;
% correct, re-questioned,
15%.] The risk of warfarin embryopathy may be lower if the daily
dose is
<
? mg. [
Accepted answer:
5 mg;
% correct, 1st questioned,
49%;
% correct, re-questioned,
31%.] How does pregnancy alter
the pharmacokinetics of low molecular weight heparins? [
Accepted
answer:
Various;
% correct, 1st questioned,
40%;
% correct, re-ques-
tioned,
38%.] How would you determine the dose of low molecular
weight heparin? [
Accepted answer:
Anti-factor Xa levels;
% correct,
1st questioned,
40%;
% correct, re-questioned,
35%.] Rank in order
thromboembolic risk during pregnancy: A) heparin throughout, B)
warfarin throughout, C) heparin first trimester, warfarin thereafter.
[
Accepted answer:
A
>
C
>
B;
% correct, 1st questioned,
49%;
%
correct, re-questioned,
35%.]
Conclusions:
Knowledge among local cardiologists regarding the
management of pregnant women with mechanical valves was limited.
There was also a limited effect of improving knowledge with targeted
education.
139: VASCULAR FUNCTION IN ADULTS WITH REPAIRED
COARCTATION OFTHEAORTA –ASSESSMENT BYMULTI-
MODAL MAGNETIC RESONANCE IMAGING
James Oliver
1
, Kate English
1
, Steven Sourbron
2
, John Greenwood
2
1
Leeds Teaching Hospital NHS Trust, Leeds, UK
2
University of Leeds, Leeds, UK
Background/hypothesis:
Patients with surgically repaired coarcta-
tion of the aorta remain at increased risk of premature cardiovascular
events including myocardial infarction and stroke. Magnetic reso-
nance imaging (MRI) can be used to assess a number of measures of
vascular function, including endothelial function (as flow-mediated
dilatation (FMD) of the brachial artery) and large artery stiffness (as
aortic pulse wave velocity (PWV) and distensibility).
Aim:
Our aim was to gather preliminary comparative data on vascu-
lar function by MRI in adults with repaired coarctation and healthy
controls.
Methods:
Seven patients with previous coarctation repair and 14
age-matched healthy controls underwent multimodal MRI assess-
ment of vascular function. Blood pressure was measured in the
