CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
116
AFRICA
right arm. Distensibility of the ascending aorta was measured at the
level of the right pulmonary artery. Phase contrast MRI was used
to measure aortic arch PWV. The transit time between the arrival of
the flow wave at ascending aorta and the proximal descending aorta
was calculated by a foot-to-foot method. Cine imaging of the right
brachial artery was performed to measure brachial artery reactivity
to reactive hyperaemia (FMD) and glyceryl trinitrate. Comparisons
were made using Student’s
t-
tests. Data are expressed as mean (SD).
Results:
In 2 patients PWV data was of poor quality and was there-
fore excluded, along with the corresponding data from controls.
Ascending aortic distensibility was lower in patients than in controls
(4.3(2.2) vs 7.2(2.1) mmHg
-1
.10
-3
,
p
<
0.01), aortic arch PWV was
higher (6.3(1.5) vs 4.3(1.1) m/s,
p
<
0.05). There was no difference
in brachial artery FMD (13(10)% vs 16(6)%,
p
=
0.3) or response to
glyceryl trintrate (22(12)% vs 27(7)%,
p
=
0.08).
Conclusions:
In small numbers MRI appears to have identified
differences in vascular function between patients with repaired coarc-
tation and controls. Incorporation of these measures into surveillance
MRI assessment of repaired coarctation may determine whether they
have any prognostic value in the long term.
153: WOMEN WITH CONGENITAL HEART DISEASE:
THEIR IMPERATIVE TOWARDS CONCEIVING
Kylie Ngu
1
, Margaret Hay
2
, Samuel Menahem
2
1
Faculty of Medicine, Dentistry and Health Sciences, University of
Melbourne, Australia
2
Monash University, Melbourne, Australia
Background:
Advances in medical care have increased the number
of women with congenital heart disease (CHD) reaching child-bear-
ing age and wishing to conceive. Pregnancy adds an additional stress
on their compromised cardiovascular system, with risks to both them-
selves and their unborn child. Despite these risks, they still proceed
to conception. A qualitative study was undertaken to determine their
motivations for conception.
Methods:
A two-group design of women with (
n
=
20) or without
(
n
=
20) CHD, over 18 years of age who had completed one or more
successful pregnancies were recruited from a tertiary centre and
private clinics. The women completed a questionnaire and a semi-
structured interview. Their medical records were reviewed. Thematic
analysis was conducted on the interview data.
Results:
CHD in the women ranged from minor lesions (e.g. atrial
septal defect) to moderately severe lesions (e.g. Fontan circulation).
The motivations for conceiving in women with CHD were similar to
those of healthy women. These motivations included: the influences
of relationships with their partners, family and friends; concern for
the reproductive changes associated with increasing age; their innate
desires for motherhood; the women’s personal goals; and cultural and
social expectations. Women with CHD had a tendency to underesti-
mate the severity and associated risks of their CHD. They exhibited a
strong reliance on their treating clinicians and assumed advances in
medical care would carry them through their pregnancies.
Conclusions:
Motivations to conceive are similar for healthy women
and women with CHD. Those with CHD had a tendency to harbour an
unrealistic understanding of the severity of their CHD and its impli-
cations in pregnancy. This perception emphasises the importance for
clinicians caring for these patients to be knowledgeable about the
impact of CHD on the woman’s pregnancy and of pregnancy on their
CHD, as they carry great responsibility in caring for these patients.
201: SURGERY OFTETRALOGY OF FALLOT INADULTS IN
AHMED GASIM CARDIAC CENTER
Abdelmoneim Abdellah
1
, Murtada Mohammed
2
, Yassir Ali
2
, Hani
Elamin
3
, Ahmed Elamin
3
1
Department of Anatomy, University of Khartoum, Sudan
2
University of Khartoum, Sudan
3
Department of Cardiac Surgery, Ahmed Gasim Cardiac Center,
Sudan
Background:
Corrective surgery of tetralogy of Fallot (TOF) beyond
childhood is very rare as a result of improved methods of early detec-
tion and early repair. In our centre 20% of TOF patients who under-
went repair were adults, with good early results.
Method:
This is a descriptive retrospective study. The data were
collected by the authors from the records of the patients who under-
went surgical repair of TOF from 2003 to 2011 in our centre. We
included all patients above 18 years. The data were collected manu-
ally and analysed by a computer program SPSS.
Results:
Adult TOF surgical repair represents 20% of TOF surgery.
Fourteen patients were male (75%). The mean age was 20.47 years.
Eleven patients were classified as NYHA III, and 60% of patients
had pulmonary gradients of more than 50 mmHg. There was no
previous palliative surgery or associated major cardiac anomaly.
All patients underwent total surgical repair through right atriotomy
and the ventricular septal defects (VSDs) were closed by synthetic
patch. In one patient the pulmonary artery was opened and enlarged
with a pericardial patch. The mean follow-up time was 4.5 years.
Two patients died during their hospital admission and another 3 died
during the period of follow-up.
Conclusion:
Although operating on adult patients with TOF is
a challenge and rarely seen, we still had a reasonable number of
patients with good early surgical outcome but poor in the mid-term
follow-up period.
233: DEMONSTRATION OF STRONG FEASIBILITY OF
THE iHeartChange WEBSITE FOR TRANSITIONING
PATIENTS WITH CONGENITAL HEART DISEASE
Adrienne Kovacs
1
, Luke Burchill
1
, Geraldine Cullen-Dean
2
, Jeanine
Harrison
1
, Jennifer Stinson
2
, Krista Gruenwald
1
, Candice Silversides
1
,
Erwin Oechslin
1
1
Peter Munk Cardiac Centre, University Health Network, Toronto,
Canada
2
Hospital for Sick Children, Toronto, Canada
Background:
Published guidelines recommend initiatives to improve
the rate of transfer and quality of transition of patients with
congenital heart disease (CHD) from paediatric to adult cardiac care.
Unfortunately, there are few published interventions for transitioning
patients with CHD, proposed initiatives are often resource intensive,
and strategies for engaging adolescents are unknown. We created
and evaluated the feasibility of the iHeartChange website targeting
transitioning CHD patients.
Methods:
Patients transferring from a paediatric to adult CHD
programme in a 1-year period were invited to participate in the study.
Feasibility outcomes, specifically eligibility, participation rate, and
patient feedback about the website, were investigated.
Results:
A total of 207 CHD patients aged 16–19 were transferred,
of whom 187 (mean age 17.7 years, 58% male, 75% with moderate/
great defect complexity) met full inclusion criteria and were invited
to participate. Thirty-four per cent (63/187) of eligible patients
logged on and completed baseline surveys; there were no signifi-
cant differences in age, sex, or defect complexity between patients
who did and did not complete baseline surveys. Forty-eight patients
completed follow-up surveys at least 1 month after initial website
access. The majority of patients mostly or strongly agreed that the
website was easy to use (95%), fun to use (82%), gave information
that was useful (91%) and they could trust (95%), gave a better
understanding of CHD medical issues (86%), should be offered to all
patients moving to adult care (91%), and is something they would use
again if available (87%).
Conclusion:
Strong feasibility of the iHeartChange website was
demonstrated. One-third of patients with CHD chose to access a
website as part of a research study; higher use is anticipated if offered
in a clinical setting. Adolescent feedback in terms of design and
content was extremely positive. In conclusion, a website targeting
transitioning CHD patients holds significant clinical promise.
