CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
119
Methods:
This is a descriptive study of 176 GUCH patients (over
the age of 16 years) who underwent surgical intervention. Data
were acquired from the cardiac surgery database over 6 years from
July 2006 to June 2012. The majority of surgical procedures were
performed by paediatric cardiac surgeons as first-time surgery.
Results:
Of 176 patients, 54.3% were male, ranging in age from 16 to
76 years (mean 37.3 years). The majority of patients underwent surgical
interventions for closure of atrial (
n
=
77) and ventricular septal defect (
n
=
36); 16 patients were operated for tetralogy of Fallot, and 5 for coarctation
of aorta. The average length of hospital stay was 7.4 days. Overall mortal-
ity was 4%, and morbidity was 30.7% including re-operations, prolonged
ventilator use, arrhythmias, heart block and others. Re-operations were
performed in 1.7% patients as compared to almost 50% in developed
countries. A similar trend was observed in literature from other developed
countries along with a decline in primary procedures.
Conclusion:
GUCH surgery in our practice is often a primary proce-
dure for simple diagnoses. At present we do not have dedicated facili-
ties for GUCH patients. This report highlights the fact that most of
these simple lesions should have been treated before patients reached
adulthood. There is a need to focus on developing GUCH services in
developing countries to decrease the morbidity of untreated congeni-
tal heart disease.
591: AORTOPATHY IN ADULT PATIENTS WITH REPAIRED
TETRALOGY OF FALLOT: HOW MUCH SHOULD WE
WORRY?
Beatrice Bonello
1
, Gerhard-Paul Diller
1
, Yumi Shiina
1
, Darryl F
Shore
1
, Michael A Gatzoulis
1,2
, Sonya V Babu-Narayan
1,2
Royal Brompton and Harefield NHS Foundation Trust, Sydney
Street, London
2
NIHR Cardiovascular Biomedical Research Unit, Royal Brompton
Hospital, and National Heart & Lung Institute, London
Background:
We investigated the prevalence and progression of
aortic dilatation (AD) late after repair of tetralogy of Fallot (rtoF) and
sought to determine its predictors.
Materials and methods:
Retrospective study of 110 rtoF adults with
native aorta studied with cardiovascular magnetic resonance (CMR)
at baseline and at
≥
1 year follow-up. Aortic measurements were
performed in diastole at sinus and ascending aorta (AA) level. AD
was defined as diameter 2 standard deviations larger than published
normal values.
Results:
Age at baseline CMR was median [interquartile range]; 30.9
[22.9–39.4] years and at repair was 4.5 [2.1–9.1] years. Time interval
between CMR scans was 6.3 [5.1–7.6] years.
Sixty-eight patients (61%) had AD, 65 had sinus dilatation (SD)
(39 [35–41] mm, range 31–55) and 24 had associated AA dilatation
(AAD) (40 [37–45] mm, range 36–51). Predictors of SD were age at
baseline (
p
=
0.009), male gender (
p
=
0.039) and previous palliation
(
p
=
0.0004); previous palliation remained an independent predic-
tor (
p
=
0.0004).
Predictors of AAD were age at repair (
p
=
0.01),
systemic hypertension (
p
=
0.04), pulmonary atresia variant (PA) (
p
<
0.0001), male gender (
p
=
0.008), and sinus diameter (
p
<
0.0001);
PA (
p
<
0.0001) and male gender (
p
=
0.004) were independent
predictors for AAD. On ROC curve analysis, sinus diameter
>
39 mm
predicted AAD (AUC 0.90,
p
<
0.0001).
Mean rate of sinus and ascending aortic diameter progression was
respectively 0.05
±
0.1 and 0.12
±
0.26 mm/year. No risk factor for
increasing sinus diameter was identified. Predictors of AA diameter
increase were age at repair (
p
=
0.008) and previous Blalock-Taussing
shunt (
p
=
0.01). The latter was the only independent predictor (
p
=
0.01). No patient underwent aortic surgery.
Conclusion:
AD is common in patients with rtoF but the rate of
progression of aortic size is low in this large contemporary adult
cohort. This should be taken into account when planning for scans
in follow-up and/or prophylactic aortic replacement. Patients with
sinus diameter
≥
39 mm need cross-sectional imaging to assess for
ascending aortopathy.
648: CLINICAL FEATURES OF ADULT CONGENITAL
HEART DISEASE: A CHINESE INSTITUTIONAL EXPERI-
ENCE
Hong Gu, Chen Zhang, Bao-jing Guo, Ai-jie Li, Hong-wei Zhang,
Meng-pei Cheng, Hui Zhang, Pei Cheng, Ying-long Liu, Jia Li
Department of Pediatric Cardiology, Beijing Anzhen Hospital,
Capital Medical University, China
Background:
A substantial number of children with congenital heart
disease (CHD) now reach adolescence and adulthood as a result of
advances in paediatric cardiology, surgery and other subspecial-
ties over the past few decades. Consequently, there has been fast
development in the management of this special group of patients in
many countries. However, it remains a new phenomenon in China.
We obtained clinical information about adults with CHD at Beijing
Anzhen Hospital, China.
Methods:
A total of 431 consecutive patients aged 18 years or
older diagnosed with CHD from January 2005 to March 2012 were
enrolled. Demographics and disease characteristics including diagno-
sis, haemodynamics, treatments and outcomes were recorded.
Results:
Patients’ age was 30.3
±
11.0 years; 71% were female. Four
hundred and one (92%) patients were diagnosed with CHD for the
first time. The majority had simple left to right shunt defects, includ-
ing atrial septal defect (ASD) in 182 patients (42%), ventricular
septal defect (VSD) in 90 (21%) and patent arterial duct (PDA) in
78 (18%). Other defects in the remaining patients included tetralogy
of Fallot and total abnormal drainage of pulmonary veins. Cardiac
catheterisation was performed in 82 patients with severe pulmonary
hypertension. Systolic pulmonary arterial pressure was 79.6
±
14.7
mmHg, and pulmonary vascular resistance 24.4
±
14.0 Wood*m
2
.
Thirty-five patients were diagnosed with Eisenmenger syndrome
and received pulmonary vasodilator treatment. Surgical repair was
performed in 129 patients, and cardiac interventions in 180 patients
including VSD, ASD and PDA device closures. There was no
in-hospital death.
Conclusions:
In our centre, the majority of patients were first diag-
nosed with CHD at adulthood, with severe pulmonary arterial hyper-
tension and increased pulmonary vascular resistance. Patients who
underwent surgical or cardiac interventional repairs had good early
outcomes. A formal organisation to define treatment strategies and
long-term follow-up in adults with CHD is urgently needed in China.
709: THE VALUE OF A SPECIALISED PSYCHOLOGICAL
SERVICE FOR ADULTS WITH CONGENITAL HEART
DISEASE
Meaghan Ferguson, Adrienne Kovacs
Peter Munk Cardiac Centre, University Health Network, Toronto,
Canada
Background:
Adult congenital heart disease (ACHD) patients are at
increased risk of developing mood and anxiety disorders; there are
few dedicated psychological programmes for this patient population.
A specialised ACHD psychological service has not previously been
described, but the information would be valuable to programmes
considering expanding their scope to include psychological care.
Methods:
A retrospective review of 100 ACHD patient psychology
files was performed and the following data were abstracted: sociode-
mographic and medical variables, presenting psychological concerns,
and course of psychological treatment.
Results:
Of 100 patients, the mean age was 33
±
11 years, 51% were
female, and the majority were single (
n
=
63), educated beyond high
school (
n
=
70), and had defects of moderate or great complexity (
n
=
90). The most common psychological concerns were general anxiety
(
n
=
82), health/heart-related anxiety (
n
=
71), depressed mood (
n
=
60), and/or coping with a medical condition (
n
=
49); 65 patients met
diagnostic criteria for a psychiatric disorder. Following assessment,
individual psychotherapy with the ACHD psychological service was
recommended to 87 patients, of whom 75 agreed to proceed with
treatment. The median number of psychotherapy sessions was 8.
