Cardiovascular Journal of Africa: Vol 24 No 1 (February 2013) - page 127

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013 AFRICA 125
Background: With rapid westernisation in sub-Saharan Africa,
cardiovascular disease is gradually becoming the major cause of
morbidity and mortality in this part of the world. Unfortunately, there
is still a dearth of data on the pattern of heart disease in sub-Saharan
Africa given the size and diversity of the region and population. We
therefore studied the pattern of heart disease in Abuja, Nigeria and
compared our findings with similar data derived from the Heart of
Soweto Study.
Methods: We prospectively studied 1 515 subjects with confirmed
cardiac diseases referred to the cardiology clinic of the University of
Abuja Teaching Hospital during a 4-year period. We then developed
a prospectively designed registry and gathered detailed clinical data.
Results : There were slightly more women (50.7%) than men, and the
mean age of the study cohort was 49.0 ± 13.7 years. Hypertension
was the primary diagnosis in around two-thirds of the study cohort,
comprising more women than men (odds ratio (OR) 1.96 95%
confidence interval (CI) 1.26–2.65). Hypertension was also the
commonest cause of heart failure (HF) accounting for HF in 60.6%
of cases. The Abuja cohort were more likely to present with a primary
diagnosis of hypertension (adjusted OR 2.10, 95% CI 1.85–2.42),
hypertensive heart disease/failure (OR 2.48, 95% CI 2.18–2.83); p
< 0.001 for both comparisons and representing more than two-thirds
of presentations in Abuja. Alternatively, they were far less likely to
present with coronary artery disease (OR 0.04, 95% CI 0.02–0.11),
DCMO (OR 0.35, 95% CI 0.26–0.46), right HF (0.09, 95% CI
0.05–0.17) and valve disease (predominantly RHD in both sites, OR
0.21, 95% CI 0.16–0.28); p < 0.001 for all comparisons.
Conclusions: Hypertension and its complications is the common-
est cardiovascular disease in the Nigerian population in Abuja, and
unlike in Soweto, coronary artery disease is not common.
1253: EXERCISE TESTING IN COARCTATION OF AORTA:
AN UPDATE
Tiow H Goh 1,2, Kooi-Lean Tan2, Timothy Goh2, Eugene Goh2, Yuli
Willis3 , Chris Chan3
1Epworth Hospital, Victoria, Australia
2Wholeheart Clinic, Melbourne, Australia
3Heartwise Centre, Melbourne, Australia
Background: Long-term follow up of coarctation of aorta (COA)
poses issues of optimal evaluation non-invasively. Routine clinical
and ambulatory/home blood pressure (BP) measurements and echo
may not provide enough answers.
Aim: To assess usefulness of exercise testing (ET) in COA follow-up
(fu).
Patients and methods: Forty patients (pts) (7–32 yrs, median 21.06)
(29 male) were followed up to 20 years post COA repair (surgical
29, native 11).
Methods: Modified Bruce treadmill protocol was done with VO2
uptake measured where possible. Tests were undertaken to evaluate
BP, endurance and VO2max responses to exercise where there was
suspicion of hypertension, aortic arch hypoplasia and question-
able response to medication. Pts had no residual pressure gradients.
Seventeen pts had two or more studies during individual fu. Response
to stenting and growth of patients during fu were important factors
needing repeat studies. Twenty-three pts had one study (4 pre stents
and 19 post stent/surgery).
Results : Nine pts had hypertensive peak BP response, 5 resolving
post stenting, 1 unchanged post stenting (with weight gain), 3 wait-
ing for stent and 1 resolving with medication. Endurance time and
VO2 max tended to improve post stenting. Seventeen pts had normal
pre and peak BP response and 13 pts had borderline pre BP and
normal peak BP response not requiring active management. One pt
had marked improvement with endurance time post stent but still had
hypertensive peak BP response (super athlete).
Conclusion: ET allows peak BP response to be assessed and appro-
priate interventions/surgery/medication undertaken. ET is a useful
tool to evaluate optimal long-term management for COA.
1254: COARCTATION OF AORTA: 31-YEAR FOLLOW-UP
Tiow H Goh1, 2, Kooi-Lean Tan2, Timothy Goh2 , Eugene Goh2, Yuli
Willis3, Chris Chan3
1Epworth Hospital, Victoria, Australia
2Wholeheart Clinic, Melbourne, Australia
3Heartwise Centre, Melbourne, Australia
Background: Coarctation of aorta (COA), although eminently treat-
able, continues to present with ongoing morbidity/mortality even
after good treatment. This study explores potential areas of improve-
ment in follow-up (fu) by highlighting detection of hypoplasia (hao)/
distortion of aortic arch (ao)
Aim: We analysed the fu of 70 patients (pts) with special emphasis
on ongoing persisting hypertension (hbp).
Patients and methods: Fu to 31 years was analysed for 70 pts (6–36
yrs, median 19.96 yrs; 22 female); surgery infancy/early childhood: 30
subclavian flap, 12 end to end; 27 native ballooned (ba) – 7 infants.
Records were analysed for initial and subsequent adequacy of treat-
ment, upper and lower limb blood pressure (BP), periodic echo ambu-
latory/home blood pressure (amb bp/home bp), and especially during
periods of rapid growth (adolescence), exercise testing, and imaging of
ao by computed tomography/magnetic resonance imaging (CT/MRI)
with hbp and suspicion of hao/ao distortion. No pressure gradient at
catheterisation does not mean good outcome in presence of hbp. Where
hao (indexed) was present, stenting of ao was undertaken to normalised
(indexed) ao to produce BP improvement. Stented pts fu was 1–4 yrs.
Results: Three infants/toddlers had failed ba with resultant surgery;
2 still had hbp 2–4 yrs post surgery. Many pts tend to develop hbp at
puberty. Of 22 pts followed up post ba, 10 remained stable, and 12
had stents. Post surgery 42 pts, 22 pts had stents, 8 remain normoten-
sive, 5 await stents. Post stenting, there is improvement in exercise
endurance and BP control. One pt needed surgery, with adequate BP
response. Stented pts tend to maintain BP response thus far.
Conclusion: Persistent hbp warrants imaging of the ao. Many COA
pts develop hbp with proven hao (indexed) and/or distortion and
are improved with stenting and/or surgery. Further long term fu is
necessary.
1288: LATE PULMONARY VALVE REPLACEMENT IN
PATIENTS WITH TETRALOGY OF FALLOT REPAIRED IN
INFANCY AND CHILDHOOD
Ricardo Gomez1, Tomasa Centella 1, Maria Jesus Lamas1 , David
Cabestrero1, Cesar P Caballero2, Jose Luis Vazquez2, Luis F Pineda 1,
Ruth Solana1, Miguel Angel Palomero1
1GUCH Unit, Ramon y Cajal University Hospital, Madrid, Spain
2GUCH Intensive Care Unit, Ramon y Cajal University Hospital,
Madrid, Spain
Background: Total repair of tetralogy of Fallot (TOF) has a good
long-term prognosis, but the frequent chronic pulmonary regur-
gitation (PR) established after the correction can lead to exercise
intolerance, right ventricular (RV) dilatation and failure, deleterious
arrhythmias and even sudden death. Pulmonary valve replacement
(PVR) may improve and/or avoid these situations.
Material and methods: As the ideal substitute for PVR remains
a source of dispute, since January 2004, in our Unit, we have been
implanting the bovine pericardium biological prosthesis. This study
was retrospective at its inception and prospective during the later
years. Eighty-two patients were operated on between January 2004
and June 2012. Median age was 22.15 years. The average interval
between TOF repair and PVR was 17.2 years.
Results: Two patients died in the early postoperative period. Mean
follow-up has been 3.5 years (0.2–8.5 yrs). There was one late death
after heart transplant for persisting biventricular failure. Of surviving
patients 95% are classified as NYHA class I. The postoperative (> 1
yr postop) assessment of RV volumes and function using magnetic
resonance imaging (MRI) improved significantly compared to MRI
preoperative data. Mean postoperative peak transprosthetic echo-
Doppler gradient at follow-up is 19.38 ± 14.47 mmHg.