CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
131
History and progress
: The patient was first seen at our combined
obstetrics and cardiology clinic, at 33 weeks’ gestation. On her initial
presentation she reported symptoms of grade 2 dyspnoea and inter-
mittent episodes of palpitations. The examination revealed a dextro-
cardia with a 3/6 pansystolic murmur along her right parasternal
area. In addition she had a palpable and loud pulmonary component
of the second heart sound. Her echocardiography revealed a dextro-
cardia, L-type TGA and a small restrictive ventricular septal defect.
The patient subsequently had an elective caesarian section and her
perioperative period was uneventful. She and her baby remained
haemodynamically stable. The patient declined any form of invasive
stratification or intervention for her heart. She was discharged and
then followed up in the cardiology outpatient department.
Discussion and conclusion
: There is limited literature on transposi-
tion of great vessels in pregnancy; however it can be associated with
disastrous outcomes. The main recommendations in these patients
include: a) consultation with a cardiologist who has an experience
with adult congenital heart disease before pregnancy; b) scheduled
cardiology evaluation and follow-up during pregnancy; and c) a
multidisciplinary co-ordination for labour, delivery, and postpartum
periods. Long-term effect of pregnancy on right ventricular function
is unclear; however there is an increased risk of heart failure and
arrhythmias with tricuspid valve regurgitation. Long-term outcomes/
problems depend on presence/severity of associated lesions and right
ventricular (systemic ventricle) failure.
1737: COMPARATIVE EVALUATION OF NORMALWEIGHT
AND OBESE CHILDREN WITH ESSENTIAL ARTERIAL
HYPERTENSION
Bozena Werner, Piotr Wieniawski
Department of Pediatric Cardiology and General Pediatrics, Medical
University of Warsaw
Aim
: To compare normal weight and obese children with essential
hypertension.
Materials and methods
: A total of 114 patients
diagnosed with
primary hypertension (87 boys and 27 girls, aged 10–18 years, mean
15.2
±
1.8 years, were analysed. Patients were divided into two
groups according to body mass index (BMI): group I normal BMI
(
<
85 percentile), group II overweight and obese patients (BMI
>
85 percentile). Analysed parameters included systolic and diastolic
blood pressure (SBP, DBP), fasting glucose, total cholesterol, high-
density lipoprotein (HDL) cholesterol, triglycerides levels, and heart
rate at rest (HR). Mean values of the parameters in both groups were
compared using Student’s t test. The correlations between studied
parameters and blood pressure in the selected groups were assessed
by Pearson’s correlation coefficient (r).
Results:
Statistically significantly higher SBP, triglycerides levels,
and HR were observed in overweight and obese children, and positive
correlations between SBP-triglycerides levels (
r
=
0.34), HR-DBP (
r
=
0.4), DBP-BMI (
r
=
0.2), BMI-triglycerides levels (
r
=
0.25) were
found. In children with normal BMI, no relationships between the
studied parameters were observed.
Conclusions:
The overweight and obese children with hypertension
are characterised by higher blood pressure values, serum triglyceride
levels and heart rate compared to children with hypertension and
normal BMI. The moderate apparent correlations between blood
pressure values and BMI, serum triglycerides levels and heart rate
are observed in children with overweight and obesity.
1782: CAN ARRHYTHMIA SURGERY AT THE TIME OF
PULMONARY VALVE REPLACEMENT PROTECT FROM
FUTURE ARRHYTHMIA?
Helen C Michael
1
, George CHT Ballard
1
, John D Thomson
1
, James J
Oliver
1
, Nihal A Weerasena
2
, Kate M English
1
1
Department of Adult Congenital Heart Disease, Yorkshire Heart
Unit, Leeds Teaching Hospitals NHS Trust, UK
2
Department of Congenital Cardiac Surgery, Yorkshire Heart Unit,
Leeds Teaching Hospitals NHS Trust, UK
Background/hypothesis:
Longstanding pulmonary regurgitation
after surgery for tetralogy of Fallot (TOF) or pulmonary stenosis
leads to progressive right ventricle (RV) dilatation and arrhythmia.
Pulmonary valve replacement (PVR) is often required in adult life.
Arrhythmogenesis is complex, relating both to scars and ongoing
haemodynamic problems. Our unit has performed surgical cryoabla-
tion in selected patients at the time of PVR since 2007.
Materials/methods:
Retrospective analysis of case notes for all
patients undergoing PVR by a single surgeon at our institution
between 2007 and 2010.
Results:
Fifty operations were performed in 47 patients; 42 had
underlying TOF. The main indication for PVR was significant pulmo-
nary regurgitation; 33 patients with arrhythmia were also referred for
surgical cryoablation to the right atrium (RA) and RV outflow tract
(RVOT). Mean age at operation was 27.8 y (range 14–61). Twelve
patients had atrial fibrillation/flutter pre-op; all had cryoablation
performed. Three (25%) had a recurrence of AF post-op. In 22 cases,
RVOT cryoablation was performed; in 11 there had been pre-op
ventricular tachycardia. Four patients developed VT post-op after
a mean time of 12 months (range 1–30); only 2 required long-term
medication. One already had an implantable cardioverter defibrilla-
tor (ICD); 1 required a new device insertion years later. Three further
patients had ICDs inserted post-op: this had been planned electively
pre-op and was not due to new arrhythmia. Three patients who under-
went cryoablation required insertion of a pacemaker post-op for new
bradyarrhythmias at a mean time of 5 months (range 0–12).
Three deaths occurred; 2 in patients post-ablation. None appear
related to arrhythmia.
Conclusions:
Surgical cryoablation at time of PVR appears to reduce
arrhythmia recurrence in the short-term although long-term outcome
data are required. Patients selected for this have already demonstrated
a clinical arrhythmia burden and although initial results appear
promising, whether this provides effective future protection remains
to be seen.
