CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
134
AFRICA
Department of Clinical Pathology, Faculty of Medicine, Ain Shams
University, Cairo, Egypt
Dilated cardiomyopathy is an important cause of congestive cardiac
failure in infants and children. Mobilising haematopoietic progenitor
cells is a promising intervention to this deadly disease.
Aim:
to evaluate the granulocyte colony-stimulating factor as a ther-
apeutic modality in children with idiopathic dilated cardiomyopathy.
Methods:
This case–control prospective study was conducted on 20
children with idiopathic dilated cardiomyopathy following up at the
cardiology clinic of the Children’s Hospital, Ain Shams University,
Cairo, who were compared to 10 age- and gender-matched children
as a control group. They were subjected to history taking, clinical
examination, echocardiographic study of the left ventricle and cluster
of differentiation 34 T-cell assessments in the peripheral blood before
and one week after granulocyte colony-stimulating factor
intake, for
five consecutive days.
Results:
A significant improvement in echocardiographic data
and increase in the cluster differentiation of 34 T cells was found
in patients post granulocyte colony-stimulating factor intake. The
percentage change in the cluster of differentiation 34 T cells showed
no significant correlation with the percentage change of left ventricu-
lar dimension and systolic function.
Conclusion:
Administration of granulocyte colony-stimulating
factor to children with dilated cardiomyopathy resulted in clinical
and echocardiographic improvement that was not correlated to the
mobilised cluster of differentiation 34 T cells, implying the involve-
ment of additional mechanisms than simple stem cell mobilisation.
42: THE ROLE OF ECHOCARDIOGRAPHY IN THEASSESS-
MENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION
IN PATIENTS WITH TRANSPOSITION OF THE GREAT
ARTERIES AND ATRIAL REDIRECTION
Xavier Iriart
1
, Alice Horovitz
1
, Irene E van Geldorp
2
, Jean-Benoit
Thambo
1
1
Division of Paediatric and Congenital Cardiology, Bordeaux, France
2
Department of Biomedical Engineering, Maastricht, the
Netherlands
Background
: Dysfunction of the systemic right ventricle (RV) in
patients with complete transposition of the great arteries (TGA)
after atrial redirection by Mustard or Senning procedures is well
recognised. However, the complex crescentic shape and the trabecu-
lation of the RV, exaggerated by chronic systemic pressure overload,
hampers echocardiographic assessment of the systemic RV. The
purpose of this study was to examine feasibility, and variability of
echocardiographic parameters for the assessment of systemic RV,
and to discuss the role of echocardiography in the assessment of RV
systolic function in patients with a systemic RV.
Methods
: Multiparametric transthoracic echocardiographic analy-
sis, including global function parameters for RV ejection fraction
(RVEF), fractional shortening (RVFS), Tei index and dP/dt
max
;
longitudinal function parameters (tricuspid annular plane systolic
excursion (TAPSE), lateral tricuspid annulus TDI peak systolic
velocity (S’), tricuspid regurgitation (TR) evaluation and asyn-
chrony assesssement, was performed in 35 patients with TGA after
atrial redirection. Functional parameters were compared with MRI.
Inter- and intra-observer variability on echographic assessment were
analysed from 10 randomly selected cases.
Results
: RVEF, RVFS, dP/dt
max
, TAPSE and 2D strain of the RV were
not correlated with RVEF calculated by MRI. Peak systolic velocity
(S’) was weakly correlated with MRI-RVEF (
r
=
0.37,
p
=
0.02).
Inter- and intra-observer variability was high (
>
10%) for RVEF,
RVFS, and dP/
dtmax
, and low (5%) for TAPSE and S’. Assessment of
asynchrony and TR was feasible in all patients.
Conclusion
: Conventional echocardiographic parameters for RV
function assessment are neither very reliable nor reproducible.
However, asynchrony and TR assessment are feasible in routine
practice and highly reproducible. Echocardiography does not permit
complete assessment of systemic RV but is complementary to MRI
and should not be abandoned.
43:MULTIPARAMETRICASSESSMENTOFRIGHTVENTRI-
CLE BY ECHOCARDIOGRAPHY IN ADULT PATIENTS
WITH REPAIRED TETRALOGY OF FALLOT UNDERGO-
ING PULMONARY VALVE REPLACEMENT: A COMPARA-
TIVE STUDYWITH MRI
Xavier Iriart, Jean-Bernard Selly, Zakaria Jalal, Jean-Benoit Thambo
Division of Paediatric and Congenital Cardiology, Bordeaux, France
Aim
: Evaluation of the right ventricle (RV) using transthoracic
echocardiography is challenging in patients with congenital heart
diseases affecting the right ventricular outflow tract such as tetralogy
of Fallot (TOF). MRI is commonly used to determine the best timing
for PV replacement but accessibility remains limited. The objective
of this study was to evaluate the feasibility and the accuracy of a
multiparametric echographic approach including 2D strain and 3D
for RV volumes and function assessment, in comparison with MRI.
Methods
and Results
: We performed a complete echocardiographic
study including 2D parameters [TAPSE, S’TDI, Tei indice, Fractional
area change (FAC)], 2D strain and 3D and an unsedated cardiac MRI
in 26 consecutive patients with repaired TOF before pulmonary valve
replacement and one year after surgery. TAPSE, S’TDI and 2D strain
parameters were poorly correlated with MRI regarding RV function
assessment. FAC was well correlated with REVF before and after
PVR
(
r
=
0.70,
p
<
0.01 and
r
=
0.68,
p
<
0.01, respectively). Despite
RV volume underestimation, 3D analysis using dedicated software
was well correlated with MRI values in both pre- and post-operative
assessment (
r
=
0.88,
p
<
0.01 and
r
=
0.91,
p
<
0.01, respectively for
RV end-diastolic volume;
r
=
0.92,
p
<
0.01 and
r
=
0.95,
p
<
0.01,
respectively for RV end-systolic volume).
Conclusion
: A global approach of RV function using 2D (FAC) or
(3D) parameters seemed reliable in patients with repaired TOF. The
commonly used TAPSE and S’ TDI focused on segmental analysis
of RV inflow were less sensitive, probably because RV inflow is less
affected by RV remodelling related to initial surgical repair.
45: CONGENITAL ANOMALIES OF THE MITRAL VALVE: A
CLINICAL AND ECHOCARDIOGRAPHIC STUDY
Nilda Espinola-Zavaleta, Maria Elena Soto, Eulo Lupi
Instituto Nacional de Cardiología Ignacio Chávez, Mexico City,
Mexico
Background:
Congenital anomalies of the mitral valve (CAMV)
comprise a wide range of leaflet and subvalvular apparatus anoma-
lies. Their presentation in adults is not frequent.
Objective:
In this work, we assessed the clinical and echocardio-
graphic aspects as well as the treatment of five adult patients with
CAMV.
Methods:
A complete clinical history was taken for each patient and
also an electrocardiogram, chest X-ray and transthoracic echocar-
diogram.
Results:
Two patients were in functional class (FC) I, one in FC II,
and two in FC III of the New York Heart Association. Diagnoses
were: prolapsed mitral valve with severe mitral failure; parachute
mitral valve associated with a subvalvular aortic fibrous ring and
patent ductus arteriosus; trileaflet mitral valve with subaortic
obstruction; double mitral orifice associated with bicuspid aorta and
aortic coarctation; and tunnel-forming mitral valve associated with
ostium primum interatrial communication and pulmonary arterial
hypertension and pulmonary artery hypertension. One patient was
subjected to mitral valve change, one to dilation of the aortic coarcta-
tion, and another was put on sitaxentan treatment, with improvement
in the FC. The two remaining patients are awaiting surgery.
Conclusions:
Review of these cases with CAMV reveals the rele-
vance of the echocardiogram in evaluation of the mitral valve and
subvalvular apparatus, because it allows for identification of different
