Cardiovascular Journal of Africa: Vol 24 No 1 (February 2013) - page 138

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013 136 AFRICA
the arrhythmia (control of the HR, with intermittent periods of sinus
rhythm) and amiodarone was the most effective anti-arrhythmic drug,
either alone or in combination with other drugs (p = 0.02). During
follow up, all patients persisted with intermittent JET, with HR under
control and within normal ranges for age.
Conclusions: Children younger than one year old presented gener-
ally with incessant JET, ventricular dysfunction and heart failure
requiring admission and a combination of drugs.
In children older than one year, the JET was better tolerated, with
less HR and occasionally paroxistic. The treatment with amiodarone
either alone or in combination with other drugs was effective in
controlling HR, but the arrhythmia remained in all patients during the
follow up, without spontaneous cure in serial Holter studies.
59: SCALING CARDIAC STRUCTURES IN CHILDREN
Magnus Dencker1, Ola Thorsson 1, Magnus K Karlsson2, Christian
Lindãn2, Lars B Andersen 3, Per Wollmer1
1Clinical Physiology and Nuclear Medicine Unit, Sk åne University
Hospital, Denmark
2Clinical and Molecular Osteoporosis Research Unit, Sk åne
University Hospital, Denmark
3University of Southern Denmark
Background: Body composition influences cardiac dimensions.
Body surface area (BSA) or body mass are the most commonly used
denominator in paediatric echocardiography to normalise cardiac
dimensions for differences in body size. Lean body mass (LBM) has
been suggested by many investigators to be the best scaling factor.
Data on LBM are, however, not available in clinical practice. We
assessed whether cardiac dimensions normalised by LBM compared
with cardiac dimensions normalised by various anthropometric meth-
ods in younger children.
Methods: This was a cross-sectional study of 139 healthy children
(boys n = 82 and girls n = 57) aged 9.7 ± 0.6 years (range 7.9–10.7).
Dual-energy X-ray absorptiometry measured total lean body mass
(LBM). Echocardiography was performed with two-dimensional
guided M-mode according to current guidelines and left atrium diam-
eter (LA), left ventricular diastolic diameter (LVDD), left ventricular
systolic diameter (LVSD), septal wall thickness in diastole (Sep),
posterior wall thickness in diastole (Post) were measured and left
ventricular mass (LVM) was calculated.
Results: There were significant (p < 0.05) univariate correlations
between various cardiac structures normalised by LBM and with
various anthropometric methods.
Conclusions: This investigation showed close correlations between
cardiac dimensions normalised by LBM and by BSA or height2.7.
These results support the use of them as appropriate denominators
in paediatric echocardiography to normalise cardiac dimensions for
differences in body size.
63: EVIDENCE FOR AORTOPATHY OF THE NATIVE
DESCENDING AORTA IN CHILDREN WITH HYPOPLAS-
TIC LEFT HEART SYNDROME
Inga Voges1 , Michael Jerosch-Herold2, Christopher Hart1 , Gunther
Fischer1, Dominik Gabbert1, Ana Andrade 1, Minh Pham1, Hans-
Heiner Kramer1 , Carsten Rickers
1University Hospital of Schleswig-Holstein, Kiel, Germany
2Brigham & Women’s Hospital, Harvard Medical School, Boston,
USA
Background: Patients with hypoplastic left heart syndrome (HLHS)
after Norwood operation show dilatation and reduced distensibil-
ity of the reconstructed proximal aorta. Cardiovascular magnetic
resonance imaging and angiographic examinations indicate that the
native descending aorta is also dilated, but this has not been inten-
sively studied.
Methods: Seventy-nine children with HLHS in Fontan circula-
tion (6.4 ± 3.3 years) and 18 controls (6.8 ± 2.4 years) underwent
3.0-Tesla cardiovascular magnetic resonance imaging. Gradient-echo
ciné and phase-contrast imaging were applied to measure cross-
sectional areas, distensibility and pulse wave velocity (PWV) of
the entire thoracic aorta. Cross-sectional areas were compared with
normal values for healthy children.
Results: Patients had significantly elevated cross-sectional areas
of the descending aorta at different levels (p < 0.05). In 41 (51%)
patients they exceeded the 95th percentile. These HLHS patients also
showed a higher PWV of the descending thoracic aorta compared to
those with normal cross-sectional areas (4.0 ± 1.1 vs 3.4 ± 1.3 m/s, p
< 0.05). Distensibility of the descending aorta was not significantly
different between patients and controls (12.4 ± 6.5 vs 9.9 ± 3.0 10-3
mmHg-1, p > 0.05).
Conclusions: About half of our HLHS patients showed aortic dilata-
tion and increased PWV as a marker of aortopathy of the descending
aorta. These findings require further scientific evaluations to investi-
gate potential clinical implications in the Fontan circulation.
64: IMPAIRED AORTIC BIOELASTICITY IS ASSOCIATED
WITH DIASTOLIC DYSFUNCTION IN PATIENTS AFTER
SUCCESSFUL COARCTATION REPAIR
Inga Voges1, Julian Kees1, Michael Jerosch-Herold2, Christopher
Hart1, Dominik Gabbert1, Eileen Pardun1 , Hans-Heiner Kramer1,
Carsten Rickers1
1University Hospital of Schleswig-Holstein, Kiel, Germany
2Brigham & Women’s Hospital, Harvard Medical School, Boston,
USA
Background: Arterial hypertension and accelerated arteriosclerosis
are late complications even after successful coarctation (CoA) repair,
which may clinically affect left ventricular (LV) function in the
long-term follow-up. However, only few data exist on the occurrence
of abnormal bioelastic properties of the aortic root and their effect
on diastolic LV function in asymptomatic CoA patients at midterm
follow up. Therefore, we evaluated this question in children and
young adults after successful CoA repair using magnetic resonance
imaging (MRI).
Materials and methods: Fifty-two patients (18.9 ± 10.7 years) were
examined 14.6 ± 9.2 years after CoA repair using 3.0-Tesla MRI and
compared with 39 controls (17.1 ± 7.9 years). The data were used
to calculate aortic distensibility and pulse wave velocity (PWV)
at different levels. LV ejection fraction (EF), volumes (LVEDV,
LVESV) and mass were assessed from short axis views. Axial cine
images were used to measure left atrial (LA) volumes and functional
parameter (LAEFPassive, LAEFContractile, LAEFReservoir) as markers for dias-
tolic function.
Results: In patients aortic distensibility was reduced at all levels of
the thoracic aorta (aortic root: 5.5 ± 3.8 vs 7.6 ± 2.9 10-3mmHg-1,
ascending aorta: 5.8 ± 3.1 vs 9.1 ± 3.6 10-3mmHg -1, descending aorta
at the isthmus: 5.6 ± 3.0 vs 6.9 ± 2.1 10-3 mmHg-1, descending aorta
at the diaphragm: 6.7 ± 2.8 vs 8.3 ± 3.1 10-3mmHg-1; all p < 0.05) and
PWV in the aortic arch was significantly elevated (4.7 ± 1.8 vs 3.3 ±
0.6 m/s, p < 0.01). The minimal LA volume (LA-Volmin) and the LA
volume before atrial contraction (LA-Volbac) were higher in patients
(LA-Volmin: 25.3 ± 7.6 vs 20.8 ± 5.4 ml/m2, LA-Volbac: 33.2 ± 9.8
vs 26.8 ± 6.2 ml/m2; all p < 0.01). LAEFPassive and LAEFReservoir were
reduced (LAEFPassive: 31.7 ± 8.4 vs 38.3 ± 5.7 %; LAEFReservoir: 48.0 ±
7.2 vs 52.0 ± 7.1 %; all p < 0.01). LAEFReservoir and LAEFPassive correlated
negatively with aortic arch PWV (p < 0.05). LVEF, LVEDV, LVESV,
LV mass and blood pressures were not different compared to controls.
Conclusions: Patients after CoA repair show reduced aortic bioel-
asticity of the entire thoracic aorta and this likely contributes to LV
diastolic dysfunction. Therefore this aspect should be focused on
during long-term follow-up.
72: ECHOCARDIOGRAPHIC FEATURES OF CONGENI-
TALLY CORRECTED TRANSPOSITION OF THE GREAT
ARTERIES