CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
137
Xiao-jing Ma, Guo-ying Huang, Xue-cun Liang, Qi-shan Lin, Bing
Jia
Children’s Hospital, Fudan University, Shanghai, Peoples Republic
of China
Objective:
To elucidate the pathological anatomy of congenitally
corrected transposition of the great arteries (ccTGA) by echocardi-
ography.
Methods:
Twenty-seven consecutive patients (20 males and seven
females), aged from one month to 15 years, diagnosed as ccTGA by
echocardiography between June 2006 and June 2010 in our paedi-
atric heart centre were included. According to van Praagh sequen-
tial segmental analysis, transthoracic echocardiography includ-
ing M-mode, two-dimensional mode, colour Doppler, pulse-wave
Doppler and continous-wave Doppler was performed.
Results:
(1) Combination of atrio-ventricular discordance and
ventriculo-arterial discordance was diagnosed in all of the 27 cases.
Levocardia was detected in 23 cases, including 21 cases of {S, L,
L} and 2 cases of {I, D, D}, while dextrocardia with {I, D, D} was
seen in the other four cases. (2) Co-existence of atrioventricular
valvular abnormalities was seen in three cases, including complete
atrio-ventricular septal defect (two cases) and straddling tricuspid
valve (one case). In addition, functional tricuspid regurgitation was
detected in 19 cases (severe in four, moderate in eight and mild in
seven cases), and functional mitral regurgitation in 10 cases (severe
in one, moderate in one and mild in eight cases). Compared with
functional mitral regurgitation, functional tricuspid regurgitation was
more frequent (41.7 vs 79.2%) and worse (moderate to severe regur-
gitation 20.0 vs 63.2%). (3) Other co-existing abnormalities were
seen in 24 cases (88.9%), among which, ventricular septal defect
(18 cases, 66.7%) and left ventricular outflow obstruction (18 cases,
66.7%) were the most common structural lesions.
Conclusion:
Based on the findings of echocardiography, {S, L,
L} was the most frequent pathological anatomy of ccTGA, and
ventricular septal defect and left ventricular outflow obstruction were
the most common co-existing abnormalities. Additionally, attention
should be paid to the functional tricuspid regurgitation in patients
with ccTGA.
73: LUNG BIOPSY DIAGNOSIS OF OPERABILITY ASSOCI-
ATEDWITH CONGENITAL HEART DISEASEAND PULMO-
NARY HYPERTENSION IN 358 PATIENTS
Shigeo Yamaki
Japanese Research Institute of Pulmonary Vasculature, Japan
Background:
I performed a lung biopsy diagnosis in order to deter-
mine operability in a total of 358 patients over five years, as request-
ed by the departments of Paediatric Cardiology and Cardiac Surgery
from all over Japan, and introduced the prospective data collection.
Method:
Decision regarding surgery in simple cardiac anomalies
(SCA) or atrioventricular septal defect (AVSD) was based on the
index of pulmonary vascular disease. In total anomalous pulmonary
venous connection (TAPVC), the operative indication was deter-
mined by the degree of hypoplasia of the small pulmonary arteries.
Operability of the Fontan procedure was based on the degree of
residual medial hypertrophy after pulmonary artery banding.
Results:
In SCA, pathological examination revealed radical surgery
was indicated in 145 patients but was not indicated in 19. In simple
atrial septal defect (ASD), ASD closure was indicated in 21 patients
but not in six. Radical surgery was indicated in 50 patients with
AVSD but not in 12 –these 12 patients were all associated with Down
syndrome. In 26 patients with TAPVC, radical surgery was indicated
in all patients. In 68 Fontan candidates, surgery was not indicated in
49. Among seven patients with tetralogy of Fallot, one was not indi-
cated for radical surgery because of occlusive longitudinal smooth
muscle cells. Four patients with IPPHN were treated with nitric oxide
or bosentan.
Conclusion:
Although this was a prospective study in patients with
congenital heart disease and pulmonary hypertension, the results
have the confidence of cardiac surgeons, paediatric cardiologists
and cardiologists who asked for lung biopsy diagnosis of pulmonary
vascular disease.
77: CLINICAL IMPACT OF HUMAN RHINOVIRUS IN CHIL-
DRENWITH CONGENITAL HEART DISEASE
Janet Simsic
1
, Christina Phelps
1
, Andrew Yates
1
, Richard Fernandez
1
,
Jill Fitch
2
, Anthony Lee
2
, Eric Lloyd
2
, Joseph Tobias
3
, Patrick
Mcconnell
4
, Mark Galantowicz
4
1
Cardiology, Nationwide Children’s Hospital, Columbus, OH, USA
2
Critical Care, Nationwide Children’s Hospital, Columbus, OH, USA
3
Anaesthesia, Nationwide Children’s Hospital, Columbus, OH, USA
4
Cardiothoracic Surgery, Nationwide Children’s Hospital, Columbus,
OH, USA
Background:
Community-acquired bronchiolitis is common in
infants, and presents with varying clinical severity. Limited informa-
tion is available regarding the impact of human rhinovirus (HRV) on
the management of children with congenital heart disease (CHD).
The purpose of this review was to evaluate and describe the clinical
impact and management strategies of HRV in children with CHD.
Methods:
This was a retrospective review of children with CHD
hospitalised and diagnosed with HRV from 1 January to 1 May
2012. Outpatient, pre-operative, operative and postoperative vari-
ables were reviewed with an interest in management strategies and
clinical impact.
Results:
Nine patients tested positive for HRV. Median age was
five months (range 1–9); single-ventricle defects (
n
=
3); trisomy
21 (
n
=
2); community-acquired HRV (
n
=
5); nosocomial HRV
(
n
=
4); postoperative patients (
n
=
3). Surgical management was
altered with elective palliative procedure instead of complete repair
in two patients. Median length of mechanical ventilation associated
with HRV was 11 days (range 0–70); median length of non-invasive
ventilation was nine days (range 0–45). Postoperative hospital stay
increased significantly in patients with single-ventricle physiology
and in patients with trisomy 21 compared to a similar cohort without
HRV. Comprehensive stage II (BDG and Norwood type aortic arch
reconstruction) median length of stay 14 days without HRV vs 62
days with HRV; atrio-ventricular septal defect repair median length
of stay six days without HRV vs 72 days with HRV. There was one
death in this patient population that was not attributed to HRV.
Conclusions:
The clinical impact of HRV was significant in patients
with CHD undergoing cardiac surgery, especially in patients with
single-ventricle physiology and patients with trisomy 21. This study
emphasises the importance of pre-operative evaluation of respiratory
viral bronchiolitis in high-risk children prior to cardiac surgery.
80: CARDIAC ENTRAPMENT AND INJURY DUE TO
EPICARDIAL PACEMAKERWIRES
Walter Duncan, Angelica Oviedo, Eric Carreras, Benjamin Auld,
Andrew Campbell
Children’s Heart Centre, British Columbia Children’s Hospital and
The University of British Columbia, Vancouver, Canada
Placement of epicardial pacemaker wires in neonates and young
infants is a common procedure for congenital or surgically related
complete heart block. It is estimated that
>
40 000 epicardial pacing
systems were implanted in patients in North America over the past 20
years. Historically, the excess loops of the wires were placed in the
pericardial space to provide sufficient length for anticipated cardiac
and thoracic growth. Reports of cardiac compression by the pacing
leads are available in seven patients (incidence of
<
0.02%).
Case reports:
At our centre, we have now seen 3/93 patients (inci-
dence of 3.2%) with severe entrapment of the heart by fibrous
fixation of these wires to the atrio-ventricular groove. In one seven-
year-old patient, unidentified pacemaker lead compression was felt
to have caused sudden unexpected death. Post mortem angiography
confirmed compression of the circumflex coronary artery. Two other
