CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
139
Conclusion:
A syncope unit for the paediatric population with a
dedicated team improved diagnostic processes, reduced hospitalisa-
tion and decreased syncope recurrence when adapted follow up was
proposed.
94: THE IMPACT OF HUMAN DEVELOPMENT INDEX
ON SURVIVAL OF CHILDREN AND ADOLESCENTS WITH
RHEUMATIC HEART DISEASE HOSPITALISED FOR
HEART FAILURE IN BRAZIL
Vitor Manuel Pereira Azevedo, Regina Elizabeth Muller, Renato
Kaufman, Marco Aurelio Santos, Rogerio Brant Martins Chaves, Arn
Migowski Rocha Santos, Márcia Cristina Chagas Macedo Pinheiro,
Regina Maria de Aquino Xavier
National Institute of Cardiology, Rio de Janeiro, Brazil
Background:
Rheumatic heart disease (RHD) is still the main aetiol-
ogy of acquired heart disease in children and adolescents worldwide.
The major outcomes are heart failure (HF) and death. Their survival
rate after the onset of HF is unknown. In addition, the impact on
prognosis of social conditions in an individual community’s human
development index (HDI) remains unknown.
Purpose:
To assess children and adolescents’ survival rate with RHD
and HF, using probabilistic database linkage methods and to study the
influence of geographic regions and HDI on the prognosis.
Methods:
We performed probabilistic database linkage from
Brazilian hospital admission and death certificates (2001–2007).
We used Chi-square, analysis of variance, and Kaplan-Meier method
for survival curves, and compared groups by log-rank tests. We esti-
mated hazard ratios (HR) with 95% confidence intervals, followed
by Cox proportional hazards model. The significance was achieved
at
p
<
0.05.
Results:
Seven hundred and eighty patients were hospitalized for
the first time for RHD and HF, with 421 (54.0%) deaths in seven7
years of follow up. The median age was 12.8
±
4.36 (4–19) years
old, and 53.8% were boys. The overall survival rates were 61.4% at
one, 54.9% at two and 37.2% at six years. There was no difference in
survival between genders (
p
=
0.107), but by geographic regions (p
=
0.0001), with the lowest in north and north-east regions. HDI was
lower in the north (0.727
±
0.727) and north-east (0.682
±
0.078)
compared with the mid-west (0.796
±
0.049), south-east (0.784
±
0.051), and south (0.800
±
0.038) regions (
p
<
0.0001). With Cox
analysis, the increase in the overall HDI of 0.01 points reduced the
HR for death (0.959; 0.949–0.970;
p
<
0.001), as for income (0.966;
0.958–0.975;
p
<
0.001), longevity (0.961; 0.947–0.974;
p
<
0.001),
and educational (0.968; 0.958–0.977;
p
<
0.001) criteria.
Conclusion:
Patients with RHD hospitalised for HF are at increased
risk of death. An increase of 0.01 point in HDI reduces that risk.
97: ATRIAL SEPTAL DEFECT IN INFANCY: SINGLE-
CENTRE EXPERIENCE
Neville Solomon, Ganapathy Subramaniam, CS Muthukumaran,
Prasad Manne, Shapna Varma, Kothai
Apollo Children’s Hospital, Chennai, India
Background
: Isolated ASD usually does not present in infancy, and
such presentation should prompt careful search for additional lesions.
It is also known that the development of pulmonary vascular disease
is not uniformly related to age or degree of shunting across the ASD.
We present our experience in the management of five patients who
were operated in infancy.
Methods
: Between January 2009 and June 2012, five patients were
operated on with an isolated diagnosis of ASD, mean age was six
months, weight was 4.5 kg. Three were operated for failure to thrive,
one for repeated respiratory tract infections and one had an emer-
gency operation as the child was ventilator dependent with no other
associated anomalies or infection. Two children had cathetersation
before surgery to ensure that (1) there were no associated lesions, (2)
the LV end-diastolic pressure was not elevated, and (3) the pulmonary
vascular resistance was reversible. All had autologous pericardial
closure. Two patients had a prolonged postoperative course (15 and
28 days) due to signs and symptoms of RV failure. There was no
mortality.
Results
: The mean follow-up duration was 18 months (six months
to three years). Three children have normalised pulmonary pressures
with good catch-up growth. Two children still have elevated PAP
with mild FTT, and they are being followed up closely. They are on
sildenafil and bosentan.
Conclusion
: ASD can present in infancy, and would benefit by surgi-
cal closure. A proportion of them will have pulmonary hypertensive
issues. Whether a concomitant lung biopsy or a fenestrated closure
would prognosticate and hasten their postoperative course needs to
be evaluated.
102: NEW INSIGHTS INTO ASPECTS OF PULMONARY
DIFFUSING CAPACITY IN FONTAN PATIENTS
Lars Idorn
1,2
, Birgitte Hanel
2
, Annette Jensen
1
, Klaus Juul
2
, Jesper
Reimers
2
, Kim Nielsen
2
, Lars Søndergaard
1
1
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
2
Department of Paediatrics, Rigshospitalet, Copenhagen, Denmark
Background:
Functional univentricular heart patients were palliated
in the morning. Fontan patients lack a sub-pulmonary ventricle and
consequently have non-pulsatile pulmonary blood flow. They are
known to have reduced pulmonary diffusing capacity, however, the
cause of this reduction remains unclear. We aimed to assess possible
determinants in the aetiology of reduced diffusing capacity and to
assess if it could be increased. Furthermore, we aimed to search for
predictors of reduced diffusing capacity.
Methods:
Eighty-seven Fontan patients (mean age 16.3
±
7.6 years)
performed sitting pulmonary function tests using the single-breath
method and two different mixtures of gas. Furthermore, 72 of the
87 patients performed a maximal cycle ergometer test using the
Innocor
TM
rebreathing technique, thereby estimating cardiac output
and stroke volume. Ten Fontan patients and nine matched controls
performed a supine pulmonary function test after a supine rest.
Results:
In the sitting pulmonary function test, mean
z
-scores were:
diffusing capacity corrected for haemaglobin and alveolar volume
(DLCOc/VA): –2.38
±
1.20, alveolar capillary membrane diffusing
capacity: –0.14
±
0.84, and pulmonary capillary blood volume (Vc):
–2.04
±
0.80. In the supine compared to sitting pulmonary function
test, DLCOc/VA increased 51.7
±
11.9% in the Fontan group and
23.3
±
17.7% in the control group (
p
<
0.001) and Vc increased 48.3
±
17.4% in the Fontan group and 20.2
±
13.9% in the control group
(
p
=
0.001). In a univariate and multiple linear regression analysis
including explanatory variables of surgical data and exercise data
at rest and peak exercise, resting cardiac index was an independent
predictor of sitting DLCOc/VA (regression coefficient; 0.18,
p
<
0.001).
Conclusions:
Pulmonary diffusing capacity was reduced in Fontan
patients due to reduced pulmonary capillary blood volume while
the function of the alveolar capillary membrane was preserved.
The diffusing capacity was highly increasable in Fontan patients
compared to controls and resting cardiac index was an independent
predictor of diffusing capacity.
103: ARRHYTHMIA AND EXERCISE INTOLERANCE IN
FONTAN PATIENTS: CURRENT STATUS AND FUTURE
BURDEN
Lars Idorn
1,2
, Klaus Juul
1
, Annette Jensen
2
, Helle Andersen
3
, Jesper
Reimers
1
, Keld Sorensen
4
, Lars Søndergaard
2
1
Department of Paediatrics, Rigshospitalet, Copenhagen, Denmark
2
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
3
Department of Paediatrics, Odense University Hospital, Odense,
Denmark
4
Department of Cardiology, Aarhus University Hospital, Skejby,
Aarhus, Denmark
