CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
155
six cases and discuss their management issues.
Methods:
We conducted a retrospective analysis of seven pregnan-
cies in six patients with pacemaker implantation from 2008 to 2012
in our institution. The course of pregnancy, perinatal outcome, mater-
nal baseline disease, and pacing mode were studied.
Results:
All six patients had atrio-ventricular block (AVB). Of these,
three patients had structural cardiac lesions (single ventricle in two
and atrio-ventricular septal defect in one), and the other patients
had normal structure heart (cardiomyopathy in one and congenital
AVB in two). In five patients, implantation of the pacemaker was
performed before pregnancy. The mode of pacemaker was DDD in
four (transvenous lead), and VVI in one patient (epicardiac lead).
One patient who had congenital AVB required pacemaker implanta-
tion during pregnancy due to a large difference between the atrial and
ventricular rate. There was no maternal or foetal death. Three patients
had four uneventful vaginal deliveries. One patient delivered a baby
by cesarean section for intra-uterine growth retardation and non-
reassuring foetal status. One patient who had a single right ventricle
with a pacing due to surgical AVB developed cardiac decompensa-
tion in the third trimester, and was induced at 36 weeks’ gestation.
One patient with VVI pacing system had to have the ventricular
pacing rate changed due to failure of cardio-acceleration during the
intrapartum period.
Conclusion:
There were no serious maternal or neonatal complica-
tions. The outcomes of pregnancy in patients with pacemakers were
uneventful by multidisciplinary medical care.
309: LONGITUDINAL COMPARISON OF OUTCOMES
BETWEEN PRE VERSUS POSTNATALLY DIAGNOSED
INFANTS WITH TRANSPOSITION OF THE GREAT ARTER-
IES
Nelangi Pinto
1
, Jaewhan Kim
2
, Sergey Krikov
3
, Michael Puchalski
1
, L
Minich
1
, Norman Waitzman
2
, Lorenzo Botto
3
1
Division of Cardiology, Department of Paediatrics, University of
Utah, USA
2
Department of Economics, University of Utah, USA
3
Division of Medical Genetics, Department of Paediatrics, University
of Utah, USA
Prenatal diagnosis of transposition of the great arteries (TGA) may
decrease peri-operative morbidity but few data exist regarding its
long-term impact or costs. Linking the Utah Birth Defects Network
(UBDN, a statewide surveillance system) and the Utah Population
Database (UPDB, statewide in-patient discharge abstracts and
charges) captures all hospitalisations regardless of whether ICD-9-
DM codes include the primary heart defect. We sought to determine
differences in longitudinal medical encounters and in-patient costs
for prenatally (predx) and postnatally (postdx) diagnosed TGA.
TGA cases identified at the UBDN (born 1997–2009) were
reviewed and preterm gestation excluded. Linkages to the UPDB iden-
tified in-patient encounters and charges for cases (up to 12/2011) and
their mothers (10 months prior to birth). Charges were adjusted to 2011
using the consumer price index and cost/charge ratio. We compared
cost, using generaliszed linear regression with gamma distribution
and log link function, and in-patient encounters, using multivariate
modeling, adjusting for demographic and clinical risk factors.
Of 108 cases identified, 12 (11%) were prenatally diagnosed.
Predx were similar to postdx in gestational age (38.6 vs 38.8 weeks),
birth weight
<
2.5 kg (0 vs 4%,
p
=
0.62) and additional congenital
defects (8 vs 10%,
p
=
0.39). There were seven deaths (6%) with no
difference in survival between groups (mean follow up 7.4 years).
Predx cases had similar hospitalisations (median two in both groups),
but higher total LOS (23 vs 19 days,
p
<
0.004) as well as higher costs
for both mothers ($8 200 vs $5 200) and index cases ($290 000 vs
$151 000) after adjusting for gestational age, birth weight and addi-
tional congenital defects (
p
=
0.001).
Predx TGA cases had longer hospitalisations after adjusting for
available risk factors. Both mothers and infants in the predx group
had higher longitudinal in-patient medical costs. Ongoing investiga-
tion should explore specific cost components responsible, including
additional testing, surgical delays and other risk factors.
311: MYOCARDIAL PERFORMANCE INDEX (TEI INDEX)
IN CHILDREN AND ADOLECENTS IN A REGION OF
SOUTHERN BRAZIL
Vera Regina Fernandes
1
, Mauricio Laerte Silva
1
, Mario Sãrgio Soares
De Azeredo Coutinho
2
, Leandro Latorraca Ponce
1
1
Hospital Infantil Joana Gusmão, Florianopolis, Santa Catarina, Brazil
2
Hospital Universidade, Federal De Santa Catarina, Brazil
Introduction:
Myocardial performance index (MPI) is a relatively
simple and non-invasive echocardiographic approach to a quantita-
tive assessment of the global ventricular cardiac function.
Objectives:
The main purpose of this study was to define values for
the right and left ventricular MPI in healthy children and adolescents
and to compare the values between healthy subjects and a small
sample of patients with dilated cardiomyopathy (DCM).
Methods:
Observational and cross-sectional study was done at the
Hospital Infantil Joana de Gusmão, in Florianopolis, Santa Catarina,
Brazil. The left ventricular MPI (LVMPI) and right ventricular MPI
(RVMPI) were measured in 121 healthy children and adolescents
and in seven children with DCM. Also measured were the mitral
valve peak E/A ratio (MVE/A) and tricuspid valve peak E/A ratio
(TVE/A). The index was obtained from conventional inflow and
outflow Doppler velocity waveforms of each ventricle. For evalua-
tion of the intra- and inter-observer reproducibility, the author and
another independent observer analysed 28 children and adolescents,
randomly selected from the healthy group, at a minimum of 30-day
intervals between the measurements.
Results:
Among the healthy individuals, the age ranged from three to
173 months. The LVMPI was 0.37
±
0.08, RVMPI was 0.32
±
0.06,
peak MVE/A ratio was 2.13
±
0.57 and the peak TVE/A ratio was
1.01
±
0.08. Among the DCM children, the LVMPI was 1.16
±
0.16,
RVMPI was 1.05
±
0.42, peak MVE/A ratio was 1.14
±
0.38 and the
peak TV/EA ratio was 1.01
±
0.08.
Conclusions
: Age did not affect MPI in healthy children and adoles-
cents. The LVMPI and RVMPI to DCM individuals were signifi-
cantly prolonged compared to the values in healthy children and
adolescents. The intra-observer reproducibility was high for LVMPI
and moderate for RVMPI and inter-observer reproducibility was
considered high for LVMPI and low for RVMPI.
316: ARRHYTHMIA PHENOTYPE DURING FOETAL LIFE
PREDICTS LQTS MUTATION: RISK STRATIFICATION OF
PERINATAL LONG QT SYNDROME
Bettina Cuneo
1
, Denver Sallee
2
, Hitoshi Horigome
3
, Anita Moon-
Grady
4
, Michael Ackerman
5
, D Woodrow Benson
6
1
The Heart Institute for Children, Advocate Hope Children’s Hospital,
Chicago, IL, USA
2
Sibley Heart Centre, Atlanta, GA, USA
3
Department of Paediatrics, The University of Tsukuba, Tsukuba,
Japan
4
The University of San Francisco Medical Centre, San Francisco,
CA, USA
5
Departments of Medicine and Paediatrics, Mayo Clinic, Rochester,
MN, USA
6
Division of Cardiology Children’s Hosptial of Milwaukee,
Milwaukee, WI, USA
Background:
Torsades de pointes (TdP) and/or second-degree atrio-
ventricular block (2° AVB) are signature rhythms for perinatal LQTS,
known for their high morbidity and mortality rates. We hypothesised
that the clinical profile of patients with these complex foetal arrhyth-
mias might be genotype specific.
Methods:
Perinatal records of LQTS subjects exhibiting complex
foetal arrhythmias were reviewed. Foetal echocardiograms, neonatal
ECG and genetic testing were evaluated.
