CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
160
AFRICA
significantly decreased in iPAH vs cPAH patients during follow up.
In iPAH patients, survival was significantly different based on RV
function cut-off points (RV fractional area changes
<
than 15.5%,
RV end-systolic area
>
than 18.4 cm
2
/m
2
, RV end-diastolic diameter
in cm
z-
score
>
than 4.8 and TAPSE
z-
score
<
than –4.3).
Conclusion:
Conventional echo RV function indices including RV
end-diastolic area, fractional area of change and tricuspid annular
excursion appear to be useful for prognosis in children with PAH.
375: ARTERIAL SWITCH OPERATION: TIMING OF
SURGERY BASED ON NEUROIMAGING
Ievgeniia Iershova
1
, Tetyana Yalynska
1
, Andrii Maksymenko
2
, Ilya
Yemets
2
1
Department of Radiology, Ukrainian Children’s Cardiac Centre,
Ukraine
2
Department of Cardiology, Ukrainian Children’s Cardiac Centre,
Ukraine
Objectives:
We examined the relationship between duration of pre-
operative hypoxaemia and prevalence of postoperative brain injury in
neonates with TGA who were managed with two different strategies.
Methods:
From September 2009 to March 2012, 93 newborns with
TGA underwent brain MRI. Patients were divided in two groups
according to ASO time. Group A included 35 patients who under-
went surgical repair in the first hours of life (4
±
2 hours). MRI
was performed pre-operatively in patients aged 3.6
±
1.9 hours, 30
of them had postoperative MRI at 10.8
±
3.2 days of age. Group
B included 58 patients with a conventional surgical approach who
underwent ASO at the age of 8.1
±
4.0 days; in 43 patients BAS was
performed prior to surgery. All of them had pre-operative MRI at
age 6.6
±
4.0 days. Correlations between MRI findings and systemic
arterial oxygen saturation were analysed.
Results:
Parenchymal brain damage was diagnosed in 40% of
patients (
n
=
12) from gGroup A in comparison to 57% (
n
=
33)
from group B. Postoperative parenchymal brain damage was limited
to WMI. There was no focal arterial brain stroke or basal ganglia
injury in group A. In group B arterial stroke was diagnosed in 26%
of patients (
n
=
15). We found a correlation of risk of brain injury
with level and duration of systemic hypoxaemia. In patients with
WMI, the average value of SaO
2
was 60.2
±
13.7% compared to 77.5
±
8.4% in patients without brain injury (
p
<
0.001). The mean age in
newborns with WMI was 7.25
±
4.2 days and –4.6
±
3.1 (
p
<
0.001)
without it. Mean age for BAS in neonates with brain stroke was 6.7
±
2.9 days, and without stroke 2.5
±
1.5 days.
Conclusion:
Prolonged systemic hypoxaemia is associated with
higher risk of brain injury. Our brain MRI-based research shows that
early TGA repair enables prevention of brain injury associated with
prolonged systemic hypoxaemia.
378: CORRELATION BETWEEN QRS DURATION, PULMO-
NARY ARTERY REGURGITATION AND RIGHT VENTRI-
CLE PERFORMANCE INTOTALLY CORRECTEDTETRAL-
OGY OF FALLOT PATIENTS
Asadolah Tanasan
1
, Armen Kocharian
2
, Kayhan Sayadpour
2
, Farah
Payravian Kazerooni
3
, Puya Tanasan
4
1
Paediatric Cardiology, Hamedan University, Iran
2
Paediatric Cardiology, Children’s Medical Centre, Tehran, Iran
3
Paediatric Cardiology, Shiraz University, Iran
4
Tehran University of Medical Sciences, Tehran, Iran
Background:
Tetrallogy of Fallot (TOF) is the most common cyanot-
ic congenital heart disease and total correction has a good prognosis.
Despite this progress, pulmonary artery regurgitation and progressive
disorders of the right ventricle affect the long-term prognosis after
total corrective surgery by causing fatal arrhythmias and death. In
this study we reviewed the correlation between QRS duration with
pulmonary artery regurgitation and right ventricle performance.
Methods:
We reviewed 57 TOF patients with total corrective surgery
who returned to the paediatric cardiology clinic at the Children’s
Medical Centre of Tehran. They had 13-lead ECGs to calculate
QRS duration, continuous Doppler echocardiography to calculate
pulmonary artery regurgitation (total time of pulmonary artery insuf-
ficiency/diastolic time), and Tei index to assess performance of the
right ventricle. QRS duration was measured in milliseconds (ms) in
the D2 lead and the patients were categorised into the groups. Group
1 was patients with normal QRS and QRS duration
<
120 ms. Group
2 was patients with long QRS and duration between
≤
120 and
<
160 ms. Group 3 patients had QRS duration
≥
160 ms. Pulmonary
artery regurgitation was measured as a percentage and its index (PRi)
calculated. The group with mild regurgitation was PRi
≥
70% and the
group with severe regurgitation was PRi
<
70%.
Result:
Twenty-one of 57 patients were in group 1 (36.8%). Among
the 36 patients with long QRS, 24 patients (42.1%) were in group 2
and 12 patients (21.1%) in group 3, and had a QRS duration
>
160
ms. Only one patient had a QRS duration
>
180 ms. PRi in group 1
was 80
±
12% and PRi in groups 2 and 3 were 75
±
8.8 and 63
±
15 respectively, which was significantly different (
p
<
0.001). Right
ventricular function (RV MPI) in group 1 was 0.27
±
0.13, in groups
2 and 3, it was 0.32
±
0.12 and 0.34
±
0.15, respectively, which was
not significantly different (
p
=
0.143).
Conclusion:
Increments in QRS duration of more than 120 ms in
totally corrected TOF patients could be relevant to indicate increases
in pulmonary artery regurgitation.
380: DEXTROCARDIA, SITUS INVERSUS AND CYANOTIC
CONGENITAL HEART DISEASE WITH MULTIPLE CARDI-
AC DEFECTS IN A NIGERIAN INFANT: A CASE REPORT
Chika Duru
1
, Barbara Otaigbe
2
, Oliemen Peterside
1
, Oyedeji
Adeyemi
1
, Felix Akinbami
1
1
Department of Paediatrics, Niger Delta University Teaching
Hospital, Nigeria
2
Department of Paediatrics, University of Port Harcourt Teaching
Hospital, Nigeria
Background:
The association of dextrocardia with situs inversus is
reported to be 1:2 500 to 1:20 000; dextrocardia with situs solitus
being less common. The incidence of congenital heart disease varies
from 10% in situs inversus to up to 90% in situs solitus. We report an
unusual case of dextrocardia, situs inversus, and cyanotic congenital
heart disease with multiple heart defects.
Methods:
We carried out a retrospective review of case notes.
Results:
A seven-month-old Nigerian male infant presented at the
children’s out-patient clinic with symptoms of recurrent cough and
bluish discolouration of the lips. On examination, he was found to
be centrally cyanosed with grade 3 digital clubbing and a right-sided
apical impulse. He had widely spaced nipples but no other dysmor-
phic features, and weighed 7.6 kg. His respiratory rate was 40 cycles
per minute. He had normal volume pulses with a heart rate of 140
beats per minute, the first heart sound was normal while the second
was single and soft with no murmur.
He was the product of term gestation delivered by spontaneous
vertex to a 32-year-old woman. There was no history of exanthe-
matous febrile illness, ingestion of herbal concoctions or exposure
to irradiation in pregnancy. Yhere was no history of hypertension or
heart disease in the family. His birth weight was 3.2 kg. There was
no history of feeding difficulties but occasional respiratory distress.
Chest radiograph revealed dextrocardia with situs inversus.
Abdominal ultrasonography confirmed a left-sided liver and gall
bladder with a right-sided spleen. Echocardiogram revealed atrial
situs inversus, a common atrio-ventricular valve with moderate
regurgitation, non-restrictive ventricular septal defect, biventricular
hypertrophy, an atretic pulmonary artery and a patent ductus arterio-
sus. This child has been referred for urgent open-heart surgery
Conclusion:
This case shows that dextrocardia when associated with
situs inversus can be associated with multiple congenital cardiac
anomalies.
