CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
161
386: PATIENTS WITH UNBALANCED ATRIO-VENTRICU-
LAR SEPTAL DEFECT AND SMALLER LEFT VENTRICLE:
THE OUTCOME
Andrea Kantorova
1
, Monika Kaldararova
1
, Matej Nosal
1
, Viktor
Hraska
2
1
Slovak National Institute of Cardiovascular Diseases, Children’s
Cardiac Centre, Slovak Republic
2
German Children’s Cardiac Centre, Sankt Augustin, Germany
Background:
Borderline unbalanced atrio-ventricular canal defect
and borderline small left ventricle (uCAVC-small LV) is characterised
by an atrio-ventricular valve index (AVVI) of 0.30–0.67 and left–right
ventricle long-axis ratio (LV/RV)
<
0.65 by echocardiography. The
aim of this study was to compare long-term outcome of these patients
after biventricular repair versus univentricular palliation.
Patients:
Between 1992 and 2012, 18 patients (eight male, 10
female) with uCAVC-small LV underwent surgery; seven patients
(group 1) had univentricular palliation due to associated atrio-
ventricular valve (AV) malformations and/or large ventricular septal
defect. In 11 patients (group2) biventricular repair was possible.
Methods:
Differences at time of surgery and prospective follow up
(FU) with repeated clinical and echocardiographic evaluation were
performed. Differences in outcomes after biventricular repair versus
univentricular palliation were evaluated.
Results:
Group 1/group 2 at time of surgery (SURG): median age
8.9/2.7 months (
p
=
0.01). Two early deaths were present in: group
1 on postoperative day 306 (sepsis); group 2 on day 40 (cardiac
failure). Sixteen patients underwent regular FU, group 1/group 2:
median length 8.6/5.9 years
(
p
=
0.19). Comparing progress accord-
ing to patients’ weight: all patients were under the 3rd percentile at
SURG, not changing during FU in group 1 (
p
=
0.2), but reaching
normal weight five years after operation in group 2 (
p
=
0.042).
More than mild AV/mitral valve regurgitation in group 1/group 2
was present: in two (28.6%)/four (36.4%) patients (
p
=
0.07). Late
re-operation for severe regurgitation was performed in two patients,
with no difference between group 1 and group 2 (
p
=
0.94): AV
valvuloplasty in one (14.3%) vs mitral valvuloplasty in one (9.3%),
2.8/4.6 years postoperatively. Mitral valve (group 2) showed normal
long-term growth [median
z
-score at SURG –2/+0.26 at the last visit
(
p
=
0.02)].
Conclusions:
When possible, in patients with uCAVC-small LV
biventricular repair should be done. During FU these patient gener-
ally do better and the mitral valve reaches normal values. On the
other hand, mitral as well as AV valve regurgitation may represent a
severe problem after both types of correction.
388: HOW DOES AGE AFFECT LEFT VENTRICULAR
TWIST IN CHILDREN?
Lucy Eun, Nam Kyun Kim, Jae Young Choi
Severance Cardiovascular Hospital,Yonsei University Health System,
Seoul, South Korea
Background:
The recently introduced method, speckle tracking
echocardiography, represents a simplified, objective and angle-inde-
pendent modality for quantification of regional myocardial deforma-
tion. As previously published, there was no significant change in LV
torsion with aging. There may however be some difference in LV
rotation at the base and apex with aging.
Objective:
The purpose of this study was to assess the relationship of
LV rotation for torsion twist with aging in children.
Methods
: Forty healthy children were recruited and divided into two
groups of 20 pre-school children (age 2–6 years) and 20 school-age
children (7–12 years). After obtaining conventional echocardio-
graphic data, apical and basal short-axis rotations were assessed with
speckle tracking echocardiography. LV rotations in the basal and
apical short-axis planes were determined on six myocardial segments
along the central axis.
Results
: There was no significant change in apical and basal LV rota-
tion with age between preschool and school-age children. However,
there was a change between the two age groups with each basal and
apical rotation. With basal and apical rotation, the values of pre-school
children were higher than those of school-age children at the six
anteroseptal, anterior, lateral, posterior, inferior and septal segments.
Conclusion
: There was a trend of higher rotation values in pre-school
children than in school-age children, with decreased rotation and
torsion values with aging during childhood from two to 14 years old.
Although there was no statistically significant age-related change in
LV torsion from the rotation data, the decreasing trend with aging
for rotation and torsion twist during childhood warrants further
investigation.
393: A FEASIBILITY STUDY OF LEFT VENTRICULAR
ROTATION AND TORSION BY TWO-DIMENSIONAL ECHO
SPECKLE TRACKING DURING SEMI-SUPINE CYCLE
EXERCISE IN CHILDREN
Shreya Moodley
1
, Astrid De Souza
1
, Terri Potts
1
, Thomas Rowland
2
,
James Potts
1
, George Sandor
1
1
British Columbia Children’s Hospital and The University of British
Columbia, Canada
2
Baystate Medical Centre, Springfield, USA
Background:
Rotation (R) of the LV apex and base produces torsion
(T), an important component of the active phase of the cardiac
cycle. Ventricular dysfunction leads to inadequate R and abnormal
T. Changes in these aspects of ventricular function during exercise
can be used to assess myocardial function. Echo speckle tracking can
be used to measure LV rotation from which T can be calculated. We
sought to determine the feasibility of measuring R and T in controls
(CON) and paediatric transplant patients (PT) during incremental
semi-supine cycle exercise (SSCE).
Methods:
Fourteen CON (median age: 11.1 years) and five PT
(median age: 14.8 years) exercised to volitional fatigue. 2D echo
basal and apical short-axis views were obtained at rest, at each stage
of SSCE, immediately and three minutes post-exercise. R and T were
obtained by standard techniques. Each variable was measured three
times and averaged. Coefficients of variation (CV) were calculated.
Results:
Data acquisition was increasingly difficult with increasing
exercise intensity. At peak exercise, it was possible to obtain data
in only 5/14 CON and 2/5 PT; however, sub-maximal exercise data
could be obtained in 11/14 CON and 5/5 PT and immediately post-
exercise data in 9/14 CON and 5/5 PT. The CV was as high as 50%.
Conclusions:
This preliminary study shows that measurement of
R and T is feasible at rest and during sub-maximal exercise, but
difficult to measure with increasing exercise intensity during SSCE.
Failure to document an increase in R and T during exercise may
reflect the technical difficulties of this method and individual meas-
urement variability.
394: NON-INVASIVE ASSESSMENT OF VENTRICULAR-
VASCULAR COUPLINGAND HYDRAULIC EFFICIENCY IN
POST-OPERATIVE CONGENITAL AND ACQUIRED HEART
DISEASE
Shreya Moodley, Yvan Mivalez, Mande Leung, Astrid De Souza,
James Potts, George Sandor
British Columbia Children’s Hospital and The University of British
Columbia, Canada
Background:
Ventricular-vascular coupling (V-VC), the ratio of
LV elastance (E
LVI
) to arterial elastance (E
AI
), measures the optimum
cardiovascular interaction. Hydraulic efficiency (HE), the ratio of
mean to total power, is another measure of V-VC. We sought to
determine E
AI
:E
LVI
and HE in healthy controls and patients with post-
operative congenital and acquired heart disease and the relationship
between these measurements.
Methods:
Subjects consisted of 20 healthy controls (CON), 17
Marfan, 17 tetralogy of Fallot (TOF), 14 coarctation (CoA), and six
transposition of the great arteries (TGA) patients. Systolic blood
