CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
165
perinatal transition in congenital heart disease. We sought to explore
the impact of the perinatal transition on myocardial function and
cerebral blood flow in hypoplastic left heart syndrome (HLHS).
Method:
Pregnancies with foetal HLHS were prospectively enrolled
(
n
=
8). Echocardiography was longitudinally performed at prenatal
(38
±
0.5 weeks) and postnatal (4 –12 hours, 24 hours, 48 hours, 3–5
days) time points. We assessed stroke volume (SV), heart rate (HR),
cardiac output (CO), and middle cerebral artery pulsatility index
(MCA-PI).
Results:
In late gestation, mean CO in foetal HLHS was 416
±
86
ml/kg/min and did not change at 4–12 hours after birth (414
±
49
ml/kg/min). However, at 24 hours, 48 hours and 3–5 days after birth
a significant increase in CO occurred (530
±
103, 597
±
142, 649
±
111 ml/kg/min, respectively) due to increases in both SV and more
so HR (
p
<
0.05). CO correlated positively with PaO
2
(
r
=
0.39,
p
<
0.05). During the same period, MCA-PI progressively increased from
the foetal stage through all time points (
p
<
0.05).
Conclusion:
In HLHS, in contrast to the normal perinatal transi-
tion, CO progressively increased from levels comparable to that in
the foetus at 4–12 hours, to more than 150% by 3–5 days. This was
likely secondary to decreasing pulmonary vascular resistance in the
presence of a patent ductus arteriosus. Changes in pulmonary vascu-
lar resistance may also contribute to increasing MCA-PI. Ongoing
investigations into the perinatal transition in HLHS with comparison
to normal neonates will provide further insight into how the myocar-
dium adapts in HLHS to postnatal demands and its influence on
peripheral circulation.
426: BRAINABSCESS IN CYANOTIC CONGENITAL HEART
DISEASE: A FIVE-YEAR REVIEW
Sukman Putra, Shierley Anggriawan, Mulyadi Djer, Nikmah Idris,
Sudigdo Sastroasmoro
Department of of Paediatrics and Child Health, University of
Indonesia/ RSCM, Jakarta, Indonesia
Background:
Brain abscess in cyanotic congenital heart disease
(CCHD) accounted for 5 to 10% of all kinds of brain abscess in chil-
dren. The prolonged uncorrected lesions, chronic hypoxaemia and
polycythaemia were the most common risk factors for brain abscess
in CCHD.
Objective:
To report the cases of brain abscess with CCHD in our
institution.
Methods:
A retrospective study was done of all patients admitted
to our institution with the diagnosis of brain abscess and cyanotic
congenital heart disease from July 2006 to July 2010.
Results:
There were nine patients, ranging in age from three to 11
years, of whom six were males and three females. The clinical pres-
entations were fever, vomiting, headache and seizure. Two patients
developed hemiparesis and five had seizures. The duration of fever
before admission was from 11 days to one month. Diagnosis was
confirmed by CT scan. The most common location of abscess was
the parietal lobe of the cerebral hemisphere. Multiple lesions were
detected in six cases and solitary lesions in three cases. The types of
CCHD were tetralogy of Fallot, complex cyanotic CHD with right
isomerism, TGA and TAPVD.
Burr hole
aspiration was performed in
five cases, pus culture in one case revealed
Acinetobacter calcoace-
tricus
, and four cultures were negative. Two patients died due to
brain herniation. BT shunt and total correction was performed in the
patients with tetralogy of Fallot.
Conclusion:
Uncorrected cyanotic CCHD after two years of age, or
delayed repair of CCHD in children can potentially lead to develop-
ment of brain abscess, with poor outcome and prognosis.
435: THREE-DIMENSIONAL SPECKLE TRACKING
ECHOCARDIOGRAPHY IN THE ASSESSMENT OF LEFT
VENTRICULAR VOLUME AND FUNCTION IN NORMAL
CHILDREN: A COMPARISONWITH CARDIAC MAGNETIC
RESONANCE IMAGING
Luvena Anthony
2
, David Black
1,2
, Jen Bryant
1,2
, Charles Peebles
2
,
Mark Hanson
1
, Joseph Vettukattil
2
1
Institute of Developmental Sciences, Human Development and
Health Academic Unit, University of Southampton, UK
2
Paediatric Cardiology and Cardiothoracic Radiology, University of
Southampton, UK
Background:
Three-dimensional speckle tracking echocardiography
(3DSTE) is a potential clinical tool for rapid assessment of cardiac
function and volume. Currently, CMRI is the gold standard for
functional and volumetric assessment of children with congenital
heart disease. 3DSTE may provide equivalent information on cardiac
function and volume, which would remove the need for general
anaesthesia, and offers a more cost effective and accessible method
of imaging in children.
Methods:
Fifty-five healthy children averaging nine years of age
were investigated using CMRI and transthoracic echocardiography
to assess LV function and volumes. Three-dimensional images were
acquired using a Phillips IE33 echocardiographic machine and an
X7-2 probe and stored for off-line analysis using Tomtec 4D LV
analysis software. Parameters derived from speckle tracking analysis
included global longitudinal strain (GLS), torsion, EF, EDV and ESV,
which were correlated with CMRI-derived indices.
Results:
LVEDV derived from 3DSTE correlated significantly with
that derived from CMRI (63.4
±
11.6 vs 72.2
±
11.7,
r
=
0.43,
p
<
0.001). These volumes were significantly different with 3DSTE tend-
ing to underestimate LV volume. The LVESV derived from the two
methods also showed a significant correlation (30.7
±
7.6 vs 25.5
±
6.2,
r
=
0.5,
p
<
0.001). There was a poor correlation with stroke
volume (32.8
±
6 vs 46.6
±
7.8,
r
=
0.215,
p
=
0.12). EF derived
from 3DSTE showed a significant correlation with that derived from
CMRI (51.8
±
6.7 vs 64.7
±
5.1,
r
=
0.29,
p
<
0.05). GLS showed
a better correlation with CMRI EF than 3DSTE EF (
r
=
–0.38,
p
<
0.005). Torsion showed no correlation with CMRI derived param-
eters of function or volume.
Conclusion:
3DSTE shows significant correlation with CMRI-
derived parameters of cardiac function and volume. 3DSTE tends
to underestimate ventricular volume and function in comparison to
CMRI-derived values. This technique has potential to be developed
as a rapid assessment tool in children with congenital heart disease
in the future.
436: EARLY REPAIR OF TETRALOGY OF FALLOT DOES
NOT PROTECT AGAINST LATE AORTIC ROOT DILATA-
TION
Deepa Rajan, David Black, Kevin Roman, Gruschen Veldtman,
Anthony Salmon, Aisling Carroll, Charles Peebes, Joseph Vettukattil
Paediatric and Adult Congenital Cardiac Service, University Hospital
Southampton NHS Foundation Trust, Southampton, UK
Introduction
: Tetralogy of Fallot (TOF) is associated with late aortic
root dilatation following primary repair. The pathophysiology of this
is thought to be related to volume loading of aortic outflow prior to
repair and/or due to an intrinsic aortic wall abnormality. We sought
to determine whether early repair of TOF would protect against late
aortic root dilatation.
Method
: Patients with repaired TOF who had undergone CMRI
were retrospectively reviewed. The size of the aorta at the level of the
sinuses was compared with that predicted for age and BSA. Details
with regards to timing of surgery and initial palliation were collected.
Results
: A total of 93 patients were included. Mean age was 23
years (1–74). The mean age at repair was 30 months (1–792).
Measurements at the level of the aortic sinuses were 33.9
±
7 mm (
n
=
60) in the group with infant repair vs 35.8
±
5 mm in the group with
later repair (
n
=
33) (
p
=
0.17). Measurements were also compared
in patients who initially required palliative procedures vs those who
did not [34.1
±
7 mm (
n
=
20) vs 34.6
±
6 mm (
n
=
71),
p
=
0.77].
Patients who had primary repair at less than six months did not show
a significant difference from those performed later [34.8 mm
±
6 (
n
