Cardiovascular Journal of Africa: Vol 24 No 1 (February 2013) - page 169

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013 AFRICA 167
441: EXERCISE CAPACITY AND QUALITY OF LIFE IN
ADOLESCENTS AFTER SURGICAL CLOSURE OF ATRIAL
OR VENTRICULAR SEPTAL DEFECT DURING CHILD-
HOOD
Thomas Moller1,2 Trond Diseth2 , Per Morten Fredriksen3, Henrik
Holmstrøm2, Erik Thaulow2
1Vestfold Hospital Trust, Tandberg, Norway
2Oslo University Hospital Rikshospitalet, Oslo, Norway
3University College of Health Sciences, Campus Kristiania, Oslo,
Norway
Background: Patients with congenital heart disease generally report
good quality of life but they also show reduced exercise capacity of
varying degrees depending on the type of congenital heart defect.
The study hypothesis was that aerobic exercise capacity would
impact on self-reported quality of life (QoL) in adolescents after
surgical closure of isolated atrial (ASD) or ventricular septal defect
(VSD) during childhood.
Methods: In 32 asymptomatic patients (18 ASD, 14 VSD, median
age 18, 13–25 years, 20 females, median age at surgical closure 57,
1–229 months) and 103 healthy control individuals (61 females,
median age 17.5, 12–24 years) we assessed maximum oxygen uptake
(VO2 peak). Assessment of quality of life was achieved with either the
PedsQL™ questionnaire (< 18 years) or the SF-36™ questionnaire
(> 18 years) with 100% response rate in both groups. All test scales
ranged from 0 to 100.
Results: The VO2 peak z-score for the patient group (n = 31) was
–1.80 ± 1.54 and for the control group (n = 103) 0.27 ± 1.64 (p
< 0.001). The results from quality-of-life assessment and group
comparisons were calculated. By linear regression analysis we found
no statistically significant relationship between the group-wise
z -score of VO2 peak and any of the subscale results or total score
results from the quality-of-life assessment.
Conclusions: Adolescents operated on for isolated heart septal
defects during childhood reported normal quality of life compared
to the healthy population. Patients younger than 18 years of age
reported better quality of life than estimated by their guardians. Our
patients had lower aerobic exercise capacity compared to normal
controls, but we found no relationship between VO2 peak and any of
the reported subscale scores or total scores of quality of life for either
the patient or control groups.
452: ARE THERE CLINICALLY IMPORTANT RACIAL
DIFFERENCES IN ATRIAL SEPTAL DEFECT MORPHOL-
OGY?
Kathleen Fenton 1, Sergio Hernandez Castillo2, Carlos Duarte Claro2,
Nubia Berrios2, William Novick1,3
1International Children’s Heart Foundation, Memphis, TN, USA
2Asociacion Programa Corazon Abierto, Nicaragua
3University of Tennessee, USA
Background: Sinus venosus defects are considered uncommon,
representing only 5–10% of interatrial communications, with the
inferior subtype being particularly rare and more difficult to diag-
nose. Suspecting and correctly identifying this unusual anatomy
facilitates appropriate repair.
Methods: A retrospective review was undertaken of patients who
underwent repair of interatrial communications at our Central
American centre between October 2006 and June 2012 to determine
the anatomical subtype. Partial atrioventricular canal defects were
excluded.
Results: Fifty-four patients (53 children and one young adult,
age range 14 months to 23 years) underwent surgery for intera-
trial communication. Sinus venosus defects with partial anomalous
pulmonary venous connection were encountered in 10 patients (19%,
p = 0.025), with half of these (five patients, 9.2% of the total oper-
ated) being inferior subtype. The remaining 44 patients (81%) had
secundum atrial septal defects, six of whom (11%) had an additional
diagnosis of pulmonary stenosis requiring valvotomy, and one of
whom had a small patent ductus arteriosus. One patient (1.9%) died
as a result of a ruptured oxygenator during bypass; the remaining
patients had an uneventful postoperative course, spending one night
in intensive care and being discharged at a median of two days
postoperatively. All surviving patients had postoperative echocardio-
grams revealing no residual shunt and no obstruction to systemic or
pulmonary venous drainage.
Conclusions: Our Central American patient population demonstrates
a higher than expected proportion of sinus venosus defects and in
particular of the inferior subtype. Data from major centres in North
America and Western Europe may not be representative of the major-
ity of the world’s children with congenital heart defects, and if the
effect is truly racial (i.e. genetic) rather than environmental these
findings may also apply to immigrant populations.
455: PRENATAL DIAGNOSIS IMPROVED THE POST-
NATAL CARDIAC FUNCTION IN POPULATION BASED
COHORT OF INFANTSWITH HYPOPLASTIC LEFT HEART
SYNDROME
Hanna Markkanen1, Jaana Pihkala2 , Jukka Salminen3 , Lisa
Hornberger4 , Tiina Ojala2
1Department of Paediatrics, Kuopio University Hospital, Kuopio,
Finland
2Department of Paediatric Cardiology, Children’s Hospital, Finland
3Department of Paediatric Cardiac Surgery, Children’s Hospital,
Finland
4Foetal and Neonatal Cardiology Programme, Department of
Paediatrics and Obstetric and Gynaecology, Alberta, Canada
Background: Prenatal diagnosis of hypoplastic left heart syndrome
(HLHS) enables planning of perinatal care and is known to be asso-
ciated with more stabile pre-operative haemodynamics. The aim was
to determine whether prenatal diagnosis of HLHS has an impact on
postnatal myocardial function.
Methods: We reviewed a consecutively encountered cohort of
66 HLHS infants born between years 2003 and 2010 in Finland.
Postnatal global and segmental right ventricular fractional area
change (FAC), strain rate (SR) and myocardial velocity (V) were
analysed from apical four-chamber views using the Velocity-Vector-
Imaging technique (Syngo USWP 3.0, Siemens). Intra- and inter-
observer correlations were good (r > 0.7, p < 0.05). Pre-operative
haemodynamic status and end-organ damage measurements were
the lowest arterial pH, highest lactate, alanine aminotransferase
and creatinine. Early mortality was studied until 30 days after the
Norwood procedure.
Results: Twenty-five infants (38%) had a prenatal diagnosis.
Prenatally diagnosed infants had better cardiac function: FAC 27.9 ±
7.4 vs 21.1 ± 6.3%, p = 0.0004; SR 1.1 ± 0.6/1.3 ± 1.0 vs 0.7 ± 0.2/0.7
± 0.3 1/s, p = 0.004/0.003; V 1.6 ± 0.6/2.0 ± 1.1 vs 1.3 ± 0.4/1.4 ±
0.4 cm/s, p = 0.0035/0.0009, respectively. In segmental analysis,
the difference was global. Mechanical dyssynchrony was similar in
both groups (p > 0.3). Infants diagnosed prenatally had less acidosis
(pH 7.30 vs 7.25, p = 0.005) and end-organ dysfunction (alanine
aminotransferase 33 ± 38 vs 139 ± 174 U/l, p = 0.0001; creatinine
78 ± 18 vs 81 ± 44 mmol/l, p = 0.05). No deaths occurred among the
prenatally diagnosed infants but four deaths were recorded among
postnatally diagnosed infants (p = 0.15).
Conclusions: A prenatal diagnosis of HLHS is associated with
improved postnatal right ventricular function, reduced metabolic
acidosis and end-organ dysfunction. Prenatal diagnosis is important
for optimal prognosis of these infants.
461: PREVALENCE OF A POSITIVE SCREENING SCORE
FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER
IN CHILDREN AFTER EARLY REPAIR OF CONGENITAL
HEART LESIONS
Drew Yamada1 , Aisling Porter1 , Jennifer Conway2, John LeBlanc1,
Sarah Shea1, Camille Hancock-Friesen1 , Andrew Warren1