CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
168
AFRICA
1
IWK Health Centre, Halifax, Canada
2
Hospital for Sick Children, Toronto, Canada
Background:
Adverse neurodevelopmental outcomes, such as atten-
tion deficit hyperactivity disorder (ADHD), are recognised as
important contributors to chronic morbidity in paediatric cardiac
surgery populations. The SNAP-IV is a validated, parent-completed
screening test used to identify children at risk of ADHD. The objec-
tive of this study was to determine whether children who underwent
congenital cardiac repair with open-heart surgery at less than one
year of age are more likely than healthy controls to have a positive
screening score suggestive of ADHD.
Methods:
Eligible cases were identified from the IWK Paediatric
Cardiology database and were included if they were aged seven to 15
years and underwent open-heart surgery at less than one year of age.
Patients were excluded if they had a known genetic disorder, multi-
ple congenital abnormalities, or a head injury. Age-matched healthy
controls were recruited from volunteers. Parents of consenting partic-
ipants completed a SNAP-IV questionnaire and a study-specific
demographic questionnaire. Case subject charts were reviewed for
baseline characteristics and potential risk factors. Frequencies of
those meeting the threshold for suspicion of ADHD were compared
using Fisher’s exact test. Regression analysis was used to identify
potential predictors of higher screening scores.
Results:
Questionnaires were completed by 57 of 170 eligible case
subjects (response rate of 34%). Responders did not differ from
non-responders in baseline characteristics. Of case subjects, 17/57
(30%) had a positive ADHD screening score in at least one domain,
compared with 3/60 (5%) of controls (
p
<
0.001). Cases and controls
differed significantly for average combined SNAP-IV scores (
p
<
0.001) and for both hyperactivity and inattention component scores
(
p
<
0.001).There was no correlation between operative factors and
SNAP-IV scores. No significant predictors of a higher score were
identified.
Conclusion:
Children who have open-heart surgery at less than one
year of age are more likely than healthy controls to have a positive
screening score for ADHD.
466: RECURRENT GIANT LEFT VENTRICULAR ANEU-
RYSM OF TUBERCULOUS AETIOLOGY IN A CHILD
Valquiria Pelisser Campagnucci, Ana Maria Rocha Pinto e Silva,
Liane Catani, Wilson Pereira, Ana Maria Thomaz, Geanette Pozzan,
Maria Lucia Passarelli, Luiz Antonio Rivetti, Carmen CH Conde
Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
Case report:
A 10-year-old girl was admitted with a six-month
history of multiple joint pain and decline in overall health status.
Pericardial effusion was observed and pericardiocentesis performed,
which failed to yield pericardial fluid. An echocardiogram 20 days
later was suggestive of antero-apical aneurysm. Left ventriculography
confirmed dyskinetic saccular formation in the antero-apical region
and surgical intervention was recommended. Aneurysmectomy was
performed using normothermic cardiopulmonary bypass on a beating
heart. The patient’s intra- and postoperative courses were uneventful,
and she was discharged 18 days after surgery. Pathological exami-
nation revealed chronic myocardial inflammation in the reparative
phase. Laboratory tests performed to shed light on the polyserositis
condition were inconclusive. The aetiology of the aneurysm was not
clearly elucidated.
Eight months after surgery the girl was brought back with
dyspnoea. A chest radiograph revealed right-sided pleural effu-
sion. Cytological examination of pleural fluid revealed lymphocyte
predominance. The Mantoux test was strongly positive. The patient
was started on antituberculous therapy. Fourteen months after
surgery the girl was re-admitted with atelectasis of the left upper
lobe. Bronchoscopic examination showed 50% narrowing of the
left main bronchus due to extrinsic compression. Left ventriculog-
raphy disclosed an antero-apical giant aneurysm. Re-operation was
performed. After an uneventful recovery, the patient was discharged.
Pathological examination revealed cardiomyocyte hypertrophy
and replacement myocardial fibrosis, confirming the diagnosis of
true left ventricular aneurysm. Given the overall clinical picture,
tuberculosis was considered as the likely cause of myocardial
involvement. A review of the pathological specimens from the first
surgery showed: inflammatory process with micro-abscesses, granu-
lomas with central caseous necrosis surrounded by epithelioid cells
in a palisade arrangement, and multinucleated giant cells, corroborat-
ing our clinical reasoning. Three aspects make this report unique: a
rare diagnosis of cardiac aneurysm caused by tuberculosis, especially
in a child; its recurrence, which is even rarer; and successful surgical
treatment.
469: ATHEROSCLEROSIS RISK AND CAROTID INTIMA–
MEDIA THICKNESS AFTER KAWASAKI DISEASE IN
MEXICAN CHILDREN
Luis Martin Garrido-Garcia
1
, Sara Solorzano
2
, Francisco Espinosa-
Rosales
3
, Silvestre Garcia de la Puente
4
, Laura Camacho-Reyes
1
1
Cardiology Department, Instituto Nacional de Pediatria, Mexico
City, Mexica
2
Radiology Department, Instituto Nacional de Pediatria, Mexico City,
Mexica
3
Investigation Director, Instituto Nacional de Pediatria, Mexico City,
Mexico
4
Head of Methodology, Instituto Nacional de Pediatria, Mexico City,
Mexico
Background:
Kawasaki disease (KD) is an acute febrile illness
characterised by systemic vasculitis of unknown aetiology. Recent
studies have shown that even after resolution of the disease, endothe-
lial dysfunction persists and may progress to atherosclerosis. Carotid
intima–media thickness (cIMT) is a well-established indicator for
atherosclerosis in both paediatric and adult patients.
Objectives:
To assess whether patients after Kawasaki disease (KD)
have increased risk factors and abnormalities suggestive of early
atherosclerosis by measuring the cIMT compared with healthy
control subjects.
Methods
: Fifty-seven patients with KD aged 9.02
±
3.98 years (2–21
years after acute illness) and 83 age-matched healthy control subjects
were examined for medical and dietary history, serum markers of
atherosclerotic risk and inflammation and carotid intimal–medial
thickness (CIMT) with vascular ultrasound scanning.
Results:
Patients and control subjects were similar in age, gender,
family and dietary history, body mass index and blood pressure.
We found no difference in the levels of triglycerides and glucose.
And the levels of total cholesterol (162
±
39.2 vs 150
±
37.4), low-
density lipoprotein cholesterol (102.57
±
32.3 vs 89.6
±
33.5), and
high-density lipoprotein cholesterol (47.38
±
17.65 vs 39.5
±
17.54)
were slightly higher, with no statistical significance. The cIMT was
slightly higher in the KD group (0.48
±
0.1 vs 0.45
±
0.15) We found
higher levels in the lipid profile and in the cIMT in children with
or with regression of coronary aneurysms compared with children
without coronary aneurysms.
Conclusions:
There was no clear evidence of increased atheroscle-
rosis in Mexican children with KD, but there was evidence of an
altered lipid profile and cIMT in patients with KD with coronary
lesions compared with children with KD without coronary lesions.
This warrants further study
477: FAMILIAL ARRHYTHMOGENIC RIGHT VENTRICU-
LAR DYSPLASIA: MAGNETIC RESONANCE IMAGING
RETROSPECTIVE STUDY IN CHILDREN
Anne Fournier
1
, Patricia Martinez-Diez
2
, Chantale Lapierre
2
, Sylvia
Abadir
1
, Laurent Desjardins
2
, Julie Dãry
2
1
Division of Paediatric Cardiology, Ste-Justine Hospital, Montreal,
Quebec, Canada
2
Radiology Department, Ste-Justine Hospital, Montreal, Quebec
