CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
171
sinus pauses resolved. Subsequently the patient showed improvement
in cardiac function. Telemetry showed normal sinus rhythm without
sinus pause for five consecutive days prior to discharge. A repeat
24-hour Holter monitor after three weeks revealed a maximum sinus
pause of 1.68 s.
Discussion:
SND can happen in children with heterotaxia or after
CHD cardiac surgery. In myocarditis, acute inflammatory processes
trigger arrhythmogenic activity. This may cause transient conduc-
tion block of the AV node. SA node inflammation in this patient led
to severe bradycardia and sinus pauses. As with other conduction
abnormalities or arrhythmias in myocarditis, it may resolve once the
inflammation improves.
488: ECHO DOPPLER ASSESSMENT OF ARTERIAL
STIFFNESS IN PAEDIATRIC PATIENTS WITH KAWASAKI
DISEASE
Al Huzaimi, Y Al Mashham, JE Potts, AM De Souza, LD Williams,
GGS Sandor
Children’s Heart Centre, British Columbia Children’s Hospital and
The University of British Columbia, Vancouver, Canada
Background:
There is growing evidence to suggest there is increased
arterial stiffness in patients with history of Kawasaki disease (KD).
Pulse-wave velocity (PWV) is the most validated measure of arterial
stiffness.
Methods:
The aortic stiffness and impedance indexes were derived
using an echocardiography Doppler method. The KD cohort were
identified using our echocardiography database (2002–2012) for
any patient who had had KD follow up of more than one year and
included 42 patients (age 9.7
±
2.0 years), compared to 44 age-
matched control subjects recruited in an ongoing prospective manner.
Our primary outcome measure was aortic PWV. Secondary outcome
measures included characteristic impedance (Zc), input impedance
(Zi), the elastic pressure–strain modulus (Ep), beta stiffness index
(
β
-index), and measures of systolic function [shortening fraction
(SF), ejection fraction (EF), mean velocity of circumferential fibre
shortening (MVCFc) and peak systolic wall stress (
σ
ps)].
Results:
Physical characteristics were similar between the two
groups. The PWV was higher among KD patients compared to
controls (458
±
153 vs 370
±
61 cm/s,
p
=
0.0008). The Zc, (Ep),
and
β
-index were slightly higher among KD patients; however, the
difference was not statistically significant. LV dimensions, M-mode
derived EF, SF and MVCFc were all within normal limits with no
difference in values between the two groups. The KD patients had
lower
σ
ps compared to controls (
p
=
0.01). There was no significant
correlation between the arterial stiffness indexes (PWV or Zi or Zc
or Ep or
β
-index) and patient age, interval from time of diagnosis
or fever duration. Logistic regression analysis of coronary artery
involvement class showed no significant correlation with any of the
arterial stiffness indices.
Conclusions:
Arterial stiffness was increased in children after
Kawasaki disease. There was no association between coronary artery
involvement and PWV.
495: WORLD HEART FEDERATION ECHOCARDIO-
GRAPHIC CRITERIA FOR RHEUMATIC HEART DISEASE
ALLOWS FOR REPRODUCIBLE DIAGNOSISWORLDWIDE
Bo Remenyi¹
,
², Nigel Wilson¹, Jonathan Carapetis
2,3
on behalf of the
international investigators
¹Green Lane Paediatric and Congenital Cardiology Department,
Starship Children’s Hospital, Auckland, New Zealand
²Menzies School of Health Research, Darwin, Australia
3
Telethon Institute of Child Health Research, Centre for Child Health
Research, University of Western Australia, Perth, Australia
Background:
Different echocardiographic definitions of rheumatic
heart disease (RHD) have been used for screening for RHD. This led
to the 2012 evidence-based World Heart Federation (WHF) echocar-
diographic criteria for RHD. The objective of this study was to deter-
mine whether the WHF criteria allow for consistent and reproducible
differentiation of normal echocardiographic findings from mild RHD
and therefore to assess the usefulness of the diagnostic criteria as a
clinical and epidemiological tool.
Methods:
Participants consisted of 15 international cardiolo-
gists/physicians with considerable RHD experience. A set of 100
echocardiograms was collated from population-based surveys of
high-risk school-aged children of Australia and New Zealand.
Echocardiograms were uploaded for blinded web-based reporting.
Inter-observer variability in categorising echocardiograms as normal,
borderline or definite RHD, as per WHF criteria, was measured by
comparing the individual readings made by 15 participants with a
reference reading.
Results:
Of the 100 echocardiograms, 99 were considered suitable
for reporting. A total of 1 485 reports were analysed. The reference
readings distribution of cases was: 33 borderline RHD, 20 definite
RHD and 46 normal or congenital heart disease. Overall agreement
in categorising echocardiograms as normal, borderline and definite
RHD (primary endpoint) was good, kappa 0.68 (95% CI: 0.65–0.72)
with overall accuracy of 76.77% (95% CI: 0.75–0.79). The agree-
ment over secondary endpoints, the presence of pathological degrees
of aortic and mitral valve regurgitation were excellent, kappa of 0.87
(95% CI: 0.8–0.90) and 0.83 (95% CI: 0.79–0.86) respectively.
Conclusions:
WHF echocardiographic criteria for RHD allows for
reasonably consistent and reproducible diagnosis of RHD when used
by experienced physicians. The ability of less experienced physicians
and community health workers to diagnose RHD by echocardiogra-
phy needs to be further evaluated if echocardiographic screening is to
have a role in RHD control in resource-poor settings. Intra-observer
studies of the WHF criteria are in progress.
496: WRESTLING MANOEUVRE AS THE CULPRIT IN
ACUTE SEVERE AORTIC REGURGITATION
Arpan Doshi
1
, Gurur Biliciler-Denktas
1
, Michael Hines
2
1
Division of Paediatric Cardiology, University of Texas Medical
School, Houston, USA
2
Division of Paediatric Cardiovascular Surgery, University of Texas
Medical School, Houston, USA
A 16-year-old Hispanic male was seen in ER for facial petechiae
after ‘choke-hold’ during wrestling. He had no chest pain, syncope,
palpitation, dizziness or shortness of breath. The examination find-
ings revealed a new onset three-quarter diastolic murmur and blood
pressure of 174/38 mmHg with bounding peripheral pulses. There
was no evidence of any diastolic murmur or elevated blood pres-
sure during his last primary physician visit, one month prior to the
episode. Past medical history was insignificant for any evidence
of infective endocarditis, rheumatic heart disease, cardiac cath-
eterisation, central line placements or blunt chest trauma. The patient
underwent an echocardiogram which revealed severe aortic regurgi-
tation, central aortic valve coaptation defect, severe left ventricular
dilatation and normal ventricular contractility. He was then admitted
to our hospital. Laboratory findings were unremarkable including
cardiac enzymes, acute phase reactants and blood cultures. Since the
initial attempt to surgically repair the aortic valve was unsuccessful,
the Ross procedure was performed, with excellent results. His aortic
valve pathology result showed slightly thickened valve cusps without
evidence of vegetation of microorganisms. Since the new examina-
tion findings and symptoms developed immediately after wrestling,
we surmised that
our
patient developed acute severe aortic regurgita-
tion secondary to sudden increase in afterload caused by ‘choke-hold’
application.
To our knowledge this is the first case of acute severe
aortic regurgitation caused by wrestling ‘choke-hold’ manoeuvre.
512: ADJUSTABLE BILATERAL PULMONARY ARTERY
BANDING FOR HYPOPLASTIC LEFT HEART AND ITS
VARIANTS
