CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
175
subsequent dynamic images acquired within a single breath-hold.
Indication for referral, diagnosis made from the MR scans and
correlation with surgical findings were assessed. All MR scans
were performed on a commercial 1.5T scanner (Achieva; Philips
Healthcare, Best, the Netherlands).
Results
: Nine neonates had 4DTRAKMR sequence performed under
general anaesthetic after injection of a contrast agent (Gadopentolate
0.1 mmol/kg). Median age was five days, range two to 23 days. Mean
weight was 3.1 kg, range was 2.1–4.5 kg. Seven patients proceeded
to surgery based on the MR, where findings were confirmed; one
required no further intervention, and one required diagnostic cath-
eterisation to assess multiple aorto-pulmonary collateral arteries
(MAPCAs).
Conclusions
: MR angiography with keyhole permits rapid acquisi-
tion of 3D datasets with high temporal resolution. Within a single
breath-hold, the sequential filling of arterial and venous vessels can
be visualised, overcoming the limitations of temporal resolution
imposed by existing MR angiography. The use of 4D TRAK confers
high diagnostic accuracy vital for surgical planning. 4D TRAK is
appropriate where diagnostic uncertainty remains following echocar-
diographic assessment and should be considered in place of invasive
diagnostic cardiac catheterisation or X-ray-dependent computed
tomography.
569: PREDICTORS OF OUTCOME IN PAEDIATRIC IDIO-
PATHIC CARDIOMYOPATHY
Ahmad Azhar
King Abdulaziz University, Jeddah, Saudi Arabia
Objectives:
Idiopathic dilated cardiomyopathy (IDCM) is a severe
illness with a high mortality rate in the paediatric population. The
purpose of this study was to highlight our experience on the clinical
course and outcome of IDCM.
Methods:
Patients’ files were reviewed retrospectively for diagnosed
cases of IDCM in the paediatric cardiology unit of King Abdulaziz
University Hospital, Jeddah, Saudi Arabia from January 2003 to June
2011. Data on full history, clinical examinations and investigations
were recorded and grouped according to outcome as alive and well
(group 1), alive and symptomatic (group 2), and worsened or dead
(group 3). Data was subjected to descriptive analysis. Chi-square
and Student’s paired
t
-test techniques were used where appropriate.
Spearman rank correlation and survival analysis was done.
Results:
Eighty-three patients were included, with presenting age
median 14 months (range 2 months to 12 years), and female predomi-
nance: 53 patients (63.9%). On presentation, cardiomegaly was noted
in 72 patients (86.7%) with increased lung vascularity in 45 (54%).
Sixty-one (74%) patients had ST-segment and T-wave changes on
electrocardiogram while the same number had left ventricular hyper-
trophy, and 15 (18%) had arrhythmias. Echocardiography records
on presentation and at last follow up showed significant differences
in several areas. Group 1 had 40 (48.2%), group 2 had 23 (27.7%)
and group 3 20 (24.1%), including nine cases who died. Survival
rate over three years was 78%. Older the age worse was the outcome
(Spearman’s rho
=
0.3,
p
=
0.04).
Conclusion:
The majority of subjects presented during the first year
of life; three-year survival rate was 78%. Favourable outcome was
correlated with younger age at presentation.
579: CARDIAC LESIONS IN NEONATES WITH GASTROIN-
TESTINAL MALFORMATIONS
Bhavisha Nagar
1
, Antoinette Cilliers
2
1
Child Health, University of the Witwatersrand, Johannesburg, South
Africa
2
Chris Hani Baragwanath Hospital, University of the Witwatersrand,
Johannesburg, South Africa
Introduction:
The association between congenital structural cardiac
lesions and major gastrointestinal malformations, for example,
trachea-oesophageal fistula, omphalocoele, gastroschisis and anorec-
tal abnormalities, has been well described in the literature. Most
of the descriptions have been made in a series of articles by RD
Greenwood who started in 1975 by documenting an incidence of
23% of cardiac lesions in patients with congenital diaphragmatic
hernia, 12% in those with imperforate anus, 19% in those with
omphalocoele and 15% in neonates with trachea-oesophageal fistula.
It was decided to do an institutional retrospective analysis of this
association at an African tertiary care centre.
Methods:
This study was a retrospective descriptive analysis of
cardiac lesions that were found in these neonates. Secondarily, it will
also give an indication as to the type of cardiac lesions these neonates
are likely to have, determine whether or not a gender preponderance
exists and document the geographical distribution of these neonates.
Results:
An average of 20 000 to 25 000 live births per year occur in
the neonatal unit at Chris Hani Baragwanath Hospital. Over the five-
year period between 1 July 2006 and 31 July 2011, 129 neonates with
the above-mentioned gastrointestinal malformations were referred
for echocardiography. The study revealed an incidence of 27% of
cardiac lesions in neonates with gastrointestinal malformations. Most
lesions occurred in neonates with anorectal malformations (27%) and
omphalocoele (38%). The commonest lesions were ventricular septal
defect, complex cyanotic heart defects and right-sided aortic arch.
There seemed to be no significant male or female preponderance.
Most of the neonates fell within the southern areas of the referral
regions of Chris Hani Baragwanath Hospital cachment area, which
includes southern Gauteng and the North West Province.
Conclusion:
The findings were similar to the world literature. It is
important to make the association between GIT malformations and
cardiac lesions. The association can impact on the outcome of both
the GIT and cardiac lesions.
580: DYSSYNCHRONY AND VENTRICULAR FUNCTION
IMPROVE FOLLOWING CATHETER ABLATION OF NON-
SEPTAL ACCESSORY PATHWAYS IN CHILDREN
Anne Fournier
1
, Sylvia Abadir
1
, Patrick Garceau
2
, Georgia Sarquella-
Brugada
1
, Marc Dubuc
2
, Paul Khairy
2
1
Division of Paediatric Cardiology, Ste-Justine Hospital, Montreal,
Quebec, Canada
2
Department of Cardiology, Montreal Heart Institute, Montreal,
Quebec, Canada
Introduction:
Prior studies assessing ventricular dyssynchrony
in children with Wolff–Parkinson–White syndrome (WPWs) have
focused on septal or paraseptal pathways and described paradoxical
or hypokinetic septal motion. Data regarding non-septal pathways are
limited, as these have generally been perceived to carry lesser risk for
ventricular dysfunction.
Methods:
We characterised the degree of left ventricular (LV)
dyssynchrony and LV function by echocardiographic analyses with
tissue Doppler imaging (TDI) prior to and following catheter ablation
of accessory pathways.
Results:
Sixteen children, age 14.2
±
3.7 years, weight 53
±
17
kg, were assessed. All had WPWs, structurally normal hearts, and
underwent successful ablation (cryoenergy in four; radiofrequency
in 12). Septal/paraseptal pathways were present in six (37.5%) and
non-septal pathways in 10 (62.5%): left lateral (
n
=
5), right lateral/
anterolateral (
n
=
3), left posterior (
n
=
2). Following ablation, LV
ejection fraction (EF) (Simpson’s method) increased by 4.9
±
2.1% (
p
=
0.038) from a baseline value of 57.0
±
7.8%, with a decrease in the
difference between aortic and pulmonary preejection times (11.0
±
3.3
ms,
p
=
0.017). By TDI, the interval from QRS onset to peak systolic
velocity decreased from 33.0 [interquartile range (IQR 20.0, 18.0)] to
18.0 (IQR 5.0, 24.0) (
p
=
0.013). No significant change in septal-to-
posterior wall motion delay or diastolic parameters was noted. LVEF
increased to a greater degree following ablation of non-septal (5.9
±
2.6%,
p
=
0.023) versus septal (2.5
±
4.1%,
p
=
0.461) pathways. The
four patients with LVEF
<
50% prior to ablation, two of whom had
left lateral pathways, improved to
>
50% post ablation. Similarly, the
