CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
176
AFRICA
magnitude of improvement in LV dyssynchrony was more marked
in patients with non-septal versus septal pathways, e.g. difference
between septal and lateral wall motion delay before and after ablation
of 20.6
±
7.1 ms (
p
=
0.015) versus 1.4
±
11.4 ms (
p
=
0.655).
Conclusion:
LV systolic function and dyssynchrony improved after
ablation of antegrade conducting accessory pathways in children,
with greater changes for non-septal pathways.
589: LEFT VENTRICULAR SUBMITRAL ANEURYSMS
Henning du Toit
1
, Ishmael Awala
1
, Christopher Hugo-Hamman
1
,
Andreas Willberg
1
, John Hewitson
2
, John Lawrenson
2
, Peter Zilla
2
1
Windhoek Academic Hospitals, Windhoek, Namibia
2
Chris Barnard Division of Surgery, University of Cape Town, Cape
Town, South Africa
Objective:
A retrospective institutional review was done of the
pathology, classification and surgical management of left ventricular
submitral aneurysms (LVSMA). This is a well-recognised but rela-
tively rare disease, commonly found in patients of African ancestry.
Methods:
The series compromised 31 patients treated surgically at
two institutions from 2001 to 2012. Patients were of African ancestry
(
n
=
25) and mixed ancestry (
n
=
6). Natural history, clinical presen-
tation, histopathological findings, aetiology, and operative techniques
are presented.
Results:
There were 19 male and 12 female patients, mean age was
19
±
6 (range 8–45) years. Patients were grouped according to the
degree of posterior mitral annulus involvement. In group I (
n
=
18)
a single neck, in group II (
n
=
3) multiple necks, and in group III
(
n
=
10) involvement of the entire annulus was found. Mean age of
group III (31
±
7 years) was older than groups I and II (15
±
5 years)
(
p
=
0.001). This is suggestive of progression of disease with age.
An intracardiac surgical approach was used in 21 patients, an extra-
cardiac approach in two and a combined approach in nine patients.
Failure to control the neck of the aneurysms (
n
=
3) and failure of
the mitral valve repair (
n
=
3) resulted in subsequent re-operation.
Operative mortality (
n
=
1).
Conclusion:
The aetiology of LVSMA is thought to be congenital
due to an inherent weakness of the posterior mitral annulus. In our
study the majority (
n
=
23) of patients had no histological evidence of
contributing aetiology, but the study confirms multi-factorial aetiol-
ogy. A new classification is proposed based on pathological findings.
600: BIOPHYSICAL PROPERTIES OF THE AORTA IN
ADOLESCENT FEMALES WITH ANOREXIA NERVOSA
Carolina Escudero
1
, James Potts
1
, Astrid De Souza
1
, Pei-Yoong Lam
2
,
Kathryn Duff
3
, George Sandor
1
1
Children’s Heart Centre, British Columbia Children’s Hospital,
Vancouver, Canada
2
Division of Adolescent Health and Medicine, British Columbia
Children’s Hospital, Vancouver, Canada
3
Department of Sport Science, Douglas College, Vancouver, Canada
Background:
Patients with anorexia nervosa (AN) have altered
physiological responses to exercise. This study aimed to determine
the differences in exercise capacity and haemodynamic parameters
with exercise in patients with AN.
Methods:
This was a retrospective case–control study. Sixty-six
adolescent females with AN and 21 adolescent female controls exer-
cised on a semi-recumbent ergometer in three-minute, 20-watt incre-
mental stages to volitional fatigue. Heart rate (HR), blood pressure
(BP) and echo-Doppler indices were measured pre-, at each stage,
immediately and three minutes post-exercise. Fractional shortening
(FS), peak aortic velocity (PAoV), mean velocity of circumferential
fibre shortening (MVCFc), wall stress (WS), cardiac index (CI), and
systemic vascular resistance (SVR) were calculated. Peak oxygen
consumption (VO
2
), minute ventilation (VE), respiratory exchange
ratio (RER), and arterial–venous oxygen difference (a-vO
2
) were
determined using open-circuit spirometry.
Results:
Patients with AN had a significantly lower BMI (16.7 vs
19.7 kg/m
2
,
p
<
0.001), total work (1 126 vs 1 914 J/kg,
p
<
0.001),
total test duration (13.8 vs 20.8 min,
p
<
0.001), peak VE (47.4
vs 72.0 l/min,
p
<
0.001), and VO
2
(31.3 vs 39.7 ml/min/kg,
p
<
0.001) and higher RER (1.14 vs 1.06,
p
=
0.001) when compared
to controls. Systolic BP, diastolic BP, and PAoV were lower at pre-
exercise, increased with exercise, and were lower at peak exercise in
ANsubjects vs controls. HR, FS, MVCFc and CI showed no differ-
ence at pre-exercise, increased with exercise, and were lower at peak
exercise in AN subjects vs controls. WS decreased with exercise
and was lower in ANsubjects vs controls at pre-exercise and peak
exercise. SVR pre-exercise was lower in AN subjects, decreased with
exercise, and there was no difference at peak exercise. The a-vO
2
increased with exercise and showed no differences between groups.
Conclusions:
Adolescent patients with AN had decreased exercise
capacity and abnormalities in their haemodynamic parameters and
myocardial performance during exercise compared with control
subjects.
621: KAWASAKI DISEASE ANALYSES IN A REFERENCE
PAEDIATRIC HOSPITAL IN SOUTHERN BRAZIL FROM
1980 TO 2012
Mauricio Laerte Silva
1,2
, Sonia Maria De Faria
1,2
, Maria Emilia
Pereira Silva Lehmkuhl
1
, Leandro Latorraca Ponce
1
, André Vaz
2
1
Hospital Infantil, Joana de Gusmao Children’s Hospital,
Florianópolis, Santa Catarina, Brazil
2
Universidade Federal De Santa Catarina, Florianópolis, Santa
Catarina, Brazil
Background:
Kawasaki disease is a systemic and acute vasculitis
with unknown aetiology and is actually considered the main cause
of acquired heart disease in children in developed countries. The
clinical presentation is typically characterised by five days or more
of fever, associated with at least four of the following: conjunctivi-
tis, oral changes, extremity changes, rash and cervical adenopathy,
and these manifestations usually appear in a sequence, but without
a defined order. Because there is no specific laboratory test, the
diagnosis is purely clinical, and may be confirmed by indirect tests
of inflammatory activity. Delayed treatment of patients increases the
risk of developing cardiac abnormalities, so early diagnosis is the key
to a better prognosis.
Objectives:
To identify and analyse epidemiological, clinical and
therapeutic aspects of the disease in patients at the Joana de Gusmao
Children’s Hospital, Florianópolis, Santa Catarina, from 1980 to 2012.
Methods:
Using data from medical records, cases were analysed
with regard to age, gender, race, origin, year and season of occur-
rence, clinical manifestations and diagnostic criteria, laboratory tests,
cardiac involvement, treatment, complications and death.
Results:
During the study period, 60 cases occurred, with higher
frequencies after 2001. Patients were predominantly white male
children under five years old from Florianópolis. Of the patients,
70% fulfilled the diagnostic criteria. Anaemia, leukocytosis with
neutrophilia, thrombocytosis, increased ESR and CRP were frequent
findings. Cardiac involvement occurred in 53.3%, predominantly
coronary changes. Intravenous immunoglobulin was used in 98.3%
of children, and ASA in 100% of them. There were complications in
6.6% of the cases and no deaths.
Conclusions:
The increased number of cases in recent years may
reflect greater attention to the clinical features, even though the
diagnosis is delayed. Cardiac compromise was found to be frequent,
especially in the coronary arteries, probably due to the long time
period until its identification.
624: LONE ATRIAL FIBRILLATION IN AN ADOLESCENT
Sit Yee Kwok
1
, Amy Fung Cheung Lo
1
, Geoffrey Chi Fung Mok
1
, Yat
Yin Lam
2
, Man Ching Yam
1
1
Department of Paediatrics, Prince of Wales Hospital, Chinese
University of Hong Kong, China
