CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
182
AFRICA
(2.7–7), PVR/SVR 0.48 (0.3–0.8), transpulmonary gradient 32
mmHg (20–40.5). At a median follow up of 35 month (IQR 17–84):
seven patients had undergone closure of shunts, 21 received specific
drug treatment for PH (PH improvement or resolution in nine), three
showed spontaneous improvement of their PH, and eight (26%) died.
Conclusion:
Severe PH in BPD carries a bad prognosis and its diag-
nosis is sometimes delayed. Prompt diagnosis, accurate detection of
CVA, early shunt closure and aggressive specific drug therapy can
improve the outcome of these patients.
710: REDUCING THE PAIN OF BENZATHINE PENICILLIN
INJECTIONS IN THE RHEUMATIC FEVER POPULATION
Ross Nicholson
1
, Kathryn Russell
1,2
, Linda Legge
1,3
, Ester
Leauanae
1,4
,Sharron Marsh
5
, Annette Olsen
5
, Rajeshni Naidu
1,6
1
Kidz First Children’s Hospital, Counties Manakau District Health
Board, Auckland, New Zealand
2
Consult Liason Service, Whirinaki Child and Adolescent Mental
Health Service, New Zealand
3
Paediatric Surgery, Kidz First Children’s Hospital, Counties Manakau
District Health Board, Auckland, New Zealand
4
Play Therapy Service, Kids First Children’s Hospital, Counties
Manakau District Health Board, Auckland, New Zealand
5
Home Health Care, Counties Manakau District Health Board,
Auckland, New Zealand
6
Paediatric Pharmacist, Counties Manakau District Health Board,
Aukland, New Zealand
Background:
In the Counties Manukau District Health Board
(CMDHB) region, 405 rheumatic fever (RF) patients were offered
pain management with their monthly benzathine penicillin injections.
It was hypothesised this would reduce the pain and fear associated
with this injection.
Aims:
To evaluate the effectiveness of pain management for benza-
thine penicillin injections.
Methods:
A BUZZY vibrating cold pack device and 0.25 ml of 2%
lignocaine, mixed with the benzathine penicillin prior to administra-
tion, were offered to patients. A survey was conducted evaluating
pain scores at four time points (delivery, 2 min post, 1 hour post,
next day). Fear of the injection and duration of that fear were also
evaluated.
Results:
Just under half of patients (49%) responded. Pain at injec-
tion delivery and fear of injection scores were significantly higher
for patients under 16 years compared with older patients. Paired
data pre- and post-intervention were available (
n
=
119). Mean pain
score at delivery changed from 5.4/10 pre-intervention to 2.4/10
post-intervention (
p
≤
0.001). Pain scores were significantly reduced
at all four time points, as was fear of the injections. Lignocaine plus
BUZZY resulted in a greater improvement in pain score than ligno-
caine alone during injection delivery. A separate file audit conducted
five months after the study found that 66% of 405 RF patients were
using lignocaine, 43% were using BUZZY and 73% were using one
or both interventions.
Conclusions:
Offering analgesia with benzathine penicillin injec-
tions has been popular with the RF population in CMDHB and is
associated with reduced pain and fear.
711: THE USEFULNESS OF SCINTIGRAPHY WITH
99M
TC
ANTI-GRANULOCYTE ANTIBODY FOR DIAGNOSIS AND
FOLLOW UP IN CHILDRENWITH MYOCARDITIS
Lidia Ziolkowska
1
, Wanda Kawalec
1
, Maria Biernatowicz
2
, Elzbieta
Swiatek-Rawa
2
, Elzbieta Czarnowska
3
, Maciej Pronicki
3
, Anna
Turska-Kmiec
1
, Agnieszka Boruc
1
, Grazyna Brzezinska-Rajszys
4
,
Jadwiga Daszkowska
1
1
Department of Paediatric Cardiology, The Children Memorial
Health Institute
2
Department of Nuclear Medicine, The Children Memorial Health
Institute
3
Department of Pathology, The Children Memorial Health Institute
4
Laboratory of Cardiac Catheterisation and Angiography, The
Children Memorial
Background:
Clinical diagnosis of myocarditis is difficult due to
variable presentation ranging from asymptomatic cases to acute heart
failure. Endomyocardial biopsy (EMB) is an invasive procedure.
Therefore, a non-invasive diagnostic method is highly desirable,
especially in children. The aim of the study was to investigate wheth-
er scintigraphy with
99m
Tc-anti-granulocyte antibody (
99m
Tc-AGA)
would be useful for diagnosis and follow up in children with myocar-
ditis and to determine its correlation with EMB and clinical features.
Methods:
From 2005 to 2010, 11 children, aged 6.6 to 17 years,
mean 13
±
8 years, presenting with symptoms of myocarditis were
evaluated at the time of initial presentation and six, 12 and 24 months
after the first study. Patients’ demographics and clinical symptoms,
as well as results of echocardiography, electrocardiography, EMB and
scintigraphy with
99m
Tc-AGA were analysed. In all patients, myocar-
dial scintigraphy was performed with estimation of antigranulocyte
antibody uptake. EMB was done in 10 patients at the time of the
initial presentation and in eight patients after six months.
Results:
Out of 11 patients, in 10 (91%), positive antigranulocyte
uptake was observed, with EMB confirming myocarditis in eight (80%)
children. With scintigraphy, after six months, positive uptake was found
in nine (82%) patients, with EMB performed in eight patients showing
persistent myocarditis. After 12 months, scintigraphy indicated positive
uptake in seven (64%) and after 24 months only in four (36%) patients.
The mean LVEF was 59
±
12% at initial presentation and 61
±
10, 65
±
12 and 66
±
7% after six, 12 and 24 months respectively.
Conclusion:
(1)
In 80% of patients with positive scintigraphy results,
biopsy-proven myocarditis was observed. (2) The positive antigranu-
locyte uptake correlated with clinical features at diagnosis and at
follow up. (3) The control
scintigraphy performed at follow up after
six, 12, and 24 months allowed us to evaluate resolved or persistent
myocarditis. (4)
Myocardial scintigraphy results indicate that the
inflammatory process in the myocardium decreased significantly
after 12 months of the onset of the disease.
714: USE OF A HANDHELD ECHOCARDIOGRAPHY
MACHINE IN LARGE-SCALE SCREENING OF NEWBORNS
FOR CONGENITAL HEART DEFECTS
Kirk Milhoan
1
, Serdar Pedawi
2
, Alicia Lay
3
, David Bush
1
1
University of Texas Health Science Centre, San Antonio, USA
2
University Teaching Hospital, Duhok, Kurdistan, Iraq
3
University of Texas Health Science Centre, Houston, USA
Background:
Early identification of congenital heart disease (CHD)
is desirable in international settings where limited surgical resources
necessitate longer planning periods. Use of large-scale screening
would facilitate this goal, but is hampered by limited resources, lack
of expertise and infrastructure.
Methods:
A convenience sample of consecutive newborns with-
in a six-day window was screened at Duhok Teaching Hospital
(Kurdistan, Iraq) as part of a Ministry of Health-directed demonstra-
tion project. All infants were first screened with a VScan
®
handheld
device (VS; assessment of 2D and colour-flow data) and then using a
Seimen’s Cypress
®
echocardiogram machine (SC; assessment of 2D
and colour Doppler data – real-time and spectral). Diagnostic accura-
cy of the handheld device was sought. Patent ductus arteriosus (PDA)
and patent foramen ovale (PFO) were considered normal findings.
Results:
A total of 178 newborns were screened out of 276 live births
(64.5%) with both ultrasound machines. VS diagnosed 16 newborns
with an abnormal screen, compared with 24 for SC. VS and SC found
150 and 154 PDAs respectively. Both diagnosed 167 of 178 newborns
with PFOs. VS diagnosed two of three infants with muscular ventricu-
lar septal defects (VSD) identified by SC. Both machines diagnosed
five infants with trivial aortic insufficiency. VS sensitivity for diag-
nosing a PDA and PFO was 97 and 100%, respectively. PDAs missed
by VS screening were considered trivial. VS sensitivity for diagnosing
muscular VSD was 67%. The positive and negative predictive values
