CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
184
AFRICA
neurodevelopmental outcomes, (2) determination of changes in an
individual baby’s neurodevelopment over time, and (3) description
of the neurodevelopmental outcomes of an aggregate population
of infants with congenital cardiac disease and early surgical repair,
followed by timely BSID at CCHDC.
Methods
: This study retrospectively reviews the charts of infants
with single-ventricle physiology after surgical repair. The purpose of
the study was to identify the influence of peri-operative procedures,
including time on ECHMO post-operatively, length of stay, certain
patient characteristics on neurocognitive outcomes, as well as oral
feeding development, oxygen saturations and weight gain.
Results
: A linear mixed-effects model will be used to model BSID
subscale scores and their trend over time. Predictor variables will
include subscale measured (cognitive, language or motor), time (or a
non-linear function thereof), medical predictors such as diagnosis or
co-morbid conditions, and demographic covariates. Any significant
interactions among these predictors will also be included in the final
model. A covariance structure suitable to model the within-subject
and within-subscale dependence will be chosen at the time of analy-
sis based on model fit.
Conclusions
: Since the inception of our clinic, all infants with
single-ventricle physiology have been followed closely for medical
recovery as well as weight gain, feeding development and neurocog-
nitive outcomes. The final mode will provide insight into the neuro-
cognitive outcomes of this vulnerable population.
727: UTILITY OF PULSE OXIMETRYAND BEDSIDE ECHO-
CARDIOGRAPHY IN IDENTIFYING CONGENITAL HEART
DISEASE IN NEWBORNS
A Saxena
1
, Ramakrishnan Sivasubramanian
1
, G Kanogiya
2
, R Juneja
1
,
M Sharma
2
, S Salhan
2
1
All India Institute of Medical Sciences, New Delhi, India
2
Safdarjung Hospital, New Delhi, India
Background:
Congenital cardiac malformations (CCM) in newborns
may be difficult to diagnose clinically. Pulse oximetry has been
shown to have better sensitivity and specificity, but echocardiography
remains the gold standard. We carried a prospective study to deter-
mine the utility of pulse oximetry in identifying CCM in newborns
in a community hospital setting.
Methods:
All 20 305 (male-to-female ration 1:0.9) consecutive
neonates born over specific period in a large community hospital
were included in the study. Recruitment was done within 48 hours
of birth. We noted cyanosis, murmurs or abnormal heart sounds,
femoral pulse and respiratory distress. The arterial saturation was
measured non-invasively by pulse oximetry. All the neonates under-
went a screening bedside echocardiogram using a portable machine.
Results:
Of 20 305 neonates screened, 151 were found to have
significant CHD by echocardiography (7.4/1 000, 95% CI:
6.3–8.6/1 000). An additional 851 babies had insignificant CHD,
small muscular VSD being the commonest lesion seen in 663
babies. Major cardiac defects needing early intervention, including
transposition of the great arteries, hypoplastic left heart, large VSD
and pulmonary atresia were identified in 64 neonates (3.1/1 000 live
births); 1 599 (7.9%) newborns had a resting arterial saturation of
<
92%. The sensitivity and specificity of clinical examination for
diagnosing CHD was 14 and 97%, respectively.
Conclusion:
The prevalence and spectrum of significant CHD in
a community-level hospital in India is not very different from that
reported from the West. In our study, clinical examination had a low
sensitivity for diagnosis of CHD in newborns. Oximetry performed
within 24 hours of life also had a poor sensitivity for diagnosing
critical CHD. However sensitivity improved markedly in cases where
oximetry was done beyond 24 hours of life.
729: LÖFFLER MYOCARDIOPATHY IN A NINE-YEAR-OLD
BOY
Maria Cristina Ventura Ribeiro
1
, Luziene Bonates dos Santos
1
,
Larissa Ventura Ribeiro
2
, Cleusa Lapa Santos
3
1
Paediatric Cardiology, Intituto de Medicina Integral Prof Fernando
Figueira Recife, Brazil
2
Faculdade de Ciencias Médicas, Universidade de Pernambuco,
Brazil
3
Intituto de Medicina Integral Prof Fernando Figueira Recife, Brazil
Background:
Löffler myocardiopathy is a restrictive cardiomyopa-
thy associated with eosinophilia. Eosinophilic states that may occur
in association with
Löffler myocardiopathy include hypereosino-
philic syndrome, eosinophilic leukaemia, carcinoma, lymphoma,
drug reactions or parasites.
Case report:
We present a nine-year-old male patient who was admit-
ted to Instituto Materno de Medicina Integral Professor Fernando
Figueira (IMIP) in June 2005 with pallor of a month’s duration, lower
back ache for one week and fever for five days prior to admission.
His vital signs included heart rate
=
140 bpm, respiratory rate
=
28
bpm, blood pressure
=
90/60 mmHg. On physical examination his
general state was found to be compromised, and he had tachypnoea
(+/4+), pallor (3+/4+). There was no sign of cyanosis and pulses
were present with normal amplitude. Heart rhythm was irregular due
to extrasystoles (20/minute), with no murmurs or thrills. The lungs
were clear to percussion and auscultation. The abdomen was soft and
non-tender, with normal bowel sounds and hepatomegaly palpable
6 cm from the right costal margin. Joint examination was normal.
Laboratory findings included microcytic and hypochromic anaemia
with haemoglobin of 5 gm/dl, thrombocytopenia with platelet count
of 47 000 /mm
3
and leukocytosis with white blood cells 74 000 /mm
2
and 83% eosinophils.
Myelography revealed hyperplasia of the eosinophil lineage and
15% lymphoblast infiltration. Chest radiography showed cardio-
megaly with normal pulmonary flow and electrocardiography a
diffuse alteration of the ventricular repolarisation. The echocardio-
gram revealed an enlarged right atrium and inferior vena cava with
mild to moderate pericardial effusion, mild tricuspid regurgitation
and a mass in the right ventricle suggestive of a thrombus. Magnetic
resonance revealed imaging consistent with Löffler myocardiopathy
in its biventricular fibro-thrombotic state. He was submitted for
another myelography which was compatible with hypereosinophilic
syndrome due to acute lymphocytic leukaemia. Anticoagulation with
warfarin was started and he was referred to paediatric oncology to
begin chemotherapy.
733: ECHOCARDIOGRAPIC CHANGES DURING AN
EPISODE OF ACUTE RHEUMATIC FEVER
Ramakrishnan Sivasubramanian, Sunil Shivdas, BB Kukreti, A
Saxena, SK Gupta, R Juneja, SS Kothari, VK Bahl
All India Institute of Medical Sciences, New Delhi, India
Background:
The purpose of this study was to evaluate the useful-
ness of echocardiography, including three-dimensional echocardiog-
raphy, to assess the structural and functional changes in mitral valve
apparatus during an episode of acute rheumatic fever.
Methods:
Twenty-two consecutive patients with acute rheumatic
fever (mean age 12.15
±
4.2 years) with carditis, satisfying WHO
diagnostic criteria, were enrolled in the study. Annular diameters,
leaflet surface area, tent height, tent volume, leaflet thickness, leaf-
let volumes and submitral volumes were measured. The follow-up
echocardiograms were repeated after four weeks of steroid therapy.
Age-matched chronic rheumatic mitral regurgitation patients were
included as controls.
Results:
Mitral regurgitation was severe in eight (36%), moderate in
12 (55%), and mild in two (9%) patients. Three-dimensional echo-
cardiography showed a diffuse nodular appearance of mitral leaflet
surface during activity. The functional class improved on follow up
after treatment with steroids. However, there were no significant
changes in echocardiographic parameters except the LV end-diastolic
dimensions, which decreased from 54.17
±
9.75 mm at baseline to
52.5
±
10.18 mm on follow up (
p
=
0.02). The thickness the anterior/
