CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
185
posterior leaflets at the tip, middle and base of during acute activity
was higher than in the controls. The thickness of the mid-part of the
anterior mitral leaflet was 5.1
±
0.6 mm in the study group initially
and 4.9
±
0.96 mm on follow up, while the control group had a thick-
ness of 3.87
±
0.8 mm (
p
=
0.008).
Conclusions
: Three-dimensional echocardiography complements 2D
echocardiography in the evaluation of patients presenting with rheu-
matic fever. Nodular appearance and leaflet thickening are important
echocardiograpic features of rheumatic carditis. The treatment with
steroids may result in some favourable changes on left ventricular
dimensions measurable by echocardiography.
734: LEFT ATRIAL MIXOMA MIMICKING REUMATHIC
FEVER
Maria Cristina Ventura Ribeiro
1
, Luziene Bonates dos Santos
1
, Larissa
Ventura Ribeiro
2
, Fernando Moraes Neto
4
, 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
4
Cardiac Surgery, Intituto de Medicina Integral Prof Fernando
Figueira Recife, Brazil
Background:
Left atrial myxoma is rare in childhood and may
present in a variety of forms, including a fever of unknown origin,
symptoms related to peripheral embolisation, acute congestive heart
failure or symptoms indistinguishable from collagen-vascular diseas-
es. Sometimes signs and symptoms of mitral valvar disease dominate
the clinical presentation.
Case report:
We present an 11-year-old female admitted to Instituto
de Medicina Integral Professor Fernando Figueira with intermit-
tent fever associated with dyspnoea on moderate exertion for six
months. Progressive symmetric arthralgia in the knees, followed
by the ankles, impaired her walking. She had asthenia and diffuses
abdominal pain. She did not have any history of repeated episodes
of tonsilitis. The patient had had a diagnosis of rheumatic fever in
another city and had used benzathine penicillin for six months before
referral to us.
On admission she had fever, pallor, finger clubbing and watch-
glass nails. Heart rhythm was regular with a murmur of mitral
insufficiency and mitral stenosis. The abdomen examination showed
splenomegaly. She had oedema and pain with any movement of her
knees and left ankle. Electrocardiography presented signs of left
atrial overload and interatrial block. Echocardiography showed a mild
enlarged left atrium, moderated mitral regurgitation and a tumour
adhered to the left surface of the interatrial septum, protruding into
the left ventricle during diastole.
The patient underwent surgical resection of the mass and the
histopathology was compatible with a myxoma. She was discharged
from hospital on medication. Four months after the surgery she was
re-admitted with heart failure. Echocardiography showed both left
atrial and ventricle overload and thickened mitral valve with severe
mitral regurgitation. She was submitted for an implant of a prosthetic
valve. Histopathology showed fibrosis with areas of calcification and
neutrophilic exudation. Postoperative course was uneventful and the
patient was discharged from hospital seven days after surgery.
737: PROPRANOLOL IN INFANTS WITH VENTRICU-
LAR SEPTAL DEFECT AND HEART FAILURE: VSD-PHF
(PROPRANOLOL FOR HEART FAILURE) TRIAL
Ramakrishnan Sivasubramanian, SS Kothari, Ramandeep Ahuja,
Kinjal Bhutt, SK Gupta, R Juneja, A Saxena, VK Bahl
All India Institute of Medical Sciences, New Delhi, India
Background:
Infants with ventricular septal defect (VSD) may
develop congestive heart failure in spite of conventional medical
therapy. We investigated the effects of additional beta-blockade in
such infants in a randomised controlled trial.
Methods:
In this single-centre, open-label, randomised, controlled
trial, infants with VSD and heart failure were randomised to
propranolol and no propranolol in addition to conventional treat-
ment. A total of 80 patients were enrolled, 40 in each group. Median
follow up was seven months (range 1–32 months). The primary
endpoint was a composite endpoint of death, hospitalisation and
referral for surgery.
Results:
Fourteen (35%) patients in the conventional arm and 10
(25%) in the beta-blocker arm had reached primary endpoint (
p
=
ns).
Worsening of heart failure occurred more commonly in the conven-
tional treatment arm compared with the propranolol-treated arm (27.5
vs 5% respectively;
p
=
0.015). Two patients in the conventional treat-
ment arm and one in the propranolol arm died. No episodes of brady-
cardia or bronchospasm were reported with propranolol treatment.
Conclusions:
The addition of propronolol was well tolerated by
infants with VSD and heart failure. Addition of beta-blocker over
and above the conventional treatment leads to symptomatic improve-
ments and reduces worsening of heart failure. However, there was no
difference in the death rate, hospitalisation or need for surgery.
739: RIGHT VENTRICULAR OUTFLOW MASS IN A
NEWBORN WITH PULMONARY ATRESIA: ECHOCARDI-
OGRAPHY AND HISTOPATHOLOGICAL ASPECT
Maria Cristina Ventura Ribeiro
1
, Isabella Marques Lira
1
, Larissa
Ventura Ribeiro
2
, Fernando Moraes Neto
4
, 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
4
Cardiac Surgery, Intituto de Medicina Integral Prof Fernando
Figueira Recife, Brazil
Background:
Typical tumours in the paediatric age group are
fibroma, rhabdomyoma and teratoma. A non-neoplastic mass may
consist of thrombus and infection, which can be defined by a patho-
logical examination. We describe a five-month-old female child who
had suffered from progressively increasing cyanosis since birth. At
five months a murmur was noticed during a paediatric consultation
and she was referred for paediatric cardiology at the Instituto de
Medicina Integral Professor Fernando Figueira.
Case report:
At admission her weight was 6.0 kg, her height was 61
cm, heart rate was 110 bpm, O
2
saturation was 73%, normal breath-
ing, cyanosis (+++), normal pulses, systolic murmur in left sternal
border, and no hepatomegaly. Electrocardiogram showed left ventric-
ular overload. Chest radiography showed increased cardiac area and
decreased pulmonary blood flow. The echocardiographic findings
were pulmonary atresia, mild hypoplasia of the tricuspid valve with
moderate regurgitation, right atrium enlargement, mild enlargement
of the right ventricle and severe hypertrophy. The pulmonary valve
was atresic. A mass (17
×
12 mm) was seen beneath the pulmonary
valve with no mobility. The ductus arteriosus was patent and the
pulmonary arteries were well developed.
The child underwent surgery to open the pulmonary valve and
excise the mass from the right ventricle outflow. The pathological
findings were a necrohaemorragic material with foci of calcification
consistent with thrombus. The child was discharged from hospital
20 days after surgery in a good condition. We have shown here the
association between cyanotic heart disease and thrombus, which is
related to slow pulmonary blood flow rather than degree of cyanosis
or coagulation abnormalities.
742: CAUSES OF HAEMOPTYSIS IN EISENMENGER
SYNDROME: A CT ANGIOGRAPHY STUDY
Ramakrishnan Sivasubramanian, Jo Joseph, Gurpreet Gulati, Priya
Jagia, SS Kothari, A Saxena, R Juneja, Sanjiv Sharma, VK Bahl
All India Institute of Medical Sciences, New Delhi, India
