CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
187
Methods:
A survey was conducted of medical records for data
collection. Median age was 10.4 years old and the median length of
stay for acute
rheumatic fever hospitalisation was 16
days
.
Results:
Evidence
of previous
streptococcus
infection, which is
very important for diagnosis was present in a few
cases (21% had
tonsillitis and 32% had increased antistreptolysin). Minor criteria
such as fever were observed in 60 patients (53%), prolongation
of
the
PR interval
on the
electrocardiogram in 86 (77%) and
raised
erythrocyte sedimentation rate or C reactive protein in 48 (36%)
patients. Because it is a reference hospital for paediatric cardiology,
there was a high incidence of carditis (96 cases, 85% of patients) and
heart failure (57 cases, 51% of patients) with 13% of the patients
requiring the use of amines during hospitalisation. Another cardiac
parameter observed was mitral regurgitation in 29 (26%) patients,
nine (8%) with aortic regurgitation, and 45 (40%) with both lesions.
The incidence of arthritis 33 (29%) was low and only seven patients
(6.25%) had chorea. Subcutaneous nodules were rare, with only two
cases (1.8%). Most of the patients received corticosteroid therapy 68
(61%) and only 13 (12%) received acetylsalicylic acid. One patient
died during the acute phase (0.89).
Conclusion:
From this study one can conclude that rheumatic fever
with cardiac involvement still remains a major cause of heart disease
in developing countries, bringing high economic and social costs to
these countries.
754: PRE-NATAL DIAGNOSIS OF COMPLEX CONGENITAL
CARDIAC DEFECT: IS THERE ANY NEURO-DEVELOP-
MENTAL BENEFIT?
David Horne
1
, Diane Moddeman
2
, Charlene Robertson
3
, Brett
Hiebert
4
, John Lee
1
, Karen Letourneau
5
, Lea Legge
6
, Karen Penner
7
,
Reeni Soni
8
1
Department of Surgery, University of Manitoba, Canada
2
Department of Paediatrics and Child Health, University of Manitoba,
Canada
3
Department of Paediatrics, University of Alberta, Canada
4
Cardiac Sciences Programme, St Boniface General Hospital,
Manitoba, Canada
5
Department of Ultra-sonography, St Boniface General Hospital,
Manitoba, Canada
6
Variety Children’s Heart Centre, Winnipeg, Manitoba, Canada
7
Newborn Follow-up Programme, Winnipeg Health Sciences Centre,
Canada
8
Department of Paediatric Cardiology, University of Manitoba,
Canada
Objectives:
High pre-operative lactate levels have been associated
with early childhood neuro-developmental delay. Our objective was
to determine whether pre-natal diagnosis (PreN) has neuro-develop-
mental benefit in patients with complex congenital cardiac defects
compared to post-natal diagnosis (PostN).
Methods:
A
s
ingle-centre retrospective review was carried out of all
patients with complex congenital cardiac defects who had complex
surgery before six weeks of age, between 2001 and 2010 (
n
=
101).
Prospective neuro-developmental assessments using the Bayley
scales of infant development-II (
n
=
25) and, in 2005 and after, the
Bayley scales of infant and toddler development-III (
n
=
50) were
performed between 18 and 24 months of age, excluding children
with chromosome anomalies or syndromes affecting development (
n
=
13). Two-year mortality was 14.8% (12/88). One patient was lost to
follow up. Grouped scores for mental and motor delay [
>
2SD below
mean (
<
70)] were compared between PreN (
n
=
47) and PostN-
groups (
n
=
28). Peri-operative variables were collected. Propensity
match analysis was performed (15 patients per group) controlling for
surgical procedure and significant peri-operative variables.
Results:
The PreN-group had trended to lower 30-day [1.9% (1/52)
vs 5.6% (2/36),
p
=
0.56 (Fisher’s test)] and 2-year mortality [9.6%
(5/52) vs 19.4% (7/36),
p
=
0.31 (Fisher’s test)].The Pre-group had
lower mean pre-operative lactate levels [2.3 mmol/l (SD 1.6) vs 4.4
mmol/l (SD 5.0),
p
=
0.024 (
t
-test)] and lower median cardiopulmo-
nary bypass flow rates
>
10 min [100 ml/kg/min (IQR
=
54–126) vs
125 ml/kg/min (IQR
=
100–131),
p
=
0.020 (Mann-Whitney test)].
Other peri-operative variables were similar between groups. Fewer
patients in the PreN group had combined delayed mental scores
[4.3% (2/47) vs 25% (7/28),
p
=
0.01 (Fisher’s test)], although mean
scores were similar. There was no difference in motor delay. No NDO
were significantly different after propensity match analysis.
Conclusion:
Patients with a pre-natal diagnosis of complex congeni-
tal cardiac defects had significantly lower pre-operative lactate levels
with a lower prevalence of cognitive delay. Longer follow up and
larger cohorts might lead to more significant beneficial effects of
pre-natal diagnosis on ND.
765: PULMONARY HYPERTENSION IN THE PRESENCE OF
AN AORTOPULMONARY WINDOW, IN PATIENTS LIVING
AT HIGH ALTITUDE, DOES NOT AFFECT MORBIDITY–
MORTALITY OUTCOMES
Gino Bresciani, Marisol Carreno, Nestor Sandoval, Sandra Romero
Fundacion Cardioinfantil, Bogota, Colombia
Background
: Aortopulmonary window is a rare abnormal congenital
communication. Early surgical correction should be offered before
the development of irreversible pulmonary hypertension. The aim of
this study was to present the morbidity–mortality rates in the surgical
correction of this pathology in patients with and without pulmonary
hypertension who live at high altitudes.
Methods:
Case reviews were examined of 17 patients who underwent
surgery between January 1990 and March 2012 at 2 640 m above sea
level. Continuous variables are presented in means or medians with
their SD or IQR, categorical variables in absolute and relative frequen-
cies; Mann Whitney and Fisher’s exact test were used to compare
patients with or without pulmonary hypertension. All patients had an
echocardiogram, which was diagnostic in 41.2% of patients (7/17).
Results:
The global median age was 10.5 months (IQR 1.4–211),
females made up 58.8% (10/17), pulmonary hypertension was
present in 41.2% (7/17), and PDA was the most frequent cardiac-
associated anomaly in 47.1% of patients (8/17). Mean time on pump
was 64
±
18.4 min, an aortotomy was carried out in 76.5% (13/17), a
goretex patch was placed in 35.3% (6/17), and low cardiac output and
arrhythmias were observed in 52.9% of patients (9/17). The mortal-
ity rate was 5.9% (1/17). Survival at 30 days was 100%, and at the
10-year follow up it was 37.5% (6/16). No statistical differences were
found in pre- or postoperative variables in patients with or without
pulmonary hypertension.
Conclusions:
Pulmonary hypertension in the presence of an aortopul-
monary window lesion in children did not differ from that in other
types of lesions with left-to-right shunt. The mortality rate was low
and apparently not related to these findings.
768: INFECTIVE ENDOCARDITIS: IMPROVING POSITIV-
ITY OF MODIFIED DUKE’S CRITERIA IN DEVELOPING
COUNTRIES
Mehnaz Atiq, Muhammad Rehan Khan, Shazia Mohsin
1
Department of Paediatrics and Child Health, Aga Khan University
Hospital, Karachi, Pakistan
Introduction:
Successful management of infective endocarditis (IE)
depends on timely accurate diagnosis, both being very challenging in
developing countries due to multiple factors.
Objective:
This study was undertaken to assess the usefulness of
additional modification of Duke’s criteria in diagnosing infective
endocarditis in children in the developing world.
Methods:
A retrospective 10-year chart review was done of children
younger than 14 years of age, suspected to have or diagnosed with
infective endocarditis (IE).
Results
: Fifty patients were diagnosed to have IE. Mean age was
8.4
±
5.6 years. Fever was present in 94%. Congenital heart diseases
were predisposing in 74% and rheumatic heart disease in 16%, and
