CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
188
AFRICA
10% had invasive lines; 80% had a history of prior antibiotic use. A
single blood culture was positive in 42%, and second and third blood
cultures were positive in 30 and 10%, respectively. On echocardi-
ography, 84% had vegetations. Thrombocytopaenia was seen 28%.
Modified Duke’s criteria were positive in 62%, probable in 16%,
and rejected in 22%. Including C-reactive protein and ESR (raised
in 80 and 60%, respectively) improved the diagnostic sensitivity. We
further modified Duke’s criteria to include one positive blood culture
and thrombocytopaenia to evaluate if it further improved positivity;
the positivity of Duke’s criteria improved to 70%, and the possibility
and rejection reduced to 10 and 18%, respectively. All nine rejected
by the modified Duke’s criteria responded to antibiotic therapy, based
on high clinical suspicion. Surgical intervention was required in 8%
and the overall mortality was 8%.
Conclusion:
Diagnosis of IE is challenging in developing countries
due to prior antibiotic use. High clinical suspicion and echocardiogra-
phy remain the mainstay of diagnosis. Modified Duke’s criteria may
have to be further relaxed to improve diagnostic application in such
situations, and we have found that using one positive blood culture
with a known organism and thrombocytopaenia may be helpful.
782: HIGHER INCIDENCE OF ENDOCARDITIS IN BOVINE
JUGULAR VEIN GRAFTS COMPARED WITH CRYOPRE-
SERVED HOMOGRAFTS
Shinya Ugaki, Jennifer Rutledge, Ian Adatia, David Ross, Ivan
Rebeyka
Stollery Children’s Hospital, Mazankowski Heart Institute, University
of Alberta, Canada
Background:
Both cryopreserved homografts (CH) and bovine
jugular vein grafts (BJVG) are used to reconstruct the right ventricu-
lar outflow tract (RVOT). We sought to compare the incidence of
endocarditis (EC) in patients receiving the BJVG conduit to those
receiving a CH.
Methods
: We reviewed retrospectively all available clinical data in
patients receiving either BJVG or CH implanted between 2000 and
2012. Endocarditis was defined as new conduit vegetation visualised
on echocardiography +/– positive blood cultures (BC) or accelerated
conduit deterioration and positive BC.
Results:
We implanted 378 conduits (BJVG 244, CH 134) in 298
patients (median age 43 months, range 1 day – 50 years), median
follow up 40 months (range 2 days – 12 years). Indications for
surgery were pulmonary atresia/ventricular septal defect (46%),
aortic stenosis (20%), truncus arteriosus (16%), other (18%). There
were 22 cases of EC, 21 associated with BJVG (8.6%) and one with
CH (0.75%;
p
=
0.0009) occurring at a median age of 12 years (range
6–21) and median time post conduit implantation 44 months (20
days – 10 years). BC were positive in 17 patients (11
Staphylococcus
aureus
, two
Streptococcus viridans
, two
Cardiobacterium hominis
,
one
Staphylococcus epidermididis
, one
Haemophilus parainfluen-
zae
). Conduit replacement was required in 14/22, three patients had
recurrent EC of the revised conduit. EC (+) patients had significantly
reduced freedom from re-operation at one, five and seven years:
EC(–): 95.7
±
1.2%, 80.0
±
2.7% and 69.2
±
3.5%, respectively;
EC(+) 95.5
±
4.4%, 63.9
±
1.2%, 32.0
±
1.2%, respectively (
p
=
0.003).
Conclusions:
The use of the BJVG conduit, compared to CH for
reconstruction of the RVOT was associated with a significantly
higher incidence of bacterial endocarditis. Furthermore, endocarditis
of the BJVB was associated with conduit deterioration and more
frequent re-operation. This information may be useful in the decision
about which conduit to use for RVOT reconstruction in children with
congenital heart disease.
783: CARDIAC FUNCTION AFTER ANATOMICAL REPAIR
AND FUNCTIONAL REPAIR IN CORRECTED TGA AND
TGA IN THE LONG TERM
Mikiko Shimizu, Hiroki Mori, Toshio Nakanishi
Department of Paediatric Cardiology, Tokyo Women’s Medical
University, Japan
Background:
In patients with congenitally corrected transposition
of the great arteries (ccTGA), it is still unknown whether anatomical
repair is better than functional repair in the long term. Furthermore,
the physiological mechanism of failure of the systemic right ventricle
(sRV) in ccTGA is not fully understood.
Objective:
To evaluate cardiac function in patients with ccTGA long
after anatomical and functional repair.
Methods:
A retrospective review of catheterisation data between
2005 and 2011 was carried out in consecutive patients older than 16
years of age with ccTGA and complete TGA. Patients were divided
into four groups; in TGA patients, an atrial switch group (
n
=
12)
and an arterial switch goup; and in ccTGA patients, a double-switch
group (
n
=
8) and conventional Rastelli group (
n
=
6). Unpaired
t
-test
and one-way ANOVA were used for statistical analysis.
Results:
Central venous pressures, cardiac index (CI), systemic pres-
sures, ejection fraction (EF) of the systemic and pulmonary ventricle,
and end-diastolic pressure (EDP) of the pulmonary ventricle were
significantly different between the four groups (ANOVA,
p
<
0.05).
Regarding EF of the systemic ventricles, EF in the arterial switch
group (anatomical left ventricle) was significantly better than that
in the atrial switch group (anatomical LV) in TGA (60
±
6 vs 44
±
77%,
p
<
0.01). In ccTGA patients, however, EF of the LV in the
DSO group was not significantly different from that of the RV in the
conventional Rastelli group (53
±
7 vs 52
±
18%). When EF of the
pulmonary ventricle was compared, EF of the RV in the DSO group
was significantly lower than that in the arterial switch group (45
±
8
vs 61
±
11%,
p
=
0.017). CI was also significantly lower in the DSO
group compared to the arterial switch group (2.3
±
0.4 vs 3.2
±
0.6,
p
<
0.05).
Conclusion:
LV and RV function after DSO were compromised.
Systemic RV function in the conventional Rastelli group was also
compromised.
784: COMPARATIVE STUDY: RIGHT VENTRICULAR
ASSESSMENT IN POST TETRALOGY OF FALLOT REPAIR
PATIENTS BY ECHOCARDIOGRAMWITH CARDIAC MRA
Worakan Promphan
1
, Thira Wonglikhitpanya
2
, Poomiporn
Katanyoowong
1
, Tawatchai Kirawittaya
1
, Pimpak Prachasilchai
1
,
Chaisit Sangtawesin
1
,Thanarat Layangool
1
, Suvipaporn Siripornpitak
3
1
Cardiac centre for CHD, QSNICH, College of Medicine, Rangsit
University, Bangkok, Thailand
2
Department of Paediatrics, Khon Kaen Hospital, Khon Kaen,
Thailand
3
Department of Radiology, Ramathibodi Hospital, Faculty of
Medicine, Mahidol University, Thailand
Background:
Post TOF repair patients should be continuous-
ly evaluated for cardiac function, especially the right ventricle
(RV). Pulmonary regurgitation (PR) is a major cause of RV fail-
ure. Currently, cardiac magnetic resonance angiography (MRA) is
considered the clinical reference method for RV assessment. The
echocardiogram is an alternate tool for evaluating cardiac anatomy
and function.
Objective:
Assessment the RV parameters using the echocardiogram
in comparison with cardiac MRA.
Methods:
Twenty patients (mean age 14
±
2 years) after TOF
repaired were recruited from June 2011 to March 2012. The RV
was evaluated by cardiac MRA followed by echocardiography. The
echocardiographic parameters were tricuspid annular plane systolic
excursion (TAPSE), fractional area change (FAC), area of right
ventricle end-diastolic index (area RVEDi), RV free wall myocardial
performance index (MPI) and severity of PR. The cardiac MRA
parameters were right ventricular ejection fraction (RVEF), right
ventricular end-diastolic volume index (RVEDVi) and severity of PR.
Comparative analyses were assessed by Pearson’s sample correlation
coefficient, Crosstab kappa, sensitivity and specificity of area of
