CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
189
RVEDi from ROC curve analysis.
Results:
There were correlations between RVEDVi and area of
RVEDi (
r
=
0.768,
p
<
0.01), RVEF with FAC (
r
=
0.759,
p
<
0.01)
and RVEF with TAPSE (
r
=
0.688,
p
<
0.01); and 100% correlation
of moderate-to-severe PR assessment by echocardiogram vs cardiac
MRA (Crosstab kappa
=
0.912). Abnormal MPI by echocardiogram
was not correlated with NYHA classification, chest X-ray and EKG
(Crosstab kappa
=
–0.10, 0.15, –0.04). The area RVEDi
≥
20.43 cm
2
/
m
2
from echocardiography was correlated with RVEDVi
≥
160 ml/m
2
from cardiac MRA (sensitivity 64% and specificity 83%) from ROC
curve analysis.
Conclusions:
The echocardiogram is an effective tool for RV evalu-
ation in TOF with PR. Measurement of area of RVEDi, FAC, TAPSE
and degree of PR correlated well with cardiac MRA parameters.
787: RESIDUAL PULMONARY STENOSIS HAS THE ABIL-
ITY TO PREVENT PULMONARY REGURGITATION AND
RIGHT VENTRICULAR DILATATION IN PATIENTS WITH
REPAIRED TETRALOGY OF FALLOT
Hirofumi Saiki, Hirotaka Ishido, Satoshi Masutani, Hideaki Senzaki
Paediatric Cardiology, Saitama Medical University, Saitama, Japan
Background:
Pulmonary regurgitation (PR) and resultant right
ventricular (RV) dilatation are important determinants of long-term
outcome in patients with repaired tetralogy of Fallot (TOF). While
residual pulmonary stenosis (PS) acts as a pressure load on RV, it may
help reduce PR and prevent RV dilatation. To test this hypothesis, we
employed wave-intensity (WI) analysis, which provides information
about wave-front behaviour based on ventricular–vascular interac-
tion.
Methods and Results:
The study subjects were 53 patients with
repaired TOF and 39 control subjects. WI of peripheral pulmonary
arteries was computed as an instantaneous product of simultaneously
measured pressure and flow velocity. WI yielded three major compo-
nents: (1) systolic compression and acceleration wave (W1), which
reflects RV ejection performance, (2) negative reflection wave (NR),
which represents intensity of wave reflection, and (3) end-systolic
expansion and deceleration wave (W2), which denotes the speed of
regression in the antegrade blood flow and encompasses ventricular
sucking effects, inertia of flow, and regurgitation. Pressure gradient
across the PS in the repaired TOF group was 24.6
±
22.8 (0–109)
mmHg. While there was no significant difference in W1 between
the two groups, both NR and W2 were markedly higher in repaired
TOF patients than in the controls, consistent with the increased wave
reflection and PR in repaired TOF patients. In the repaired TOF
patients, multivariate regression analysis demonstrated that pulmo-
nary wedge pressure and PR independently increased W2, while
pulmonary stenosis reduced W2 (standardised
β
: 0.40, 0.39, –0.30,
p
=
0.0024, 0.012, 0.016, respectively).
Conclusions:
The results indicated that residual PS served to reduce
PR, while left ventricular diastolic dysfunction, represented by the
high pulmonary wedge pressure, increased it. These data raise a
potential caveat to perform angioplasty to relieve PS, and also suggest
the importance of preservation of left ventricular diastolic function to
improve long-term outcome of repaired TOF with residual PR.
799: PAEDIATRICTHREE-DIMENSIONAL ECHOCARDIOG-
RAPHY FACILITATES DECISION MAKING IN MANAGE-
MENT OF CONGENITAL HEART DISEASES
Suthep Wanitkun
Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background:
The improved image quality and ease of use of the
current real-time 3D echocardiographic (3DE) system promotes
incorporation of this study into routine use. Which condition would
benefit most from 3DE are evolving and being defined. We describe
conditions for which 3DE provides information that has an impact
on decision making in the management of congenital heart diseases.
Methods:
During 2009 to 2012 at the university referral medical
centre, the patients were studied for 2DE and additional 3DE using
the Philips iE33 3DE system with either an X7-2 or X5-1 probe,
where appropriate, for body size. Younger and uncooperative infants
were controlled with moderate sedation. The decision to perform
additional 3DE was due to inconclusive or questionable information
from standard 2D echocardiography. The images were acquired in
live narrow-sector, zoom, full-volume, and full-volume with colour
flow Doppler modes.
Results:
Among 4 500 conventional 2DE studies, 3DE was performed
for more information in the questioned 5% of studies. The patients
were male (55%) and were in the age ranging from birth to 15 years
old. Incremental information obtained by 3DE included clarification
of septal morphology and relationship to adjacent structures, AVSD
valve morphology and location of regurgitation, valvular regurgita-
tion, confirmation and extent of aortopulmonary window, ventricu-
lar outlet morphology, identification of circumferential subaortic
membrane, and morphology of complex single ventricle. The impacts
of 3DE on decision making included cancelling unnecessary cardiac
catheterisation, cancelling unnecessary further investigation, plan-
ning for valve repair, planning for subpulmonary resection and
patch, and planning for appropriate arterial bypass cannulation. 3DE
findings were in concordance with surgical findings in 98% of cases.
2DE missed the important information in 7% of studies.
Conclusion:
Paediatric 3DE provides incremental information to
facilitate decision making in the management of congenital heart
disease.
801: CHANGES OF DIMENSIONS AND LEFT VENTRICLE
FUNCTION IN CHILDREN WITH CONGENITAL HEART
DISEASE (LEFT-TO-RIGHT SHUNT) AND HEART FAILURE
POST CARVEDILOL THERAPY
I Ketut Alit Utamayasa, Teddy Ontoseno, Mahrus A Rahman, Dewi
Astasari Budiyono
Cardiology Division, Department of Child Health, Faculty of
Medicine, Airlangga University and Dr Soetomo Hospital, Surabaya,
Indonesia
Background:
Heart failure in children due to congenital heart
disease (CHD) and left-to-right shunt lead to the activation of
compensatory mechanisms. If these mechanisms are excessively
activated, cardiac remodelling will occur, which is characterised by
changes in dimensions and function of the left ventricle. Carvedilol,
a novel third-generation nonselective
β
-blocker, can postpone this
ventricular remodelling.
Objective:
To determine changes in dimension and function of the
left ventricle after carvedilol administration in children with heart
failure due to CHD left-to-right shunt.
Methods:
This was a double-blind, randomised, controlled trial.
Children with VSD and PDA were divided into carvedilol and control
groups, and observed using echocardiography for three months. The
evaluation consisted of LVIDs, LVIDd, LVPWd, IVSd, volume, mass,
ejection fraction, shortening fraction and E/A ratio.
Results:
There were
30 children, 19 (63.3%) boys and 11 (36.7%)
girls. The mean age was 57.6 (43.57) months. Twenty (70%) children
had VSD and nine (30%) had PDA. There were significant differences
between the two groups. The mean of changes in LVIDs: 18 (SD 0.37)
vs 0.04 (0.35),
p
=
0.04; LVIDd: 0.25 (0.43) vs 0.20 (0.58),
p
=
0.04;
LVPWd: 0.04 (0.10) vs 0.04 (0.10),
p
=
0.03; IVSd: –0.11 (0.14) vs
0.01 (0.21),
p
=
0.04; volume: 7.85 (14.74) vs 7.78 (22.87),
p
=
0,01;
mass: –15.87 (13.38) vs 19.48 (51.52),
p
=
0.03; ejection fraction:
3.50 (5.96) vs –1.54 (6.17),
p
=
0.03; and the shortening fraction: 3,17
(5.43) vs –0.95 (4.89),
p
=
0.04. There was no difference in E/A ratio
0.07 (0.32) vs 0.03 (0.31),
p
=
0.71 between the two groups.
Conclusion:
There were significant changes in LVIDs, LVIDd,
LVPWd, IVSd, volume, mass, ejection fraction, and the shortening
fraction, without any difference in E/A ratio, in children with CHD
left-to-right shunt and heart failure post carvedilol therapy.
