CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
191
Overall prevalence of definite RHD was 7.2/1 000 indigenous chil-
dren (95% CI: 4.9–10.5) with a median age of 10 years and a slight
female predominance (58.6%). A significantly higher rate of 14/1000
was observed in the Top End region of the Northern Territory (
p
<
0.05). The majority of children with definite RHD had isolated
mitral valve disease. The prevalence of borderline RHD was 12.2/1
000 (95% CI: 9.2–16.4), with one in three of these having isolated
significant aortic regurgitation.
Conclusions:
The prevalence of definite RHD in indigenous children
in northern Australia is similar to that of developing countries and is
consistent with previous register-based clinical estimates, suggesting
that the WHF criteria are appropriately sensitive and specific. These
data will be critical in determining the cost-effectiveness of routine
screening in Aboriginal children.
816: WESTERN AUSTRALIA’S RECENT EXPERIENCE
IN DELINEATING PATENT DUCTUS ARTERIOSUS
MORPHOLOGY BY ECHOCARDIOGRAPHY PRIOR TO
DEVICE CLOSURE
Yukari Newman
1
, Stephen Shipton
1
, James Ramsay
1
, Rolland Kohan
2
,
Jennifer Melvin
3
1
Princess Margaret Hospital, Perth, Western Australia
2
King Edward Memorial Hospital for Women, Perth, Western
Australia
3
Notre Dame University, Perth, Western Australia
Background:
The Children’s Cardiac Centre in Perth, Western
Australia uses high-quality cardiac ultrasound equipment in its day-
to-day practice. Interventional management of PDAs is now widely
practised with a wide range of devices readily available. Choice of a
device is dependent on the anatomical detail of the duct – all of this
detail has traditionally been delineated using angiography performed
at the time of the interventional procedure. However, it has been
noted that this anatomical detail could be accurately outlined using
detailed echocardiography and therefore an accurate prediction of
the probable device type can be made prior to the interventional
procedure.
Methods:
Retrospective review was done of 2D echocardiograms of
all patients with PDAs who underwent interventional closure between
January 2006 and July 2012. Appropriate echocardiographic images
were collated side by side with lateral angiographic stills. Based on
the echo image alone, devices thought suitable were selected and
compared to the actual device deployed.
Results:
We retrospectively reviewed the echocardiograms as well as
the angiographic images of 74 patients with PDAs deemed suitable
for interventional closure. Imaging quality of the duct in the pre-
procedural echocardiogram was of sufficient quality in 31 patients to
accurately predict the choice of a device to interventionally occlude
the duct.
Conclusion:
Modern ultrasound equipment almost always enables
accurate delineation of anatomical detail of PDAs. Decisions regard-
ing choice of appropriate device can almost always be made prior to
proposed interventional procedure. This has important implications
with regard to limiting stock of expensive interventional devices
required, as well as the process of informed consent when discussing
the procedure with patients and their carers.
822: A CASE OF ANOMALOUS ORIGIN OF THE LEFT
CORONARY ARTERY FROM THE PULMONARY ARTERY
PRESENTING WITH ACUTE MYOCARDIAL INFARCTION
AND CARDIOVASCULAR COLLAPSE
Twalib Aliku
1
, Sulaiman Lubega
2
, Peter Lwabi
2
1
Gulu University, Uganda
2
Uganda Heart Institute, Kampala, Uganda
Background
: Although a rare clinical entity, anomalous origin of
the left coronary artery from the pulmonary artery (ALCAPA) is a
common cause of myocardial infarction in children. Unrecognised
and untreated, it leads to progressive left ventricular dilatation and
systolic dysfunction.
Clinical case
: We present the case of a 10-week-old infant who had
been seen a month earlier in our cardiology service with fever, cough
and difficulty in breathing. His echo showed dilated left ventricle with
poor systolic function that was attributed to a myocarditis or dilated
cardiomyopathy. Four weeks later he presented to the in-patient unit
with marked restlessness and irritability. He was inconsolable, had
marked respiratory distress, cool extremities, and central and periph-
eral cyanosis. The radial and brachial pulses were absent. The mean
arterial pressure was 65 mmHg, heart rate of 160 beats per minute
with a third heart sound. Laboratory tests showed an elevated CK-MB
of 112.5 U/l. Other laboratory tests were normal. ECG revealed deep
Q waves in leads I, aVL, V5, V6 with ST elevation in the anterolateral
leads. Echo showed a dilated left ventricle with paradoxical septal
motion, severe LV systolic dysfunction, LV anterolateral wall echo
brightness and flow reversal in the left coronary artery with its origin
from the pulmonary trunk. He was admitted to the coronary care unit,
given fluid resuscitation, dopamine, standard management of heart
failure and was discharged six days later.
Conclusion:
A combination of a high index of suspicion, typical
ECG and echocardiographic findings in a young infant presenting
with LV dysfunction could lead to an earlier diagnosis of ALCAPA.
835: TREATMENT STRATEGIES IN PATIENTS WITH
EISENMENGER SYNDROME ASSOCIATED WITH COARC-
TATION OF THE AORTA: CASE SERIES
Muthukumaran Sivaprakasam, Archana Murugan, Prasad Manne,
Neville Solomon, Ganapathy Subramaniam
Apollo Children’s Hospital, Chennai, India
Aim
:To establish the treatment strategies in patients with Eisenmenger
syndrome and coarctation.
Methods
: A review was carried out of all cases that had established
pulmonary hypertension and coarctation between January 2008 and
January 2012.
Results
: Three patients were identified.
Case 1: A 22-year-old female was referred with differential cyanosis
and large PDA. The echocardiogram showed coarctation (COA). The
RV pressure was systemic. Finally she underwent stent angioplasty
of the COA. During the procedure the RV pressure was systemic. The
COA was stented with a covered CP stent, which closed the PDA.
Immediate RV pressure was systemic. She was started on sildenafil.
On follow up her RV pressure normalised and the sildenafil was
stopped.
Case: 2. An eight-year-old was referred for differential cyanosis
and he was noted to have a large PDA with COA. He underwent stent
angioplasty of the COA as in the previous patient. His PA pressure
was systemic, which normalised on follow up.
Case: 3. A seven-year-old was referred with large VSD and COA.
Her saturations on admission were 80%. The echocardiogram showed
large VSD with bidirectional flow. She underwent stent angioplasty
of the COA. Postoperatively she was stable initially but later devel-
oped severe R-L shunt across the VSD (50% sats). She was started on
bosentan and sildenafil. The saturations on discharge were 80%, but
on follow up her PA pressure remained the same and she is currently
being medically managed.
Conclusion
: PDA with COA is a protected circulation as the pulmo-
nary blood is shunted into the descending aorta and thus the pulmo-
nary vasculature is not exposed to high blood flow. Therefore it is
safe to close the PDA and stent the COA. VSDs with coarctation have
increased pulmonary blood flow and cause irreversible pulmonary
hypertension early. However treating the coarctation will help but
patients need careful pre- and postoperative management.
837: OUTCOME OF DILATED CARDIOMYOPATHY IN
DUTCH CHILDREN
Suzanne den Boer
1
, Lennie van Osch-Gevers
1
, Gijs van Ingen
1
,
