CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
200
AFRICA
Conclusion:
Patients with DCMO with poor left ventricular function
are at high risk for ICT and should undergo routine echocardio-
graphic surveillance. While no firm paediatric guidelines exist, anti-
coagulation has been recommended for patients with FS below 20%.
906: SPECTRUM OF RHEUMATIC FEVER AND HEART
DISEASE IN A SPECIALIST CARDIAC SERVICE IN THE
UNITED KINGDOM
Atul Kalantre
2
, Nilesh Oswal
1
Philip Rees
1
, Sachin Khambadkone
1
1
Cardiac Unit, Great Ormond Street Hospital and Freeman Hospital,
UK
2
Alder Hey Children’s Hospital, Liverpool, UK
Introduction
: Acute rheumatic fever and rheumatic heart disease
remains a public health concern in the developing countries, however,
with population migration, it is not unusual in developed countries.
Methods:
We reviewed all the patients referred to the Cardiac Unit
and diagnosed and treated as acute rheumatic fever or recurrence
over a 10-year period diagnosed by modified Jones criteria.
Results:
Over a 10-year period, we saw 33 cases of acute rheumatic
fever or recurrence of rheumatic activity. Mean age 10 years (range
5–14 years), with a male preponderance (eight girls, 25 boys); 25
patients were of a different ethnic background with the majority
being South Asian or British Asian (11). All patients had carditis of
varying degrees, manifest predominantly as valvulitis. Mitral and/
or aortic regurgitation was the most common lesion, with mitral
stenosis being rare; 55 % had polyarthritis, 13 % had chorea and
none had subcutaneous nodules. Four patients required surgery in
the form of mitral valve repair or replacement (four patients) and one
had concomitant aortic valve repair. All patients with clinical carditis
were treated with bed rest, oral steroids and then salicylates for a
total period of eight weeks. Twelve patients had been undertreated
with steroids before. Secondary prophylaxis with oral penicillin over
a follow-up period of a mean of 4.5 years (range 2
–
12) led to no
rheumatic recurrences.
Conclusion
: Although the prevalence of rheumatic heart disease is
high in certain parts of the developing world, with population migra-
tion, the disease is still seen in low-prevalence areas. Carditis and
arthritis are common with chorea and subcutaneous nodules are rare.
997: HETEROTAXY SYNDROME: IS A PROPHYLACTIC
LADD PROCEDURE NECESSARY IN ASYMPTOMATIC
PATIENTS?
Charissa R Pockett
1
, Bryan Dicken
2
, Jennifer Rutledge
1
, Ivan M
Rebeyka
2
, David B Ross
2
, Andrew S Mackie
1
, Lindsay M Ryerson
1
1
Department of Paediatrics, University of Alberta, Edmonton, AB,
Canada
2
Department of Surgery, University of Alberta, Edmonton, AB,
Canada
Background:
Complex congenital heart disease and abnormali-
ties of intestinal rotation are commonly associated with heterotaxy
syndrome (HS). Malrotation is the most worrisome intestinal rotation
abnormality (IRA) due to the risk of bowel ischaemia and infarction.
There is controversy whether asymptomatic infants with HS require
screening for IRA and if present, whether a prophylactic Ladd proce-
dure is indicated. As this population grows due to continuing advanc-
es in cardiovascular care, it is vital to better understand the natural
history of IRA and devise an evidence-based treatment model. The
first objective of this study was to determine institutional practice
in the management of asymptomatic infants with HS and IRA. The
second was to prospectively observe a cohort with HS and evaluate
their long-term outcomes.
Methods:
We have begun a prospective, multi-centre, observational
study using a web-based database to follow infants with HS to five
years of age. Data collection includes screening methods used
for the detection of IRA, management of IRA, cardiac diagnosis,
cardiac interventions, long-term complications and outcomes. Patient
management will not be dictated by the study protocol, given the
observational design.
Results:
Ethics and scientific approval has been obtained at two
centres in Canada and six patients have been enrolled to date.
Fourteen other centres across NorthAmerica and the United Kingdom
are currently obtaining ethics approval. Additional centres are being
actively recruited.
Conclusions:
Results from this study may change general surgi-
cal practice in the management of this complex group of patients.
Establishment of this cohort will facilitate future studies of the
HS population with regard to gastrointestinal and cardiovascular
outcomes.
909: AN EVALUATION OF THE REPRODUCIBILITY AND
INFLUENCE OF PROCESS FACTORS ON AORTIC INTI-
MA–MEDIA THICKNESS MEASUREMENTS BY TRANS-
ABDOMINAL ULTRASOUND INYOUNG INFANTS
Kate McCloskey
1,2,3
, David Burgner
1,3
, Peter Vuillermin
1,2,4
, Michael
Cheung
1,3
, Michael Skilton
5
, Jane Koleff
1
, John Carlin
1,3
, Kim Jachno
1
,
Anne-Louise Ponsonby
1,3
1
Murdoch Children’s Research Institute, Royal Children’s Hospital,
Parkville, Australia
2
Child Health Research Unit, Barwon Health, Australia
3
University of Melbourne, Australia
4
Deakin University, Melbourne, Australia
5
Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders,
Sydney University, Australia
Background:
Aortic intima
–
media thickness (aIMT) is a novel
parameter increasingly used as a marker of early atherosclerosis. The
reproducibility of aIMT measurement by trans-abdominal ultrasound
in infancy has been established in small, tertiary hospital-based stud-
ies, but there are no data from trained staff in a community-based
setting. In addition, there are no data on whether environmental and
infant behavioural factors influence the reproducibility of aIMT
measurements.
Methods:
The Barwon Infant Study (
n
=
1 250) is a regional non-
selected Australian birth cohort. Aortic IMT is measured on four-
week-old infants by two trained research staff using trans-abdominal
ultrasound (GE vivid I
TM
with vascular probe). A subset of babies has
aIMT performed by both staff to assess inter-observer consistency.
Data were collected on infant behaviour, sleep/wake cycle, recent
feeding, sucrose use, and presence of siblings. Two analysts, blinded
to the other’s measurements, quantified image quality and aIMT
using Echopac software. Results were assessed for inter-observ-
er consistency between (1) sonographers and (2) analysts using
Pearson’s correlations, Bland-Altman plot and 2
×
n
Chi
2
analysis.
Results:
Among the first 292 babies, aIMT approximated a normal
distribution (mean 0.564 mm, SD 0.06 mm). The inter-observer corre-
lation of aIMT measurements from infants scanned by both sonog-
raphers (
n
=
17 to date) was 0.8449,
p
<
0.001. The inter-operator
correlation between measurements of aIMT made by both analysts (
n
=
115 to date) was 0.8783,
p
<
0.001 (mean difference 0.004 mm, SD
0.028). Infant and environmental factors did not affect image quality.
Conclusions:
In the setting of a large-scale population-based study,
aIMT measurement by trans-abdominal ultrasound in young infants
was reproducible and unaffected by environmental and behavioural
factors examined. (These are interim data. Data on 500 subjects will
be available by February 2013.)
915: COMPARISON OF ECHOCARDIAGRAPHIC AND
ELECTROCARDIOGRAPHIC RISK FACTORS FOR THE
PREDICTION OF SUDDEN DEATH IN PAEDIATRIC HYPER-
TROPHIC CARDIOMYOPATHY
Ingegerd Ostman-Smith
1
, Eva Fernlund
2
, Per Larsson
3
, Gunnar
Sjoberg
4
, Annika Rydberg
5
1
Division of Paediatric Cardiology, Queen Silvia Children’s Hospital,
Gothenburg, Sweden
