CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
208
AFRICA
level was 4 983.4
±
6 326 pg/ml. On the 10th day after treatment,
27 had (59%) mild, 18 (39%) moderate, and one (2%) severe CHF.
Mean NT-proBNP level was 2 177.1
±
2 629.8 pg/ml. On the 30th
day after the treatment, 41 patients (89%) had mild CHF, and five
(11%) had moderate CHF. None had severe CHF. Mean NT-proBNP
level was 1 701.8
±
2 126.4 pg/ml. NT-proBNP levels decreased with
decongestive therapy (
p
<
0.05). NT-proBNP levels were lower on the
10th day of therapy than before the therapy, and lower on the 30th
day of therapy than on the 10th day of therapy. There was no signifi-
cant correlation between NT-proBNP level and Ross scoring on the
10th day of therapy. There was a significant correlation between
NT-proBNP level and Ross scoring on the 30th day of therapy.
Conclusion:
Plasma NT-proBNP levels were elevated in infants
with CHD with left-to-right shunt before treatment, and decreased
with decongestive therapy. Nevertheless clinical evaluation is more
important to determine the severity of CHF.
1051: PROFILE OF THE PRESENTATIONAND EVOLUTION
OF RHEUMATIC FEVER IN CHILDREN AND ADOLES-
CENTS
Cleonice Mota, Rosangela Graciano, Fatima Rocha, Zilda Meira
Division of Paediatric Cardiology, Federal University of Minas
Gerais, Brazil
Background:
Rheumatic fever (RF) and rheumatic heart disease
(RHD) represent a health burden worldwide. As a condition carried
throughout life, it has repercussions at all ages and accounts for an
important number of repeated hospitalisations and deaths.
Objectives
: To analyse the profile of the clinical and epidemiological
presentation and its relationship with the severity and evolution of
cardiac involvement.
Methods:
This cohort study was carried out on 823 consecutive
patients aged between 2.7 and 18.9 years and with a mean follow
up of 7.6
±
2.8 years (1984–2004). The following variables were
analysed: age at first attack, gender, clinical manifestations and
recurrences, family antecedents, previous pharyngotonsillitis and
pattern of severity.
Results
: The first episode was most frequent at the age of 6–15
years (
x
: 9.2
±
3.1 years), without gender predisposition, except for
chorea (F/M: 1.7/1.0;
p
=
0.0013). Previous pharyngotonsillitis was
reported at 54.9%. The prevalence of RF in patients’ families (14.2%)
was higher than among relatives of children without the disease (
p
=
0.0000). At the first attack, 96.4% of patients presented with MR,
isolated (44.2%) or associated with AR. Out of those with RHD,
97.6% showed mitral and/or aortic involvement (isolated AR: 2.4%)
with regurgitation in 78.8% and mixed lesions in 21.2%, without
patients with AS. Severe carditis was more prevalent in children
with two or more recurrences, and valvar sequelae more significant
in those with severe carditis (
p
=
0.0001); 34.8% of patients showed
complete resolution of cardiac findings, mostly without recurrences,
and presented with mild regurgitant lesions but none with severe
valvar involvement. Significant decrease was seen in the occurrence
of severe carditis, surgery and death after the control of recurrences
(
p
=
0.0000).
Conclusions
: The valvar sequelae were influenced by the severity
of the carditis and by the number of recurrences. Considering the
difficulties in primary prevention, the authors reinforce the need for
effective strategies of secondary prophylaxis to reduce morbidity and
mortality rates.
1055: INNSBRUCK EXPERIENCE WITH KAWASAKI
DISEASE
Martin Schwienbacher, Ulrich Schweigmann
Allergology and Cystic Fibrosis, Innsbruck Medical University,
Austria
Background:
We describe long-term follow up of three out of 89
patients with Kawasaki disease seen in our institution in a 33-year
period, with different clinical courses of cardiac or coronary artery
involvement.
Methods:
A retrospective description including clinical investiga-
tion, echocardiography and angiography was performed.
Results:
Patient 1 had a myocardial infarction in the acute phase
of Kawasaki disease 33 years ago. At that time, aneurysms in both
carotids, subclavian, renal and mesenterial arteries were detected by
sonography and angiography. Last heart catheterisation six years ago
revealed two aneurysms of the left ventricle (one at the apex and one
at the base, each 3 cm in diameter) and a hypokinetic left ventricle.
He is in stable clinical condition and denied any therapy.
Patient 2 developed a 17
×
11-mm aneurysm of the left coronary
artery. Twelve years later, a 90% stenosis of the left coronary artery
and a 70% stenosis of the left anterior descending artery, as well as
the ramus circumflex were detected by angiography. He underwent
aortocoronary bypass with a bilateral arteria thoracica interna bypass.
He is in excellent clinical condition on treatment with a platelet
aggregation inhibitor.
Patient 3 was diagnosed with a 9
×
6-mm aneurysm of the
right coronary artery during the acute phase of Kawasaki disease.
Spontaneous regression was observed within 12 years. The right
coronary artery shows no signs of stenosis or thrombosis in angiog-
raphy, ventricle function is normal and the patient is in an excellent
clinical condition, receiving clopidogrel.
Conclusions:
In a 33-year period, two out of 89 patients evolved
giant coronary artery aneurysms; one patient therefore underwent
aortocoronary bypass surgery. One patient developed two aneurysms
of the left ventricle, and multiple aneurysms in the great arteries
affecting multiple central arteries.
1056: MYOCARDIAL RESPONSE TO EXERCISE AFTER
PAEDIATRIC HEART TRANSPLANT: A BICYCLE EXER-
CISE STUDY
Barbara Cifra, Henrik Brun, Cedric Manlhiot, Brian McCrindle,
Anne Dipchand, Luc Mertens
Department of Paediatrics, Division of Cardiology, The Hospital for
Sick Children, University of Toronto, Canada
Background:
Data on myocardial systolic and diastolic response
to exercise of the transplant heart are limited. We used semi-supine
cycle ergometry (SSCE) stress echocardiography to evaluate left
ventricular (LV) systolic and diastolic reserve in paediatric heart-
transplant (P-HTx) recipients and compared the exercise response to
healthy controls.
Methods:
Forty-three P-HTx and 24 age- and gender-matched
controls were included. A stepwise SSCE protocol was used. Peak
systolic and early diastolic tissue Doppler velocities were measured
in the lateral and septal basal segments and values were expressed
versus heart rate. LV myocardial acceleration during isovolumic
contraction (IVA) was measured in all the subjects at incremental
heart rates to evaluate the force–frequency relationship (FFR). LV
longitudinal strain was also quantified at rest and during exercise.
Results:
At rest early diastolic tissue Doppler velocities (E’) were
reduced in the P-HTx group in the lateral LV wall (11.1 vs 13.7 cm/s,
p
=
0.001) and the basal septum (8.1 vs 11.1 cm/s,
p
<
0.001). Lateral
and septal S’ values did not differ significantly between the groups.
At peak, all S’ (8.1 vs 11.1 cm/s,
p
<
0.001) and E’ (8.1 vs 11.1 cm/s,
p
<
0.001) velocities were lower in P-HTx. The change in E’ and S’
values from baseline to peak was lower P-THx compared to controls.
Also the E/E’ ratio was higher in P-HTx in the lateral wall and in the
septum. The contractile response as studied by the FFR was blunted
in P-HTx. LV longitudinal peak systolic strain values increase during
exercise in both groups, but the P-HTx had lower strain value than
the controls.
Conclusions:
P-HTx patients showed a reduced systolic contractile
response as well as a reduced diastolic response to exercise compared
to the controls. This was not related to the heart rate response. The
clinical and prognostic implications of these findings require further
study.
