CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
213
Methods:
This was a randomised, controlled trial study where 30 HF
L-R CHD patients were divided into two groups. The treatment group
consisted of 16 children with carvedilol + standard therapy (ACEI
and diuretic). The control group comprised 14 children with standard
therapy. ECG was performed before and after therapy. The changes
in heart rate, R-wave amplitude in V6, S-wave amplitude in V1 and
R/S ratio in V1 were measured. Adverse effects were monitored. The
study duration was three months.
Results:
Heart rate decreased significantly in the treatment group
compared to the control group (17.7 vs 4.1%;
p
=
0.002). R-wave
amplitude in V6 decreased significantly in the treatment group
compared to the control group (23.6 vs 7.5%;
p
=
0.03). S-wave
amplitude in V1 decreased significantly in the treatment group
compared to the control group (27.9 vs 10.1%;
p
=
0.008). R/S ratio
in V1 increased significantly in the treatment group compared to the
control group (51.6 vs 15%;
p
=
0.31). No adverse effects were found.
Conclusions:
Carvedilol was effective in improving ECG parameters
and safe as additional therapy to the standard therapy of CHF in chil-
dren with L-R shunt CHD.
1120: MANAGEMENT OF HAEMOSTASIS IN PATIENTS
AFTER PLACEMENT OF A VENTRICULAR ASSIST
DEVICE: USE OF POINT-OF-CARE INR MONITORING TO
MANAGE VITAMIN K ANTAGONISTS
Patti Massicotte
1
, Mary Bauman
1
, Aisha Bruce
1
, Holger Buchholz
3
,
Stefan Kuhle
2
1
University of Alberta, Stollery Children’s Hospital, Edmonton
Canada
2
Obstetrics and Paediatrics, Halifax, Canada
3
Mazankowski Heart Institute, University Hospital, Edmonton,
Canada
Vitamin K antagonists (VKA), required for haemostasis management
in patients with ventricular assist devices (VADs), must be regularly
monitored to avoid both thrombotic and bleeding complications. The
gold-standard monitoring method is the prothrombin time (PT) test-
ing of plasma collected via venipuncture and expressed as an INR.
The point-of-care POC INR monitor is convenient for patients, uses
a capillary whole blood sample and produces an INR within minutes.
The POC INR monitor is demonstrated to be accurate in adults and
children requiring VKA therapy facilitating more frequent INR test-
ing; a requirement for VAD patients.
Methods:
This was a prospective cohort study including all patients
with a VAD treated with VKA to determine the accuracy of the
CoaguChek XS
®
, by comparing whole-blood INR results from
the CoaguChek XS
®
with plasma laboratory INR results. Meters
were loaned to patients for use. Prior to patient use, comparisons
between POC INR and laboratory INR were performed; 158 meter
validations were performed from two time points from 16 patients
receiving warfarin, by drawing a venous blood sample for laboratory
PT INR measurements and simultaneous INR using the POC INR
meter. Agreement between CoaguChek XS
®
and laboratory INR was
assessed using the concordance correlation coefficient (CCC).
Results:
VKA therapy for VAD thromboprophylaxis was received by
six children, median age 4.1 years (range 3.1–15.5) and 10 adults,
median age 51.2 years (range 18.6–63.0) who had
n
=
5 EXCOR,
n
=
1 Heartware,
n
=
1 EXCOR, and
n
=
9 Heartmate VADs, respectively.
There were a mean of 13 (range 2–27), six (range 4–14), and nine
INR tests per patient for the Berlin Heart, Heartmate and Heartware,
respectively. The CCC was 0.65 and 0.72 in children and adults,
respectively.
Conclusions:
The CoaguChek XS
®
meter readings showed a moder-
ate to good agreement when compared to laboratory INR test results.
1125: NATRIURETIC PEPTIDE (proBNP) AS A MARKER OF
CARDIOVASCULAR DISEASE AND CONATAL INFECTION
IN PRETERM INFANTS
Juan Pablo Miranda
1,2
, Mauricio Pinto
1
, Rodrigo Diaz
1
, Ronald
Leiva
1,2
, Gabriel Penaloza
1
, Freddie Rybertt
1
, Rodrigo Salas
1,2
, Jose
Antonio Salinas
1
, Yalda Lucero
1
, Magdalena Castro
1
1
Clinica Las Condes, Santiago, Chile
2
Hospital Barros Luco, Santiago, Chile
Introduction:
Natriuretic peptide (proBNP) is a molecule secreted
by the myocardium in response to pressure or volume overload.
Objective:
To determine the relationship between proBNP levels and
the presence of cardiovascular disease and/or perinatal infection in
preterm neonates.
Methods:
A prospective study including preterm neonates (
<
32
weeks and/or
<
1 500 g) was conducted at the neonatal unit of Clinica
Las Condes between June 2011 and June 2012. ProBNP levels were
determined between 48 and 72 h after birth by electrochemilumi-
nescence assay. Echocardiogram, CBC, CRP and proBNP tests were
performed. Patients were divided into four groups according to the
presence of cardiovascular disease (PDA
>
1 mm, CHD, cardiomyo-
pahty and/or pulmonary hypertension) and/or conatal infection. The
study was approved by the local IRB. Logistic regression and ROC
analysis were performed to determine the predictive value and a cut-
off point for proBNP.
Results:
Fifty-three patients were recruited with a median gestational
age of 29.6 weeks (range 24–33) and a mean birth weight of 1 316.4 g
(750–1890). The median proBNP levels were 5 215 pg/ml (662–100
080) for the entire study group; 17 691 pg/ml (3 761–100 080) for
patients with cardiovascular disease and 2 855 pg/ml (662–6750) (
p
<
0.005) for patients without cardiovascular disease. ProBNP levels of
17 730 pg/ml corresponded to patients with associated infection and
3 184 pg/ml (
p
<
0.005) to those without infection. To detect cardio-
vascular disease, proBNP levels with 80% sensitivity, 79% specific-
ity, a positive predictive value of 60% and a negative predictive value
of 91% were obtained based on the ROC curve analysis and a cutoff
value of 9 970 pg/ml. With regard to using proBNP to detect perinatal
infection, 92% sensitivity and 73% specificity were obtained with a
cut-off value of 7 522 pg/ml.
Conclusions:
The results in this study suggest the need for proBNP
measurement to accurately predict cardiovascular disease in prema-
ture newborns. Possible perinatal infection of the patient should be
considered.
1131: SYSTEMIC VENOUS ANOMALIES IN THE MIDDLE
EAST
Antonio F Corno, Sami Alahdal, Karunamoy Das
King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
Introduction
: The purpose of this study was to evaluate the inci-
dence of systemic venous anomalies in patients requiring congenital
heart surgery in the region of the Middle East.
Methods
: From September 2010 to March 2012, 155 consecu-
tive patients undergone surgery for congenital heart defects were
reviewed for the presence of the following systemic venous anoma-
lies: persistent left superior vena cava (PLSVC); inferior vena cava
(IVC) interruption; and retro-aortic innominate vein. The modalities
utilised for the diagnosis were also reviewed: echocardiography,
computed tomography (CT) scan or intra-operative.
Results
: Systemic venous anomalies were identified in 28/155
patients (18.1%). PLSVC was present in 21 patients (13.5%), median
age 4 months (range 3 days – 18 years), median body weight 6 kg
(range 2.6–34.0 kg). IVC interruption was identified in five patients
(3.2%), median age 2 months (range 30 days – 26 years), median
body weight 3.7 kg (range 2.3–68.0 kg). Retro-aortic innominate
vein was diagnosed in three patients (1.9%), mean age 5 years (range
10 months – 5 years), mean body weight 12 kg (range 4.5–14 kg).
The diagnosis was established pre-operatively in 22/28 (78.6%)
patients; in 14/28 (50%) with echocardiography, and in 8
/
28 (28.6%)
with CT scan. In 6/28 (21.4%) patients the diagnosis was intra-
operative.
Discussion:
The incidence of systemic venous anomalies in this
study resulted in higher values than previously reported in the litera-
