CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
217
Twalib Aliku
1,2
, Sulaiman Lubega
2
, Peter Lwabi
2
1
Department of Paediatrics, Gulu University, Uganda
2
Uganda Heart Institute, Uganda
Background
: Cardiovascular dysfunction is a recognised complica-
tion of HIV infection in children. Cardiac complications of HIV
usually occur late in the course of the disease or may be associated
with drug therapy and hence become more common as therapy and
survival rates improve. Left ventricular (LV) dysfunction at baseline
is a risk factor for death independent of the CD
4
cell count, HIV viral
load, and neurological disease.
Clinical case
: We present the case of a 15-year-old girl diagnosed
with HIV and subsequently started on highly active antiretroviral
therapy (HAART) for the previous five years, on zidovudine, lami-
vudine and Nevirapine, who presented with a two-month history
of cough, orthopnoea and haemoptysis. Clinically she had pedal
oedema, a tachycardia of 118 beats per minute, BP
=
106/79 mmHg,
a laterally displaced apex, a third heart sound, basal crepitations and
a tender hepatomegaly. She had a total lymphocyte count of 1 624
cells/ml, ESR of 103 mm/h and the CRP was 132 mg/dl. Her CD
4
count was 51 cells/ml. The viral load was 36 869 copies/ml. ECG
showed a sinus tachycardia with diffuse ST-T segment changes and
LVH with strain. Echo revealed dilated left heart chambers with
severe LV systolic dysfunction and a small pericardial effusion. She
was started on heart failure medicines. Two weeks later her symptoms
had markedly improved but she was experiencing transient weakness
of her left limbs. A repeat echo showed an intracardiac thrombus
in the LV apex. Anticoagulation was started. Her HAART regimen
was switched to abacavir, lamivudine and lopinavir. Six months after
diagnosis, she was asymptomatic with normal LV size and normal
systolic function on echo. Her CD
4
count had risen to 360 cells/ml.
Conclusion
: Early cardiology referral of patients on HAART
with suspected cardiac dysfunction could lead to better treatment
outcomes.
1157: A WIDE QRS COMPLEX TACHYCARDIA WITH
GROUP BEATING IN A PAEDIATRIC PATIENT WITH
HEART FAILURE
M Cecilia Gonzalez
1
, Jean-Benoït le Polain de Waroux
2
, Francoise
Mascart
1
, Christophe Scavée
2
1
Paediatric Cardiology, Cliniques Universitaires St Luc, Brussels,
Belgium
2
Cardiology Department, Cliniques Universitaires St Luc, Brussels,
Belgium
Background:
Idiopathic sustained ventricular arrhythmias are a rare
cause of cardiomyopathy in the paediatric age. We present a peculiar
case of primary sustained ventricular tachycardia with an unusual
group beating pattern and heart failure at diagnosis.
Case presentation:
A previously healthy 11-year-old girl was
referred following a pre-syncopal episode while playing sport. On
arrival, a 12-lead ECG showed a sustained wide complex tachycar-
dia with a left inferior axis and VA concordance. A prolonged strip
showed an incessant arrhythmia, regularly interrupted by narrow
QRS complexes. A transthoracic echocardiography demonstrated
a left ventricular ejection fraction of 35%. A dose of adenosine
confirmed loss of retrograde concordance for one beat without inter-
ruption of the arrhythmia.
The patient was urgently taken to the EP laboratory. The intra-
cardiac recordings revealed a repetitive pattern of three wide beats
followed by a narrow complex. Interestingly, this pattern was accom-
panied by progressive prolongation of the retrograde VA activation.
We discovered that the ventricular activity was conducted retrograde-
ly in an alternative pattern by a fast pathway and a decremental slow
pathway. The third retrograde P wave was reconducted anterogradely
by the fast pathway and depolarised the ventricular septum, creat-
ing a fusion beat. This last ventricular event blocked retrogradely
and gave place for the phenomenon to start again. The ventricular
tachycardia was successfully ablated at the lateral free wall of the
right ventricular outflow tract. After ablation, the EP study confirmed
a dual-AV node physiology. Incremental ventricular pacing at the
right ventricular apex reproduced the observed phenomenon of a
retrograde Wenckebach in the slow pathway without induction of
supraventricular tachycardia despite aggressive protocol. No acces-
sory pathway was found. One month after the procedure, the left
ventricular ejection fraction normalised.
1165: CONGENITALLY CORRECTED TRANSPOSITION
OF THE GREAT ARTERIES: OUTCOMES OF SURVI-
VORS FROM DIFFERENT SURGICAL APPROACHES IN 46
PATIENTS
Marisa Di Santo, Erica Stelmaszewski, Alejandra Villa, Alejandra
Mori, Analia Martin, Mariela Mouratian, Victoria Lafuente, Jose
Suarez, Horacio Capelli
Garrahan Children’s Hospital, Buenos Aires, Argentina
Background:
Outcome of congenitally corrected transposition of
the great arteries (CCTGA) depends on the associated intracar-
diac defects. Different surgical repairs have been proposed. Late
outcomes are still poorly understood.
Objectives:
To compare the outcomes of different surgical tech-
niques in 46 patients with CCTGA.
Methods
: Between 1998 and 2012, 46 patiens (mean age 47.5
months) underwent surgery. Group I (nine patients): single-ventricle
repair (Glenn + extracardiac conduit); group II (11 patients):
anatomical correction (four double switch + VSD closure, four
Senning + Rastelli and three Mustard + Rastelli) and group III (26
patients): conventional surgery (five VSD closure, three tricuspid
valve replacement and 18 conventional Rastelli). Mean follow up
was: group I, 53.3; group II, 36; group III, 105 months. Tricuspid
regurgitation (TR), aortic regurgitation (AR), systemic ventricle
dysfunction, and AV block were assessed.
Results:
Group I: (19.5%) AV-valve regurgitation was mild and
non-progressive in 18%. All patients had normal ventricular function
and NYHA class I. Second-degree AV block, one patient (11.1%).
Survival was 83% at 120 months. Group II: (24%) TR was moder-
ate–severe in four patients (36%). After surgery it improved in three.
Six patients developed transient ventricular dysfunction (54.5%).
Four patients had mild–moderate AR. Neither AV block nor residual
lesions was found in the atrial switch repair. Survival was 89% (120
months). Four patients needed re-operation. Group III: (56.5%) the
main complications were progressive TR in 16 patients (
p
=
0.001),
associated with mild ventricular dysfunction in three patients and
AV block in 10 (
p
=
0.002). Seven patients required a pacemaker
implantation postoperatively and three during follow up. Six patients
required re-operation (26%). Survival was 87% at 120 months.
Conclusions:
Results for conventional repair were satisfactory,
despite TR progression during follow up. AV block and pacemaker
implantation were relevant in this group. Anatomical correction
showed decreasing TR, without AV block complication, but increased
risk for AR at mid-term follow up. Survival rates were similar among
the three groups.
1173: INITIAL EXPERIENCEWITHA NOVEL ECHO-BASED
MAGNETICTRACKING SYSTEM FOR RECONSTRUCTION
OF RIGHT VENTRICULAR VOLUMES AND FUNCTION IN
ADULTS WITH CONGENITAL HEART DISEASE
Helen Dormand, Heiko Schneider, Paul Dunne, Vaikom Mahadevan,
Bernard Clarke, Andreas Hoschtitzky, Jaspal Dua
Manchester Heart Centre, Manchester Royal Infirmary, Oxford
Road, Manchester, UK
Background:
Long-term monitoring of RV function in ACHD
patients is important and continuous. It is critical for timing the
intervention. CMR is the gold standard for this but remains a
time-consuming, costly resource and impossible in some patients.
Technology has developed a system that combines magnet-based
