CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
226
AFRICA
In the light of this difference, we performed a secondary analysis
distinguishing between those with the allele and those without. In this
new analysis, there was a significant association (
p
=
0.005) between
EMF and presence of the HLA-A*02:02 allele.
Conclusions:
HLA-A*02:02 at site A1 was more commonly found in
patients with EMF than in controls. Further investigations are needed
to more fully understand the role of the HLA system in EMF devel-
opment and the link between genetics and eosinophilia.
1260: TETHERED PRE-NORWOOD TRICUSPID VALVE IN
HYPOPLASTIC LEFT HEART SYNDROME ISASSOCIATED
WITH MEDIUM-TERM TRICUSPID VALVE REGURGITA-
TION
Timothy Colen
1
, Shelby Kutty
2
, Richard Thompson
1
, Chodchanok
Vijarnsorn
1
, Jeffrey F Smallhorn
1
, Nee Scze Khoo
1
1
University of Alberta, Edmonton, Canada
2
University of Nebraska College of Medicine, Omaha, Nebraska,
USA
Background:
Tricuspid regurgitation (TR) is a risk factor for
morbidity and mortality in hypoplastic left heart syndrome (HLHS).
Our group previously described the association between HLHS
medium-term TR and laterally displaced anterior papillary muscle
(APM). This study aims to determine whether congenital position of
the APM is an early risk factor for TR in HLHS.
Methods:
Neonates with HLHS were prospectively assessed prior
to stage-1 palliation (S1P) with two-dimensional (2DE) and three-
dimensional echocardiograms (3DE). 2DE was used to assess TR,
RV fractional area change, sphericity index and end-diastolic area.
Neonates with moderate or greater TR prior to S1P were excluded.
3DE datasets were analysed off-line to extract spatial coordinates of
TV annulus, leaflets and PM (TomTec Inc, Germany), with annulus
size, leaflet areas, prolapse and tethering volumes calculated using
MatLab-based software (MathWorks Inc, Mass).
Results:
Forty neonates were assessed pre-S1P and at mean follow up
of 23
±
19 months. Patients were divided by degree of TR at follow
up; 15 patients had moderate or greater TR (group A) whilw 25 had
mild or less TR (group B). Group A had an increased risk of death
or cardiac transplant (60 vs 28%,
p
<
0.05) and rate of TV surgery
(33 vs 0%,
p
<
0.01). Group A and B had similar RV size, shape
and function. No difference was found using 3DE assessment of the
APM position. However, group A patients had increased TV tethered
volume (0.69 vs 0.47 ml/m
2
,
p
<
0.05), increased 3D tenting height
(
p
<
0.05), with a trend for greater leaflet area (8.5 vs 7.2 cm
2
/m
2
;
p
=
0.06). No differences in annular area and TV prolapse were present
1267: OBJECTIVE ESTIMATION OF LEFT VENTRICULAR
FUNCTION IN CHILDRENWITHAORTIC INSUFFICIENCY
ON EXERCISE STRESS TEST
Igor Lebid
1
, Oleksandr Romaniuk
1
, Nadia Rudenko
1
, Illya Yemets
1
,
Ievgeniia Liebied
2
, Tetyana Kobets
2
, Tetyana Kuzmenko
2
1
Ukrainian Children’s Cardiac Centre, Ukraine
2
Crimea State Medical University, Simferopol, Ukraine
Method:
LV function was evaluated in 56 children (31 boys and 25
girls) with congenital AI, NYHA 1–II. Median age was 14.9 years
(10–18). Group 1 (36 children) had mild AI (P1/2t 485.04
±
16.85
ms). Group 2 (20 children) had moderate AI (P1/2t 324.74
±
39.41
ms). Echo and stress-echo were performed (Phillips HD11XE) to
evaluate the LV in all patients. The stress agent was a step-test. Power
was calculated by the formula: W (kg/min)
=
weight (kg)
×
height of
step (m)
×
number of raises/min
×
1.33 (1.33
=
coefficient: 6 kg/min/
kg on the step for 3 minutes). Thirty normal children were evaluated
as controls. An echo-Doppler study recorded LV end-diastolic (EDD,
EDV) and end-systolic (ESD, ESV) dimensions, volumes, ejection
fraction (EF) pressure gradient on the aortic valve.
Results:
Patients with mild congenital AI had no significant differ-
ences in LV parameters after the stress test compared to healthy chil-
dren (
p
>
0.05): EDD (4.06
±
0.13 sm), ESD (2.23
±
0.06 sm), EDV
(79.05
±
3.95 ml), ESV (17.84
±
1.19 ml) compared to the control
group (4.15
±
0.06 sm, 2.16
±
0.04 sm, 77.22
±
2.55 ml, 15.90
±
0.78
ml). EF in group 1 (77.56
±
1.09%) did not differ from that in healthy
children (79.56
±
0.63%) (
p
>
0.05). In children with moderate AI
there were significantly higher LV parameters after the stress test:
ESD (2.41
±
0.11 sm), EDV (90.03
±
4.13 ml), ESV (21.97
±
1.96
ml) compared with the same indices in healthy children (
p
<
0.05).
EF in this group (73.84
±
2.18%) was lower than in the healthy chil-
dren group (
p
<
0.05).
Conclusion:
Estimation of LV function during stress-echo in patients
with AI detected early signs of dysadaptation for developing heart
failure. This is very important for children with moderate AI as an
objective indication for surgical correction.
1271: VALVE SURGERY IN BRAZILIAN CHILDREN AND
ADOLESCENTS WITH RHEUMATIC HEART DISEASE:
TIME TO OPERATION AND ASSOCIATED FACTORS
Regina Elizabeth Møller
1
, Maria Virginia Marques Peixoto
2
, Maria
Cristina Caetano Kuschnir
3
, Dayse Pereira Campos
4
, Ana Clãudia
Almeida
2
1
National Institute of Cardiology, Ministry of Health, Rio de Janeiro,
Brazil
2
Fernandes Figueira Federal Institute, FIOCRUZ, Rio de Janeiro,
Brazil
3
State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
4
Evandro Chagas Clinical Research Institute, FIOCRUZ, Rio de
Janeiro, Brazil
Background
:
Rheumatic heart disease (RHD) remains the most
common acquired heart disease in children and adolescents world-
wide, being responsible for a high rate of morbidity and mortality,
often demanding valve surgery in acute or chronic phases of the
disease.
Hypothesis
: Valve surgery is associated with variables/factors from
three distinct dimensions: sociodemographic, clinical, and echocar-
diographic in children and adolescents with RHD.
Methods:
A longitudinal observational study of a hospital-based
population was done, using the Kaplan–Meier method for time esti-
mation and Cox regression model for hazard risk (HR) evaluation of
associated variables. The cohort was three- to 20-year-old patients,
registered between 1986 and 2006, and followed up until 2011. RHD
was confirmed by Doppler echocardiography. The variables evalu-
ated at the patient’s first visit were grouped into three dimensions:
sociodemographic (gender, age group, skin colour, residential region,
decade of diagnosis); clinical (disease status, NYHA functional class,
number of previous rheumatic episodes, secondary prophylaxis,
infectious endocarditis, atrial fibrillation); and echocardiographic
(valve lesion and severity, left atrium diameter, systolic left ventricle
diameter, left ventricle function, pulmonary hypertension, rupture
of mitral chordae). For the database, ACCESS 2000 was used. For
statistical analysis, R program. Significance was defined as
p
<
0.05.
Results
: Of the 348 patients (58% female), 39% underwent valve
operations. Median age at registration was 12.5 years. Median
follow-up time was 9.0 years (2–21 years). Median time until surgery
was 22.3 years. Univariate analysis: all variables except residen-
tial region (
p
>
0.5) presented significance (HR
>
1). Multivariate
analysis: the final model included decade of diagnosis (HR
=
1.36),
NYHA functional class II–IV (HR
=
1.97), number of prior episodes
(HR
=
1.72–2.15), endocarditis (HR
=
2.01), valve lesion and sever-
ity (HR
=
2.15–2.89), left atrium diameter
≥
40 mm (HR
=
2.67),
systolic left ventricle diameter
≥
45 mm (HR
=
2.67)
and rupture of
mitral chordae (HR
=
2.68).
Conclusions
: Valve surgery was associated with sociodemographic,
clinical and echocardiographic factors in Brazilian children and
adolescents. Although most patients underwent surgery in first two
years, long-term surveillance of this population was mandatory.
