CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
228
AFRICA
loplasty. All patients underwent epicardial or transoesophageal echo
postoperatively. Mean CPB time was 130 min. Mean aortic cross
clamp time was 78 min. Five patients had grade II MR on TEE, which
was expected as the left atrial pressure was low. No early or late
mortalities were found. Mean hospital stay 7.4 days. On discharge
eight patients had mild MR while five had grade II MR. We have
complete follow up for two years. Three patients required mitral valve
replacement after two years, while three developed new grade III MR.
Conclusion
: Mitral valve repair is a good option for children with
rheumatic mitral valve disease. With modification of surgical tech-
niques, most mitral valves can be repaired, with good surgical results.
1291: RETROSPECTIVE EVALUATION OF PATIENTS WITH
KAWASAKI DISEASE
Pelin Kosger, Birsen Ucar, Ali Yildirim, Gokmen Ozdemir, Tevfik
Demir, Zubeyir Kilic
Department of Paediatric Cardiology, Medical Faculty, Eski
ş
ehir
Osmangazi University, Turkey
Background:
The diagnosis of Kawasaki disease requires the pres-
ence of five days of fever and at least four of the five principal
clinical features, including bilateral non-exudative conjunctivitis,
erythema of the lips and oral mucosa, changes in the extremities,
rash and cervical lymphadenopathy. The most serious complication
is coronary artery aneurysm.
Methods:
In this study, 18 patients diagnosed with Kawasaki disease
in the Department of Paediatrics, Eski
ş
ehir Osmangazi University
Hospital between 1996 and 2012 were evaluated.
Results:
At admission, the mean age of the patients was 40.6
±
22.5
months (8–90 months) and the duration of fever was 8.8
±
4.4 days
(3–20). All patients had high fever and the second most commonly
seen finding was changes in lips and oral mucosa (94.4%). The other
findings were changes in the extremities (83.3%), rash (72.2%),
non-exudative conjunctivitis (55.5%) and cervical lymphadenopathy
(27.7%). Twelve (66.7%) of the cases were diagnosed with complete
and six (33.3%) with incomplete Kawasaki disease. Coronary artery
dilatation was observed in sic patients (33.3%), mitral insufficiency
in four (22.2%), pericardial effusion in one (5.6%), and increased
end-diastolic diameter of the left ventricle in one (5.6%) patient.
Sixteen patients were given intravenous immunoglobulin (IVIG)
and acetylsalicylic acid (ASA). Two patients, one complete and one
incomplete, could be given only ASA. Coronary artery pathology
was not seen in these two patients. One patient was given a second
dose of IVIG because of the persistent fever. During follow up,
coronary artery aneurysm was observed in four (25%) and coronary
artery stenosis in one (6%) of the patients given IVIG.
Conclusion:
Early diagnosis and treatment of Kawasaki disease is
important to prevent coronary artery complications. It is essential to
suspect Kawasaki disease and to perform echocardiographic evalua-
tion for cardiac involvement in patients with fever persisting longer
than five days.
1293: EVALUATION OF VENTRICULAR SEPTAL DEFECT
WITH REAL-TIME THREE-DIMENSIONAL ECHOCARDI-
OGRAPHY
Jia-Kan Chang
1
, Yen-YingYang
2
, Ta-Cheng Huang
2
, Chu-Chuan Lin
2
,
Jun-Yen Pan
3
, Kai-Sheng Hsieh
2
1
Department of Paediatrics, Cheng-Hsin General Hospital, Taipei,
Taiwan
2
Department of Paediatrics, Veterans’ General Hospital, Kaohsiung,
Taiwan
3
Division of Cardiovascular Surgery, Veterans’ General Hospital,
Kaohsiung, Taiwan
Background:
As a dynamic three-dimensional structure, the heart
can be hard to understand in conventional two-dimensional (2D)
plane imaging. Hence, real-time 3D (RT-3D) imaging can be used
for assessing cardiac structures and intracardiac lesions. This study
assessed a RT-3D platform for delineating ventricular septal defect
(VSD) geometric characteristics.
Methods:
Nine patients with VSD (four female and five male)
enrolled in this study. The VSD types included three perimembranous
cases, three inlet cases, and three outlet cases. The Philips IE 33
system was used to acquire both the 2D and the RT-3D echocardiog-
raphy images. These patients’ lesions were subsequently diagnosed
and analysed for clinical comparison.
Results:
The 2D VSD diameter was 6.78
±
1.55 mm (range: 4.2–10.1
mm). The RT-3D mean maximum and minimum VSD diameters were
7.27
±
1.74 and 6.37
±
1.66 mm, respectively. All patients underwent
VSD surgical repair; the respective intra-operative maximum and
minimumVSD diameters were 7.29
±
1.83 mm (range: 5.0–11.5 mm)
and 6.17
±
1.98 mm (range: 3.0–10 mm). The correlation coefficient
between 2D and RT-3D mean maximum diameters was
r
=
0.966,
between surgical diameters it was
r
=
0.967, while it was
r
=
0.945
between the RT-3D mean maximum and intra-operative diameters.
Conclusion:
‘Real-time’ 3D echocardiography can be a good diag-
nostic tool to clearly delineate the size, position and size of a VSD.
In the future, it may pre-operatively assess VSD and device closures.
1301: COST EFFECTIVENESS OF ECHO-BASED RHEU-
MATIC HEART DISEASE SCREENING
Justin Zachariah
1,2
, Rosemary Wyber
3
, Mihail Samnaliev
1
1
Boston Children’s Hospital, USA
2
Harvard Medical School, USA
3
Harvard School of Public Health, USA
Background
: Rheumatic heart disease (RHD) is a leading cause of
mortality and morbidity in young citizens of low- and middle-per
capita income settings. Echocardiography-based screening approach-
es dramatically expand the number of children identified at risk of
progressive RHD. We developed a Markov model to project the cost-
effectiveness of this nascent screening approach.
Methods:
A Markov model was constructed comparing a No-Screen
to Echo-Screen approach. Both scenarios commit staff to provide
secondary prophylaxis, prophylaxis transportation, consumables,
heart failure medications, anticoagulation and monitoring, general
practitioner and/or cardiology follow up appropriate to the severity
of RHD, valve replacement in a fraction of compromised patients
including operative costs, consumables, valve, and post-operative
stay, and severity-appropriate lost wages to patient/parent. The screen
scenario posits technician-driven limited screening echo followed
by detailed cardiology evaluation in screen-positive children. The
screen scenario entailed one-time costs for staff, transportation, echo
machine, and a single day’s lost wages. RHD-related states were
categorised as well (utility weight 0.9), dead (utility 0), silent RHD
defined as visible on echocardiography but silent by auscultation
(utility 0.75), auscultation-audible RHD (utility 0.75), previously
audible but now resolved RHD (utility 0.75), RHD with functional
compromise in activities of daily living (utility 0.58), and RHD post
valve replacement (utility 0.58). Sensitivity analyses varied echo
accuracy, surgical availability, disease prevalence, and screening-
associated costs. Results are denominated in Australian dollars and
future utilities and costs were discounted by 3.5% per year.
Results
: The Echo-Screen strategy may be cost-effective, and under
certain circumstances, dominated the No-Screen strategy. This result
appears insensitive to screening costs, surgical availability, and echo
accuracy, but did appear to be affected by RHD prevalence.
Conclusions
: Contrary to our expectation, a two-stage echo screen-
ing approach in a health system committed to providing secondary
prophylaxis may be robustly superior under a variety of circum-
stances.
1302: THE NEW GHENT CRITERIA FOR MARFAN
SYNDROME: CLINICAL IMPLICATIONS
Silvia Alvares, Vasco Lavrador, Esmeralda Martins, Marilia Loureiro
1
Centro Hospitalar do Porto, Porto, Portugal
