CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
243
Ramyashri Chandrasekaran
1
, Manokar Panchatcharam
1
, Muthukumar
Sivasubramaniyam
2
, Periyasamy Thangavel
3
, Jebaraj Rathinasamy
3
,
Asha Moorthy
1
, Muralidharan Thoddi Ramamurthy
1
, Murthy Jayanti
Sathyanarayana
1
, Thanikachalam Sadagopan
1
1
Department of Cardiology, Sri Ramachandra Medical College,
Chennai, India
2
Department of Cardiac Surgery, Sri Ramachandra Medical College,
Chennai, India
3
Department of Peadiatrics, Sri Ramachandra Medical College,
Chennai, India
Aim:
To study the feasibility of CMR as a useful advanced diagnos-
tic tool in the evaluation of CCHD in our institute during the period
Junuary 2011 to May 2012.
Methods:
We enrolled 12 patients with CCHD in the age group
8–50 years, female:male ratio 1:1. All patients had thorough clinical
examinations along with 2D echo evaluation. CMR was the final
decision-making tool for all patients, none had CT/cardiac cath for
delineation of anatomy. After confirmation of the diagnosis, of the
12 patients, nine underwent surgical correction. Two patients refused
surgery; one DORV with severe PAH was inoperable.
Results:
Of our 12 patients, tetralogy of Fallot was found in three
patients, DORV in its various forms in four patients, CCTGA in two
patients, unbalanced AV canal defect with reduced pulmonary flow
in one patient, DILV L-TGA with PS in one patient, and tricuspid
atresia with failed Glenn in one patient. Two patients with TOF had
total correction, one DORV with pulmonary atresia, MAPCAS had
unifocalisation with central shunt, one DORV was identified with
non-confluent PAS and had total correction, one DORV with PS with
non-routable VSD had a Fontan, DILV and unbalanced AV canal had
single staged fontan, TA also had a Fontan, one CCTGA underwent
double-switch surgery. All these patients who were taken up for
surgery had on-table assessment of PA pressures, and all were found
to be fit for final surgery. The one who we predicated to be not suit-
able for surgery was confirmed by cardiac cath.
Conclusion:
We conclude that CMR is a dynamic modality which
can give all the necessary information to help us plan the manage-
ment strategy in CCHD with decreased pulmonary blood flow, thus
avoiding the need for catheterisation studies or CT angiogram in
most of the complex congenital heart diseases.
1475: FUNCTIONAL INDEXATION OF RV PARAMETERS IN
REPAIRED TOF PATIENTS: A BETTER REFLECTION OF
CLINICAL STATUS?
Heynric Grotenhuis, August Oudshoorn, Cedric Manlhoit, Shi-Joon
Yoo
Hospital for Sick Children, University of Toronto, Canada
Background:
Routine cardiac magnetic resonance imaging (MRI) is
a well-accepted imaging method for assessment of right ventricular
(RV) and left ventricular (LV) functional parameters and degree of
pulmonary insufficiency after repair of tetralogy of Fallot (TOF).
Poor correlation with clinical status as expressed by NewYork Heart
Association (NYHA) class has however been reported. We hypoth-
esised that a combination of degree of RV dilatation [expressed by
RV end-diastolic volume (RV
EDV
) and end-systolic volume (RV
ESV
)]
indexed for LV function [expressed by LV ejection fraction (LV
EF
)]
may better correlate with clinical status than these parameters indi-
vidually.
Methods:
Wer studied 227 repaired TOF patients (mean age 12.0
years
±
standard deviation 4.6 years) with routine cardiac MRI. RV
EDV
and RV
ESV
were indexed for body surface area
1
and LV
EF
2
, respectively.
Clinical status as expressed by NYHA class was derived from clinic
visit at around the time of MRI. A univariable model was used for
statistical analysis.
Results:
RV volumes (mean
±
standard deviation) were: RV
EDV
1
:
144.96
±
38.49 ml/m
2
, RV
EDV
2
: 2.60
±
0.81, RV
ESV
1
: 76.74
±
28.25 ml/
m
2
, RV
ESV
2
: 1.39
±
0.59. Other parameters were: LV
EF
: 56.81
±
6.18%,
RV
EF
: 48.07
±
9.24%, LV
stroke volume
: 46.86
±
9.03 ml, RV
stroke volume
: 68.09
±
17.67 ml, LV
EDV
1
: 84.28
±
19.52 ml/m
2
, LV
ESV
1
: 36.35
±
9.71 ml/m
2
,
pulmonary regurgitation fraction (PRF): 32.51
±
13.61%. RV
ESV
2
and
RV
EDV
2
showed much higher correlation (0.0002 and 0.007, respec-
tively) with a higher NYHA score than RV
ESV
1
and RV
EDV
1
(0.80 and
0.03, respectively), or LV
EF
(0.43), RV
EF
(0.05) and PRF (0.11).
Conclusions:
RV volumes indexed for LV
EF
showed a much higher
correlation to clinical status than all routinely used RV and LV
parameters as indexed by BSA. RV volume indexation for LV
EF
that
combines degree of RV dilatation and LV (dys-)function may there-
fore be more useful in clinical follow up of TOF patients.
1477: HEART RATE-CORRECTED PULMONARY ARTERY
ACCELERATIONTIME CORRELATESWITH PULMONARY
CAPACITANCE AND RIGHT VENTRICULAR STROKE
WORK IN CHILDREN WITH PULMONARY HYPERTEN-
SIVE VASCULAR DISEASE: A SIMULTANEOUS ECHOCAR-
DIOGRAPHIC AND CARDIAC CATHETERISATION STUDY
Prashant Bobhate, Tim Colen, S Kaneko, Jean Trines, Nee Khoo,
Ian Adatia
1
Storlley Children’s Hospital, University of Alberta, Edmonton,
Alberta, Canada
Background:
Pulmonary capacitance calculated at cardiac catheteri-
sation is a strong independent predictor of mortality in pulmonary
hypertensive vascular disease (PHVD). However cardiac catheterisa-
tion is invasive, risky and is unsuited for frequent assessments. There
is a pressing need for non-invasive correlates of catheter-obtained
haemodynamic parameters. We sought to investigate relationships
between Doppler-derived indices and invasively obtained haemody-
namic measurements.
Methods:
We performed transthoracic echocardiograms with
Doppler interrogation on children undergoing cardiac catheterisation
with PHVD after induction of anesthesia. We measured tricuspid
regurgitation velocity (TRV) and heart rate-corrected pulmonary
artery acceleration time (PAAT). From cardiac catheterisation data
we calculated pulmonary capacitance index (PCI) and right ventricu-
lar stroke work index (RVSWi).
Results:
We studied 17 consecutive patients (11 males, median age
six years, range 0.4–15). Mean PA pressure was 40
±
20 mmHg
and mean Rp was 9.9
±
6 WU/m
2
. Peak TR velocity correlated with
systolic pulmonary artery pressures (PAp) (
r
=
0.79,
p
<
0.01). Heart
rate-corrected PAAT correlated negatively with PCI (
r
=
–0.58,
p
=
0.03) and RVSWi (
r
=
–0.68,
p
=
0.01).
Conclusion:
Increased heart rate-corrected PAAT was associated
with reduced PCI and RVSWi, both measures of the efficiency of the
RV performance and pulmonary artery–right ventricular coupling.
Heart rate-corrected PAAT is measured non-invasively by Doppler.
Heart rate-corrected PAAT is easy to obtain, reproducible and may
prove useful in the assessment of children with PHVD.
1481: PULMONARY VEIN STENOSIS IN EX-PREMATURE
INFANTS
Linda Mahgoub
1
, Ashok Kakadekar
2
, Frank Dicke
3
, Jeffrey Fineman
4
,
Andrew Redington
5
, Ian Adatia
1
1
Stollery Children’s Hospital, University of Alberta, Edmonton,
Canada
2
Royal University Hospital, Saskatoon, Canada
3
Alberta Children’s Hospital, Calgary, Canada
4
University of California, San Francisco Children’s Hospital, USA
5
Hospital for Sick Children, Toronto, Canada
Background
: Pulmonary vein stenosis (PVS) is a rare disorder that
may occur as an isolated lesion or in association with congenital heart
defects. It can be acquired following cardiac surgery or interventions
around the pulmonary veins. However, a group of ex-premature
infants who developed PVS has been identified, although the aetiol-
ogy and association with prematurity remains poorly understood.
Methods
: We reviewed all available clinical and laboratory data in
