CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
248
AFRICA
clinically and by echocardiography. Blood cytokines (interleukin-10
(I-10), tumour necrosis factor alpha (TNF-alpha) and interferon
gamma (IFN-gamma) were done.
Results:
Thirty six children were enrolled; 63% had established
RHD, and 37% ARF. Mitral regurgitation (MR) was the most
common lesion (94%). Ninety five per cent of the valve lesions
were severe. The serum I-10 level ranged between 3 and 6 pg/ml.
TNF-alpha levels were 9–100 pg/ml in 12 patients (40%), 101–1 000
pg/ml in 10 patients (33%), and more than 1000 in 8 patients (26%).
The level of IFN-gamma ranged between 2 and 7 pg/m in all patients
except 2 (84 and 135 pg/ml).
Conclusion:
RHD manifests with severe valvular lesions and a high
TNF-alpha indicating an ongoing inflammation.
1531: THE ARISTOTLE COMPREHENSIVE COMPLEXITY
SCORE PREDICTS MORTALITY AFTER SURGICAL LIGA-
TION OF PATENT DUCTUS ARTERIOSUS IN PRETERM
INFANTS
Jae Young Lee, Yun Hee Jang, Eun-Jung Lee, Sena Moon, YoungAh
Youn, Ju Young Lee, In Kyung Sung, Jung Eun Kim
Seoul St. Mary’s Hospital, the Catholic University of Korea, Seoul,
Korea
Background:
The outcome measure after surgical ligation of patent
ductus arteriosus (PDA) in preterm infants is often complicated by
prematurity-associated co-morbidities. The Aristotle comprehensive
complexity score (ACCS) has been proposed as a useful tool for
complexity adjustment in the analysis of outcome after congenital
heart surgery. The aims were to define preoperative risk factors for
mortality and to demonstrate the usefulness of ACCS to predict
mortality after surgical ligation of PDA in the preterm.
Material and methods:
Included were 49 preterm babies (
<
35
weeks’ gestation), from May 2009 to July 2012, who had surgical
ligation of PDA. Mean (range) gestational age and birth weight were
28 weeks (23–35 weeks) and 1 102 g (520–2 280 g), respectively.
Mean (range) age and weight at operation were 16 days (4–44 days)
and 1 199 g (400–2 880 g), respectively. Initial oral ibuprofen was
ineffective in 24 patients and contraindicated in 25. All surgical
ligations were done at bedside in the neonatal intensive care unit.
Preoperative clinical and laboratory profiles were reviewed and
ACCS was derived.
Results:
Eight out of 49 (16.3%) died after a median of 14 days
(2–73 days) after PDA ligation. Patients who had contraindications
for oral ibuprofen (odds ratio (OR) 8.94;
p
=
0.049), coagulopathy
(OR 12.13;
p
=
0.025), renal dysfunction (OR 28.88;
p
=
0.003),
intraventricular haemorrhage
≥
grade III or seizure within 48 hours
of operation (OR 34.00;
p
=
0.002), and ACCS
>
15 (OR 415.00;
p
<
0.001) were significantly associated with an increased risk for
mortality. At multivariate logistic regression analysis, ACCS
>
15
was the only independent risk factor (OR 103;
p
=
0.023) for mortal-
ity.
Conclusions:
The ACCS, especially procedure-independent
complexity factors, is a useful tool to predict mortality after ligation
of PDA in the preterm.
1532: COARCTATION OF THE AORTA IN INFANTS: CLINI-
CAL, THERAPEUTIC AND PROGNOSTIC IN A SERIES OF
52 CASES
Euclides Tenorio, Luziene Bonates, Cleusa Lapa, Cristina Ventura,
Izabella Brandão, Fernando Moraes, Carlos Moraes
The Medical Institution Prof. Fernando Figueira, Recife, Pernambuco,
Brazil
Objective:
To describe the clinical and therapeutic characteristics
of 52 infants undergoing surgical repair of coarctation of the aorta.
Material and methods:
A total of 52 infants under 1 year of age
underwent surgical correction of coarctation of the aorta from July
2000 to January 2012.
Results:
Thirty-nine (75%) children were male. The median age at
diagnosis was 30 days, ranging from 20 days to 1 year. Regarding the
onset of clinical manifestations, in 20 (51.9%) cases they occurred
within the first month of life, in 13 (25%) cases from the first to the
sixth month of life, and in 19 (36.5%) cases between the sixth month
and the first year of life. The most significant finding was absence or
reduction of arterial pulses in the lower limbs in 52 patients and all
clinical signs of congestive heart failure in 46 (88.5%). Cardiomegaly
was a finding common to all children. There was a predominance of
right ventricular overload in half the cases. The echocardiographic
study showed an association of coarctation of the aorta and other intra-
cardiac abnormalities in 24 (46.1%) of cases, with the bicuspid aortic
valve and ventricular septal defect (VSD) more frequent. Ventricular
systolic dysfunction was observed in all children. Regarding the
surgical procedure, angioplasty of the left subclavian artery flap was
performed in 46 (90.2%) cases, which is associated with pulmonary
artery banding in four (7.8%) and angioplasty with bovine pericar-
dium was performed in four (7.8%) cases. Paradoxical hypertension
was observed in 44 (84.6%) cases. The mortality rate was 11.5%.
Conclusion:
In our series there was a predominance of congestive
heart failure as the initial manifestation of the disease, underscoring
the importance of pulse palpation in the lower limbs as a means of
early detection of this anomaly.
1533: IMPROVING CARDIAC PATIENT EDUCATION IN A
MULTI-LINGUAL SOCIETY
Lindy Mitchell, Jayneel Joshi
Steve Biko Academic Hospital, University of Pretoria, Pretoria,
South Africa
Background:
Steve Biko Academic Hospital is the cardiac referral
centre for four of the nine provinces in South Africa, including two
with large rural populations, namely Limpopo and Mpumalanga
provinces. As such, our patients speak a wide selection of the eleven
official languages. The occasional foreign national also finds their
way to our doors and it is not unusual for as many as eight different
languages to be spoken on any outpatient clinic day. Many of the
parents and caregivers we see are also illiterate or only have primary
level literacy skills.
This provides a challenge to the cardiologist who has to explain
often very complex congenital cardiac defects to patients and parents
who do not speak his/her home language or languages. Adequate
informed consent for procedures must also be obtained and patient
compliance with treatment schedules and dosages, which often
change from visit to visit, must be ensured in order to offer the child
the best care and management possible. Skilled, informed interpreters
are not always readily available, so we have had to find other methods
of getting our message across. We present some of the teaching aids
and materials that we use in our unit to improve communication with
our patients and their caregivers.
1536: GEOGRAPHICAL INFORMATION SYSTEMS (GIS) AS
AN AID TO INVESTIGATING CONCORDANCE PATTERNS
AMONG RHEUMATIC HEART DISEASE (RHD) PATIENTS:
A PILOT PROJECT
Dylan Barth
1
, Liesl Zuhlke
2
, Alexia Joachim
1
, Blanche Cupido
1
,
Bongani Mayosi
1
, Mark Engel
1
1
University of Cape Town, Cape Town, South Africa
2
Red Cross War Memorial Children’s Hospital, Rondebosch, Cape
Town, South Africa
Background:
Lack of concordance to monthly international normal-
ised ratio (INR) monitoring in RHD patients is considered to be a
contributor to stroke and other complications. Various factors for
this non-concordance have been suggested including limited access
to health care facilities. We hypothesise that the rate of default in
patients is correlated with the travel distance from the patient’s resi-
dence to the health care facility to which they have been referred. GIS
