CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
255
Karaye
6
, Sani Mahmoud
6
, Amam Mbakwem
7
, Patience Udo
8
, Ana O
Mocumbi
9
, Karen Sliwa
1,2,10
1
Institute of Infectious Diseases and Molecular Medicine, University
of Cape Town, South Africa
2
Department of Medicine, University of Cape Town, South Africa
3
Infectious Diseases Referral Clinic, GF Jooste Hospital, South Africa
4
Division of Cardiovascular Diseases, Mayo Clinic, USA
5
Douala General Hospital, Cameroon
6
Aminu Kano Teaching Hospital, Kano, Nigeria
7
Lagos University Teaching Hospital, Nigeria
8
Cardiology Unit, University of Uyo Teaching Hospital, Nigeria
9
Instituto do Coração, Maputo, Moçambique
10
Hatter Institute for Cardiovascular Research in Africa, University of
Cape Town, South Africa
Background:
Pulmonary hypertension (PH) is a devastating, progres-
sive disease, with increasingly debilitating symptoms and, usually,
shortened overall life expectancy. The epidemiology of PH in Africa
has not yet been determined, but limited reports suggest that the inci-
dence is higher than that reported from developed countries. Many
known factors for PH are hyperendemic in this part of the world,
including HIV/AIDS, rheumatic heart disease, schistosomiasis and
sickle cell disease. We aim to describe the aetiology of PH in Africa.
Materials and methods:
A prospective observational study of
patients with newly diagnosed and previously untreated PH based on
echocardiography. Fifteen cardiovascular centres from sub-Saharan
Africa participate in this study. Preliminary data analysis after 1 year
of recruitment is presented.
Results:
A total of 63 patients were recruited within the first year
of the study. Median age was 40 years (range 11–86) and 62%
were female. Twenty-four per cent of patients were living below
the WHO poverty line of one US$ per day; 37% of patients were
known to be HIV positive with a median CD4 count of 401 cells/
µ
l (interquartile range (IQR) 226–537 cells/
µ
l) and 83% were on
antiretroviral therapy at presentation. Thirty-two per cent of patients
had documented previously treated TB with site of TB being pulmo-
nary in 85% of documented cases; 50% of those had at least two or
more documented episodes of TB. At presentation, median pulse at
rest was 94 bpm (IQR 78–100 bpm) and pulse oximetry was 95%
(IQR 91–98%); respiration rate was 26 bpm (IQR 21–32 bpm). On
echocardiography, median right ventricular systolic pressure (RVSP)
was 56 mmHg (IQR 48–68 mmHg), tricuspid annular plane systolic
excursion (TAPSE) 14 mm (11–17 mm) and left ventricle ejection
fraction (LV-EF) 50% (35–65%). Thirty-three per cent of patients
died within 6 months of presentation.
Conclusion:
PH in Africa is an acquired cardiovascular disease
of high mortality and of multiple aetiologies. HIV seems to be an
important risk factor for PH in Africa.
1620: IMPACT OF SURGERY BY A VISITING TEAM ON
QUALITY OF LIFE INDICATORS IN PATIENTS WITH
CONGENITAL OR ACQUIRED HEART DISEASE IN
NATIONS WITH LIMITED HEALTHCARE RESOURCES
Aubyn Marath
4,8
, Laura Schiff
6,8
, Chrisanna Gustafson
7,8
, Janine
Henson
5,8
, Van-Trang Nguyen
3,8
, John Connett
2
, Kyle Rudser
2
, Susan
Lowry
2
, Lazaros Kochilas
1
, James St.Louis
1
1
Amplatz Children’s Hospital, University of Minnesota, MN, USA
2
Biostatistics and Informational Technology, University of Minnesota,
MN, USA
3
University of Minnesota, MN,
4
Oregon Health & Sciences University, OR,USA
5
Fairview Hospital, University of Minnesota, MN, USA
6
Enloe Medical Center, Chico, CA, USA
7
California State University, Chico, CA, USA
8
CardioStart International, USA
Hypothesis:
Surgery by a visiting team improves quality of life indi-
cators in patients with congenital or acquired heart disease in nations
with developing healthcare programmes.
Method:
CardioStart International’s visiting surgical teams inter-
viewed patients via translator between February 2008 until November
2011 (
n
=
198) in Peru, Ghana, Vietnam, and Grenada. Ages ranged
from 24 days to 80 years old. Data were collected regarding symp-
toms, income, perception of health, and emotional status. Parents/
guardians were interviewed if the child was unable to answer ques-
tions. Follow-up interviews were conducted with patients who had
undergone surgery in prior years (
n
=
33).
Results:
For surgical candidates, the most common symptoms were
shortness of breath (46.5%, 92/172) and fatigue (46.0%, 91/172);
57.1% (76/133) of patients had their symptoms for more than one
year. Half (50.4%, 71/141) reported a household income loss of
50% or greater since diagnosis of the heart condition. In compari-
son with others, 51.6% (79/153) reported their health as fair or
poor. Emotionally, 20.6% (29/141) felt fears and 36.4% (43/118)
felt concern for the future related to the heart condition (‘often’
or ‘almost always’). Follow-up data: After surgery, 63% (17/27)
revealed no symptoms; 11.1% (3/27) reported shortness of breath;
11.1% (3/27) reported fatigue. For income, 72% (18/25) reported no
loss or an improvement in income since the operation. Health percep-
tion: 81.5% (22/27) reported their health as ‘good’, ‘very good’, or
‘excellent’ compared to others, while emotionally, 8.7% (2/23) felt
fears and 20% (4/20) felt concern for the future related to the heart
condition (‘often’ or ‘almost always’).
Conclusions:
Surgery to correct congenital and acquired heart
disease has the potential to improve quality of life in these diverse
populations. Lack of health care infrastructure in these countries
made it difficult to obtain follow-up data. More follow-up data are
needed to make reliable inferences, and a more efficient implementa-
tion of follow-up is in progress.
1626: PREVALENCE AND CLINICAL IMPACT OF MAJOR
AORTOPULMONARY COLLATERALS IN POSTOPERA-
TIVE PATIENTS WITH TRANSPOSITION OF GREAT
ARTERIES
Vikas Satwik, Raimonda Stukiene, James Gnanapragasam, Kevin
Roman, Gruschen Veldtman, Tony Salmon, Nicola Viola, Markku
Kaarne, Joseph Vettukatil
Southampton University Hospital, Southampton, UK
Background:
Transposition of great arteries with intact ventricu-
lar septum (TGA) is rarely associated with clinically significant
aortopulmonary collateral arteries (MAPCA). The known associ-
ated complications are: congestive heart failure, pulmonary volume
overload, left ventricular dysfunction and respiratory failure. The
aim of this study is to evaluate the prevalence and clinical impact of
MAPCAs in postoperative patients with TGA.
Methods:
All patients with TGA admitted after arterial switch proce-
dure for a period of 7 years from July 2005 to August 2012 were
included in the study. Data was analysed from PICU database regard-
ing duration of ventilation, length of stay and outcome. Data from the
catheter laboratory was obtained to identify infants with TGA who
had undergone catheter occlusion of MAPCA.
Results:
A total of 48 cases were identified to have TGA. Three
haemodynamically significant cases requiring catheter occlusion
of MPACA were identified on echocardiography. Two patients had
difficulty in weaning from ventilation and 1 presented with pulmo-
nary haemorrhage. Outcome of TGA with (3) vs without MAPCA
(45) in relation to ventilation, PICU stay and mortality is as follows:
ventilation: 10 (5–14) vs 3.8 (1–6) days, PICU stay: 14 (12–22) vs
5 (2–9) days; and mortality 0 vs 1. The mean duration of ventilation
post coiling was 2 days (1–3 days). No coronary abnormality or
ischaemic changes were identified on ECG in any of the 48 cases,
except in one who died.
Conclusion:
TGA with MAPCAs is associated with prolonged venti-
lation, pulmonary hypertension (PHT) and pulmonary haemorrhage.
There is a higher than expected incidence of clinically significant
MPACA in our series and we report the first case of postoperative
pulmonary haemorrhage in this setting. TGA with prolonged venti-
