CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
262
AFRICA
pneumothorax) was compared between groups. The data collected
was analysed with chi-square, Mann-Whitney and multiple logistic
regression tests.
Results:
The age of diagnosis and echocardiographic initial findings
were significantly different in neonates with spontaneous closure
and those with significant PDA (
p
=
0.00). PDA internal diameter
>
2.0 mm, reversal of diastolic flow in descending aorta and treatment
after 8 days were associated with complications (death, indomethacin
failure, CLD, NEC and HIV). Indomethacin and surgery gave similar
benefits. There were no differences in deaths, CLD or NEC. Surgery
was more effective in closing PDA (
p
=
0.00) but it was associated
with increased risk for HIV and pneumothorax (
p
=
0.00).
Conclusions:
Early PDA diagnosis and treatment in preterm infants
improves their outcome. Echocardiographic parameters predicted
risk of complications and should be useful to guide the therapy.
Indomethacin and surgical closure were safe and there were no long-
term complications as a result of surgery.
1722: TETRALOGY OF FALLOT AND MENINGITIS
COMPLICATED BY BRAIN ABSCESS: LATE FATAL PRES-
ENTATION IN A CHILD
Bosede Adebayo
2
, Felix Ayun
1
, Abel Alonge
1
, Ade Omotayo
1
1
Federal Medical Centre, Owo, Ondo State, Nigeria
2
College of Medicine, University of Ibadan, Ibadan, Nigeria
Brain abscess is a known complication of cyanotic congenital heart
diseases. We report the case of a 4-year-old girl whose first presenta-
tion in the hospital was because of symptoms related to the neuro-
logical system. The illness was however fatal as a result of the late
presentation, which is not uncommon in this environment because of
various reasons.
In a resource-poor environment like ours, this is a reminder that
proper history taking, clinical examination and subsequent investiga-
tions will aid in early diagnosis and subsequent management of such
cases to reduce childhood mortality.
1723: COMPARISON OF THE ECHOCARDIOGRAPHIC
RESULTS IN INFANTS WITH VENTRICULAR SEPTAL
DEFECT AND DIFFERENT NT-PROBNP AND ENDOTHE-
LIN-1 LEVELS
Bozena Werner, Jacek Skiendzielewski
Departmentt of Pediatric Cardiology and General Pediatrics, Medical
University of Warsaw, Poland
Aim
: To analyse the haemodynamic disturbances assessed by echo-
cardiography in infants with ventricular septal defect (VSD) and
different NT-proBNP and endothelin-1 (ET-1) levels.
Material and methods:
The study group consisted of 34 infants
(aged 38–338 days, mean 130
±
81 days) (15 boys, 19 girls) with
VSD without pulmonary hypertension. In ECHO-2D the following
parameters were analysed: pulmonary to systemic flow ratio (Qp/Qs),
peak velocity of the pulmonary artery flow (Vmax PA), left atrial to
aortic diameter ratio (LA/Ao) and indexed for body surface area,
size of the defect (VSD/BSA), left atrial diameter (LAD/BSA), left
ventricular internal diastolic diameter (LVIDd/BSA), right ventricu-
lar internal diastolic diameter (RVDd/BSA), main pulmonary artery
diameter (MPA/BSA).
After the analysis of NT-proBNP and ET-1 levels, the follow-
ing subgroups were selected: subgroup I – 24 (70%) children with
NT-proBNP
<
100 fmol/ml; subgroup II – 10 (30%) children with
NT-proBNP
≥
100 fmol/ml; subgroup III – 25 (73%) children with
ET-1
<
0.4 fmol/ml; subgroup IV – 9 (27%) children with ET-1
≥
0.4
fmol/ml. Echocardiographic parameters were compared, subgroups I
vs II and III vs IV. Statistical analysis was obtained using Student’s
t test.
Results:
Results for subgroups
will be presented.
No significant
differences of the mean values of all echocardiographic parameters
in the subgroup III compared to those obtained in the subgroup IV
were found.
Conclusions:
Higher levels of NT-proBNP indicate more severe
haemodynamic disturbances in infants with VSD. The determination
of ET-1 level seems to be useless in infants with VSD.
1726: EVOLUTION OF RIGHT VENTRICLE-TO-PULMO-
NARY ARTERY CONDUIT CONCEPT DURING THE
NORWOOD PROCEDURE, 10 YEARS’ SINGLE-INSTITU-
TION EXPERIENCE
Tomasz Mroczek, Janusz Skalski
Department of Pediatric Cardiac Surgery, Jagiellonian University,
Krakow, Poland
Background:
The introduction of right ventricle to pulmonary artery
(RV-PA) conduit in the Norwood procedure for hypoplastic left heart
syndrome resulted in a higher survival rate in many centres. However,
RV-PA conduit may result in more frequent unintended interventions
becaused of stenosis at many levels.
Methods:
We describe the evolution of RV-PA conduit concept for
Norwood procedure in single institution, where between 2001 and
2012 more than 320 Norwood procedures with RV-PA conduit were
performed. The technical issue of RV-PA placement will be described
including the way of proximal and distal implantation, choosing the
right or left position according to ‘neoaorta’, the diameter of shunt
and applying of reinforced grafts.
Results:
The current technique includes the reinforced, usually 5 mm
in diameter shunt localised to the right according to the ‘neoarta’
with introduction of the proximal part of the conduit into the right
ventricle wall.
Conclusion:
The evolution of technical issue of RV-PA conduit for
Norwood procedure results in smaller number of unintended inter-
ventions and facilitates the stage II performance.
1735: A RARE FORM OF CONGENITAL HEART DISEASE
IN PREGNANCY
Mamotabo Matshela
University of KwaZulu-Natal, Durban, South Africa and Mayo
Clinic, USA
Background:
Univentricle is a rare form of congenital heart disease.
It is often associated with other congenital heart defects.
Objective:
To describe the clinical presentation and echocar-
diographic features of a patient presenting with a single atrium and
single ventricle in pregnancy.
History and progress:
A 19-year-old woman presented with a
history of univentricle with left ventricular morphology, univen-
tricular arteriovenous connection, absent right LV valve, pulmonary
and tricuspid atresia and dextrocardia. In addition she had situs
inversus and a single kidney. She had a classic BT shunt in 1991
at 6 weeks of age. She subsequently developed adhesions around
the shunt and stenosis at the insertion site and on either side of the
left pulmonary artery. Six years later she had total cavopulmonary
connection. Thirteen years later she presented with an unplanned
pregnancy, complaining of dizziness and dyspnoea. She subsequently
had episodes of syncope, cyanotic spells and worsening dyspnoea.
She was admitted for close monitoring and 3 weeks later had an
elective caesarean section with no perioperative complications. She
was discharged a few days later and during her follow-up period she
remained haemodynamically stable. Her baby girl remained in a good
condition.
Discussion and conclusion:
There is lack of literature on the
prevalence and success of pregnancies in this form of a complicated
congenital heart disease. The terms complex single ventricle and
univentricular heart are used to describe this congenital heart disease.
These terms are also used to describe a group of rare heart defects,
which have in common, a large single pumping chamber or ventricle.
It is a serious problem because without surgery, most children would
not be able to survive the first year of life. These patients may present
