CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
263
with congestive heart failure or cyanosis. Complex single ventricle
can be diagnosed before birth by fetal echocardiography and as early
as 18 weeks into pregnancy. This should be suspected especially if
there is a family history of congenital heart disease.
1740: PROGNOSTIC IMPLICATIONS OF VENTRICUALR
SEPTAL DEFECTS IN PREGNANCY
Mamotabo Matshela
University of KwaZulu-Natal, Durban, South Africa and Mayo
Clinic, USA
Background:
Ventricular septal defects (VSDs) are among the
commonest congenital heart disease conditions. These can occur in
isolation or as part of a more complex congenital heart disease. In
adults they are usually small and restrictive; however if large they
are commonly associated with Eisenmenger syndrome or part of
complex congenital heart disease. In pregnancy isolated small or
moderate-sized VSDs or surgically closed with normal ejection frac-
tion and without pulmonary hypertension are usually well tolerated.
Objective/aim:
To evaluate the prognostic outcome of VSD in preg-
nancy.
Methods and design:
Thirty-two patients who presented with VSDs
during pregnancy were reviewed. Their clinical profiles and echocar-
diography were retrieved and re-evaluated. The patients were divided
into three groups based on the size of the defect, i.e. small, moderate
or large. More than 70% of these VSDs were discovered incidentally
during pregnancy. The New York Heart Association functional clas-
sification of dyspnoea was used to classify their functional capacity.
All these patients were admitted and closely monitored during their
peripartum period. They were subsequently followed up 6–8 weeks
post-delivery for full cardiac evaluation.
Results:
Of these patients 26 had small, 4 had moderate and 2 had
large VSDs. Two patients had associated dextrocardia, 1 had associ-
ated congenitally corrected transposition of great vessels and 12 had
pulmonary hypertension (8 patients had mild pulmonary hyperten-
sion and 4 had moderate pulmonary hypertension). The majority of
these patients presented with at least class II symptoms (18) and 14
presented with class I symptoms. None of these patients experienced
any peripartum complications related to either cardiac lesion or preg-
nancy. All patients received infective endocarditis prophylaxis during
labour. At 6–8 weeks’ follow-up, only patients with a large VSD
reported at least class II symptoms and needed an earlier intervention.
Conclusion:
In this study we predominantly had patients with a
small VSD which is associated with favourable overall outcome. One
patient had complex congenital heart disease as part of the syndrome.
No associated maternal or foetal complications occurred periopera-
tively or post delivery.
1741: THE USE OF IMMUNOGLOBULIN FOR MYOCAR-
DITIS IN CHILDREN - VARIATION IN PRACTICE ACROSS
THE UNITED KINGDOM
Nitha Naqvi, Margerita Bartsota
Royal Brompton Hospital, London, UK
Background:
The UK Department of Health has produced updated
guidelines for the use of immunoglobulin (Ig) in 2011 which do not
include myocarditis. A Cochrane review in 2009 found no evidence
to support this indication but recent publications disagree. In the
current financial climate British National Health Service funding of
Ig is under review.
Objective:
To investigate variations in current UK practice for the
administration of Ig in children with acute myocarditis.
Method:
Design and setting:
A questionnaire was emailed to paedi-
atric cardiology consultants in all 13 UK paediatric cardiac tertiary
units. Paediatric cardiac pharmacists were also contacted.
Main
outcome measures:
Use of Ig and status of recipients at preferred
administration time (early in illness vs later when ventilated vs only
proven viral infection cases).
Results:
Eleven centres responded (85% response rate) with consid-
erable variation in practice. Four units do not use Ig in myocarditis.
Two units give only if a proven viral cause is known. One unit
reported use only in desperately sick ventilated children while the
remaining 4 units were using it more liberally early in the illness in
non-ventilated patients.
Conclusion:
Because of a paucity of evidence-based practice there
is wide variation in management in whether Ig is given or not.
Furthermore in those units continuing to use Ig for myocarditis there
is no agreement on timing of administration (early or later in illness).
There is a need for consensus guidelines, particularly because if a
shortage occurs Ig will be withdrawn for this indication.
1746: LIVE REAL-TIME 3D ECHOCARDIOGRAPHY IN
PAEDIATRIC CARDIOLOGY - FULFILLINGTHE PROMISE?
Uriel Katz, Yshai Salem, Amir Vardi, David Mishaly
The Edmond and Lilly Safra Children’s Hospital, Sheba Medical
Center, Tel Hashomer, Israel
Three-dimensional (3D) imaging is one of the most significant devel-
opments in ultrasound technology, providing realistic and unique,
comprehensive views of cardiac structures. When initially intro-
duced, it held a great promise in imaging of congenital abnormalities.
However, acquisition of full-volume 3D data requires good patient
cooperation, and lack of it in the paediatric population results in tech-
nically limited, often incomplete studies, causing in turn underuse
of 3D. Labour-intensive and time-consuming off-line reconstruction
further limits use of this technology.
Live real-time three-dimensional echocardiography
(LRT3DE) is
performed by acquiring still images and short clips using the narrow-
angle 3D option, and applying appropriate views and angles. This
readily available technique is practical in children, requires short
added examination time, and enables incorporating 3D imaging into
the daily clinical setting in a busy hospital clinic. Using LRT3DE
routinely, and making it an integral part of the echocardiographic
evaluation provides familiarity with its unique advantages as well
as its limitations. We find it enhances understanding of anatomy
and morphology of cardiac lesions, improves cardiologist-surgeon
communication, and aids teaching.
We present examples of our experience in LRT3DE in both simple
and complex congenital lesions and valvular heart disease, demon-
strating its use and added value compared to 2D imaging.
1749: PATTERNS OF PRENATAL CEREBRAL GROWTH
AMONG INFANTS WITH CONGENITAL HEART DISEASE
Niels Bjerregaard Matthiesen
1
, Peter Agergaard
1
, Vibeke Hjortdal
2
,
John Rosendahl Ãstergaard
1
1
Department of Pediatrics, Aarhus University Hospital, Skejby,
Denmark
2
Department of Cardiothoracic Surgery, Aarhus University Hospital,
Skejby, Denmark
Background:
Microcephaly is more common in children with
congenital heart disease (CHD), and the relation to neurodevelop-
mental abnormalities has been demonstrated. However confounders
such as genetic syndromes and low placental weight were not suffi-
ciently accounted for in existing studies. Additionally the focus has
been on complex CHDs, and the impact of more common CHDs has
yet to be evaluated.
Materials and methods:
A register-based study was performed
comprising a validated cohort of 2 947 Danish children born from
2000 to 2008 with CHD. Genetic, newborn and maternal parameters
were identified in national registries, and each child was randomly
matched to three non-syndromic children without CHD (
n
=
8841)
according to gender and gestational age. By means of linear and
logistic regression analysis, newborn head circumference will be
adjusted to birth weight, maternal pre-pregnancy weight, smoking
status, medical diseases, genetic abnormalities and placental weight
