CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
264
AFRICA
Results
: The cohort represents high numbers of diagnostic subgroups:
e.g. transposition of the great arteries (
n
=
189), hypoplastic left
heart syndrome (
n
=
98), tetralogy of Fallot (
n
=
210), pulmonary
stenosis (
n
=
178), coarctation of the aorta (
n
=
207), aortic valve
stenosis (
n
=
88), atrioventricular septal defect (
n
=
184), VSD (
n
=
904) and ASD (
n
=
535). Trisomy 21 (
n
=
180), 22q11.2-deletion/
duplication (
n
=
46) and other genetic abnormalities have been
determined. Main outcome measure is newborn head circumference,
non-adjusted and adjusted to newborn, maternal and genetic param-
eters comparing diagnostic subgroups of CHD to healthy controls.
Preliminary comparison of unadjusted means revealed significantly
smaller newborn head circumference in non-syndromic (-0.233 cm,
p
<
0.0001) and syndromic CHD cases (-1.299 cm,
p
<
0.0001)
compared to controls. Analyses are undergoing and the results will
be presented at the meeting.
Conclusion:
The strength of this study, more than tripling the
numbers of the largest study in the field, lies within the possibility
to adjust head circumference to confounders such as genetic abnor-
malities and placental weight through data from unique national
registries.
1764: ETHICAL ANALYSIS OF HLHS
Mahmoud Elbarbary
King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia
In a limited-resources Middle Eastern country, a foetus was diag-
nosed intrauterine with hypoplastic left heart syndrome (HLHS)
after 120 days’ gestation. No paediatric cardiac surgery programme
or heart transplant programme is available. It is also not feasible to
send patients abroad. The baby was born and required PGE1, and
mechanical ventilation for severe cyanosis. Saturation improved with
these actions but the baby developed NEC (started on TPN). The
baby is obviously PGE1 and ventilator-dependant. Parents agreed
to ‘no code’ status. ICU beds are full and there are 2 cases in ER
of severe asthma that require urgent PICU admission with expected
excellent outcome.
The presentation will include the following 5 steps:
• Collecting clinical data. The starting point in the ethical analysis
of a clinical case consists in gathering information related to:
medical aspects (diagnosis, prognosis, potential treatments);
personal and relational aspects; and cultural aspects (Islamic
perspective).
• Assessing responsibilities. What are the specific responsibilities
of health care professionals in the given case? Has the patient (or
his/her legal guardian) been adequately informed? What is the
role of the family? What are the responsibilities of social bodies
(social services, etc.)?
• Identifying ethical problems. What ethical problems are involved
in the evolution of the given case?
• Proposing alternative courses of actions. What are the possible
courses of action for this case, e.g. abortion vs no abortion;
asthma vs HLHS priority? What are the motivating reasons?
• Formulating and justifying ethical judgement.
1767: CHANGING PATTERN OF RHEUMATIC HEART
DISEASE IN KANO: DATA FROM THE AMINU KANO
TEACHING HOSPITAL ECHOCARDIOGRAPHY REGIS-
TRY
Mahmoud U Sani
1,2
, Muhammad S Mijinyawa
1,2
, Shehu A Kana
2
,
Nasir A Ishaq
2
, Umar Abdullahi
2
1
Department of Medicine, Bayero University, Kano, Nigeria
2
Department of Medicine, Aminu Kano Teaching Hospital, Kano,
Nigeria
Background:
Rheumatic heart disease (RHD) remains a major
public health problem in developing countries. Anecdotal reports
across Africa show that the disease is becoming less prevalent in
cities and patients are surviving longer, although with high morbidity.
Between 2002 and 2006 from our echo register we found 9.8% of 1
312 patients to have RHD, with a mean age of 24 years. We set out
to review our current data for RHD to see if there are any changes in
patterns of presentation in our centre.
Material and methods:
This is a retrospective analysis of prospec-
tively collected echocardiography data between August 2010 and
July 2012. The study was conducted at the Aminu Kano Teaching
Hospital, Kano Nigeria. The procedure was performed with Aloka
SSD 4000. The standard techniques for depicting the anatomical
structures of the heart were employed. All the procedures were
performed by a cardiologist. Information obtained from the records
included the age, gender, clinical diagnoses and echocardiographic
diagnoses. Prevalence and patterns were compared with previous
findings.
Results:
During this period, a total of 1 496 echocardiographic
examinations were done. One hundred and four (7.0 %) had RHD.
There were 69 females (66.3%) and 35 males (33.7%) aged 30.71 +
13.99 years (range 12–70 years). Forty (37.7 %) were aged 15–24
years. The commonest lesions were mixed mitral valve disease and
aortic regurgitation (26.9%) followed by combination of mitral and
aortic regurgitation (25%) and pure mitral regurgitation in 17.3 %.
Complications of RHD observed included secondary pulmonary
hypertension, left ventricular dysfunction, atrial fibrillation and
infective endocarditis.
Conclusion:
Although there is an improvement in prevalence
compared to previous finding, RHD is still an important cause of
cardiac morbidity. While the patients are a bit older, they had more
severe disease and still had complications at diagnosis.
1769: PERIOPERATIVE VASOPRESSIN RESULTS IN
REDUCED LENGTH OF HOSPITAL STAY AFTER THE
FONTAN OPERATION
Pooja Kashyap
1
, Christopher Knott-Craig
1
, Steven Goldberg
1
, TK
Susheel Kumar
1
, Michele Harris
2
, Jean Ballweg
1
, Mayte Figueroa
1
1
University of Tennessee/Le Bonheur Children’s Hospital, Memphis,
Tennessee, USA
2
Le Bonheur Children’s Hospital, Memphis, Tennessee
Background:
The Fontan operation is the final palliative surgery in
patients with single ventricle physiology. Although early postopera-
tive outcomes have improved over time, the length of hospital stay
is still prolonged as a result of persistent chest tube output in the
postoperative period. We hypothesised that the use of vasopressin
(VP) in the perioperative period would reduce chest tube output by
maintaining vascular tone, thereby limiting third spacing and the
need for volume replacement.
Materials and method:
We retrospectively analysed 31 consecu-
tive patients undergoing Fontan operation between 2008 and 2012.
In 2010 VP was introduced as part of the standard management of
patients undergoing Fontan operation. The patients were grouped
according to VP use (
n
=
24) or non-use (no-VP,
n
=
7) in the perio-
perative period; dosage 0.3–0.5 mU/kg/min. The endpoints analysed
were hospital mortality, length of hospital stay (LOS), and chest tube
output.
Results:
The VP and no-VP subgroups were well matched for age
and weight (14.9 kg vs 15.5 kg,
p
=
NS). There was no hospital
mortality. The LOS in the VP group was 11.2
±
2.3 days compared
to 18.4
±
3.6 days in the no-VP group (
p
=
0.01). Daily chest tube
output decreased significantly in the VP subgroup but not in the
no-VP subgroup (
p
=
0.01).
Conclusions:
Use of vasopressin in the early postoperative period is
associated with reduced chest tube output and length of hospital stay
after the Fontan operation.
1771: ISOLATED LEFT VENTRICULAR NONCOMPACTION
Bozena Werner, Malgorzata Golabek Dylewska
Department of Pediatric Cardiology and General Pediatrics, Medical
University of Warsaw, Poland
