CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
268
AFRICA
response is much lower than historically quoted which may neces-
sitate redefining hypertensive response to exercise in childhood.
1823: PROOF OF CONCEPT OF A SMART PHONE-BASED
PHONOCARDIOGRAPHIC SYSTEM
Pouya Hemmati
1
, Quan Ni
3
, Hanbo Tang
2
, Baishun Gao
2
, Bing Song
2
,
Andreas Tsakistos
3
, Lee Pyles
4
1
University of Minnesota Medical School, USA
2
First University Hospital of Lanzhou, University Department of
Cardiac Surgery, Lanzhou, China
3
Children’s HeartLink, Minneapolis, USA
4
University of Minnesota Amplatz Children’s Hospital, Minneapolis,
USA
Introduction:
Clinical auscultation remains essential for the diag-
nosis of congenital heart disease in the developing world. In screen-
ing programs of Lanzhou First University Hospital, Children’s
HeartLink, First Affiliated Hospital of Kunming Medical University
and China-California Heart Watch in People’s Republic of China,
children were screened with phonocardiography (iAusc,
n
=
52),
standard auscultation (sAusc,
n
=
19) and echocardiography (echo).
Our hypothesis is that iAusc detection of murmurs is sensitive to
facilitate referral to a cardiac centre.
Methods
: Children were examined with an electronic stethoscope
connected to an iPhone
®
that stored, retrieved and transmitted the
iAusc data, and then with a commercial stethoscope. Endpoints
include pathologic vs innocent murmur, location and intensity
for iAusc and their overall concurrence with echo diagnosis. An
echocardiogram was performed using standard techniques. Initial
difficulty with high-pitched vibratory innocent noises required
different earphones.
Results:
Organic murmur was differentiated from innocent murmur
in each case with both iAusc (48/52, LAP) and sAusc (19/19). iAusc
was recorded from the four primary cardiac exam areas on the chest,
URSB, ULSB, LLSB, apex. Principal diagnoses included: ventricular
septal defect (23), pulmonary stenosis (3), atrial septal defect (5),
aortic stenosis (2), normal (10). Sensitivity for murmur type was
48/52 or 92%. Specificity for innocent murmur was 10/14 (71%).
Pulmonary hypertension was present for 3 of 4 murmurs in heart
disease misdiagnosed as innocent.
Conclusion:
Phonocardiography can be used to detect congenital
heart disease. We report a proof-of-concept of iAusc to detect heart
disease in underserved areas. The iAusc tracings can be emailed
to remote experts from a cloud-based server, providing cost-effect
access to care with reduced travel for disadvantaged children and
a link to the cardiac referral centres. The methodology can provide
a venue for international volunteerism for cardiologists based in
advanced countries accounting for unfamiliar challenges such as
Eisenmenger pulmonary hypertension.
1831: REDUCTION OF RADIATION DOSE FOR CORONARY
COMPUTED TOMOGRAPHY USING A 128-SLICE DUAL-
SOURCE MACHINE IN CHILDREN AND YOUNG ADULTS
WITH CORONARY LESIONS AFTER KAWASAKI DISEASE
Shigeru Uemura
1
, Kazuto Fujimoto
1
, Hiroaki Kise
1
, Hideshi Tomita
1
,
Nobuo Ooyama
2
, Madoka Sawada
2
, Soga Takashi
2
1
Cardiovascular Center, Showa University Northern Yokohama
Hospital, Japan
2
Pediatrics, Showa University Northern Yokohama Hospital, Japan
Background:
Coronary artery lesions (CAL) of coronary aneurysm
followed Kawasaki disease (KD) have progressed into stenosis, occlu-
sion and calcification. Coronary computed tomography (CCTA) has
provided much information on the diagnosis of CAL after KD. CCTA
using a conventional 64-slice single-source machine provided high
radiation exposure. A 128-slice dual-source CT (DSCT) can take
coronary artery images very fast and can reduce of the radiation dose.
Aim:
The aim of this study is to evaluate the reduction of radiation
dose and recognition of the CAL by DSCT.
Patients and methods
: A total of 35 patients (median age 11 y 6 m,
range 2 y 5 m–45 y) were examined. All patients were administered
beta-blockade to reduce the heart rate. Six children were sedated and
the other 29 patients could breath-hold. Scan parameters were as
follows; mAs adapted body weight (100–310 mAs) at 70 Kv, 80 Kv,
100 Kv and 120 Kv, with prospective ECG gated. To assess radiation
dose, we recorded the dose-length product (DLP) in mGy cm and the
effective dose in mSy estimated from the DLP. We used two modes
to take CCTA, named flash spiral mode (FSM) and adaptive flash
cardio mode (AFCM).The quality of images for proximal and middle
segments of the right and left coronary arteries was evaluated.
Results:
A total of 29 patients (median age; 11 y 6 m) were exam-
ined by FSM, and 6 patients (median age; 11 y 0 m) were examined
by AFCM. Total DLP was extremely low (median 45 mGy cm) and
effective radiation dose was 0.74 mSy (median) by FSM. Total DLP
was very low (median 128.5 mGy cm) and effective radiation dose
was 1.93 mSy (median) by AFCM. The image of 1 patient (7 y) was
not taken by FSM because of movement.
Conclusion;
Prospective ECG-gated DSCT can provide adequate
CAL images in children and young adults. These methods are associ-
ated with extremely lower radiation doses.
1832: ANALYTICAL COMPARISON OF CARIOVASCU-
LAR RISK FACTORS FOR ADULT CONGENTIAL HEART
DISEASE AND NORMAL CONTROLS: A CASE-CONTROL
STUDY
Ju Ryoung Moon
GUCH Clinic, Samsung Medical Center, Seoul, Korea
Background:
Objectives of this study are to identify cardiovascular
risk factors in adults with congenital heart disease (CHD) and to
provide basic materials for developing media to lower the risk factor
levels.
Methods:
This study conducted a survey of 240 people in total,
including 120 adult patients with CHD and 120 patients in the control
group whose selection was based on age, sex, and body mass index
(BMI). The survey was conducted regarding fasting blood glucose
(FBS), lipid profile, apoprotein A-1/B, occurrence of carotid steno-
sis, and environmental influences.
Results:
Compared to the control group, the CHD group had signifi-
cantly high FBS, HDL, and apoproteinA-1, but significantly low total
cholesterol, LDL, and apoprotein B. The two groups had significant
difference in occurrence of carotid stenosis, exercise, and smoking.
Regarding differences by sex between the two groups, males of the
CHD group had lower total cholesterol and LDH than males of the
control group; females of the CHD group had higher FBS and lower
total cholesterol than females of the control group. However, there
was no difference according to sex in the CHD group. Comparison of
acyanotic and cyanotic CHD patients in the CHD group showed that
acyanotic CHD patients had higher FBS, total cholesterol and LDH,
and lower apoprotein than cyanotic CHD patients. When age and
sex were adjusted, cyanotic CHD patients without surgery, cyanotic
CHD patients with surgery, acyanotic CHD patients with surgery, and
acyanotic CHD patients without surgery in this order had a high risk
of developing metabolic syndrome (
p
<
0.001). BMI and smoking
were identified as variables influencing metabolic syndrome.
Conclusions:
It is believed that regular follow-up of risk factors,
BMI control, and education about non-smoking may reduce the risk
of developing metabolic syndrome in adult patients with CHD.
1836: POST-RHEUMATIC CARDIAC VALVULAR LESIONS
MANAGEMENT INATERTIAIRY SUB-SAHARAN CENTRE:
THE EXPERIENCE OF THE CARDIAC CENTRE, SHISONG
JC Tantchou Tchoumi
1
, JC Ambassa
1
, A Giamberti
2
, S Cirri
2
, G
Butera
2
1
Cardiac Centre, St. Elizabeth Catholic General Hospital Shisong,
Kumbo, Cameroon
