CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
269
2
Department of Cardiac Surgery, Istituto Policlinico San Donato,
IRCCS, San Donato Milanese, Milan, Italy
Abstract:
The aim of the study was to investigate the early post-
surgical mortality, and challenges in the care of operated children in
St. Elizabeth Catholic General Hospital Cardiac Centre.
Patients and methods:
This retrospective analysis included 56
patients aged between 6 and 17 years old who underwent mitral repair
or replacement and/or aortic valve replacement from November 2009
through June 2012. Data from patients’ records, operative interven-
tion, and preoperative and postoperative two-dimensionalechocardio-
graphic studies were reviewed.
Results:
A total of
56 patients aged between 6 and 17 years old with
a mean age of 10
±
3.4 years underwent surgical correction of mitral
and/or aortic valvulopathy. Mitral regurgitation was the common-
est echocardiographic diagnosis present in 51.7% patients; 13.3%
patients had mixed mitral valve disease, 35% had pure mitral steno-
sis. Before surgery, 8 patients were in class IV, 12 in class III, 25 in
class II and 11 in class I according to the NewYork Heart Association
classification. Patients were extubated from 5 to 10 hours after
surgery with low doses of inotropes. The mean stay in intensive care
unit was 1.5
±
0.5 days. In the early post-surgical period, the ejec-
tion fraction (EF) changed from 45.3
±
1.5 % to 56.1
±
1.4% (
p
<
0.005) in 3 months and stayed almost the same after 6 months 57,2
±
2,7% (
p
>
0.05); at 9 months it was 55.1
±
1.8% (
p
>
0.05), and
at 12 months 58.4
±
1.7% (
p
>
0.05); however the basal part of the
interventricular septum was hypokinetic.
Conclusion:
Post-rheumatic mitral valve regurgitation is the pathol-
ogy most encountered. Post-surgical echocardiogram is characterised
by motion abnormalities of the basal part of the interventricular
septum. Because of financial limitations, poverty and illiteracy of
parents, the post-surgical follow-up of patients is challenging.
1840: ANOMALOUS ORIGIN OF THE PULMONARY
ARTERY FROM THE ASCENDING AORTA: TWO INSTITU-
TIONAL REVIEWS OF CASES FROM 1991 TO 2012
G Dumani
1
, PA Adams
1
, B Fourie
1
, AM Cilliers
1
, A Nzimela
2
, E
Hoosen
2
, D Reddy
2
, NJ Buckles
2
, J Ragadu
2
1
Chris Hani Baragwanath Academic Hospital, University of the
Witwatersrand, Johannesburg, South Africa
2
Inkosi Albert Luthuli Hospital, University of KwaZulu-Natal,
Durban, South Africa
Introduction:
Anomalous origin of one pulmonary artery from the
ascending aorta is a rare congenital anomaly associated with early
onset of pulmonary hypertension and irreversible pulmonary vascu-
lar disease.
Methods:
A retrospective clinical review ws done of 18 cases
presenting to the Divisions of Paediatric Cardiology at the Chris Hani
Baragwanath Academic Hospital and Inkosi Albert Luthuli Hospital,
which are both tertiary care institutions in South Africa. Data
collected included clinical features, diagnosis, operative procedures,
pre-operative procedures and post-operative follow-up.
Results:
Sixteen infants, 1 child and 1 adult (11 males, 6 females)
were diagnosed. The most common presenting features were respira-
tory distress, a cardiac murmur, congestive cardiac failure and failure
to thrive. Median age at presentation was 67 days. Diagnosis was
made with echocardiography and confirmed with CT angiogram
in 5 patients and angiography in 5 patients. There were 16 patients
with anomalous origin of right pulmonary artery arising from the
aorta (AORPA) and 2 cases of anomalous origin of left pulmonary
artery (AOLPA). Patients were divided into three categories: isolated
lesions (7); simple lesions with patent ductus arteriosus (8) and
complex lesions (3). One patient with AOLPA had CATCH 22 and a
second patient with AOLPA also had Mckusick-Kaufman syndrome.
Five patients had successful direct re-implantation of the right
pulmonary artery. One patient died the day after surgery following a
pulmonary hypertensive crisis, one patient died 20 days after surgery
from sepsis, and three patients remain well on follow-up. Three
patients were deemed inoperable. The remaining 10 patients died
before surgery could be undertaken.
Conclusion:
There is a high mortality associated with anomalous
pulmonary artery arising from the aorta without surgery. A good
outcome can be expected with early surgery before pulmonary
vascular disease.
1841: INFECTIVE ENDOCARDITIS IN CHILDREN: A
CROSS-SECTIONAL STUDY OF 32 CASES IN OUAGADOU-
GOU, BURKINA FASO
NV Yameogo, KJ Kologo, AA Yameogo, CYonaba; GRC Millogo,
BJY Toguyeni, AK Samadoulougou; S Pignatelli, J Simpore, P
Zabsonre
Saint Camille Medical Centre and Yalgado Ouedraogo Hospital,
Ouagadougou, Burkina Faso
Introduction:
Infective endocarditis is a transplant of a micro-
organism on an often injured endocardium. It is rare in children. This
study aimed to determine the frequency of endocarditis in children,
and to describe the clinical presentation, data from echocardiography,
microbiological profile and clinical course.
Patients and methods:
From 1 May 2010 to 30 April 2012, we
consecutively included children admitted for infective endocarditis
at two medical centres in the city of Ouagadougou: Saint Camille
Medical Centre and the teaching hospital Yalgado Ouedraogo.
We investigated the functional and general signs and treatment
already received. Physical examination included investigation of an
infectious syndrome, pneumonia, heart failure and portals of entry.
Blood cultures, blood count, creatinine, blood chemistry, HIV status,
electrocardiogram, chest radiography and cardiac Doppler ultrasound
were systematically done. The diagnosis of the disease was based on
Duke criteria.
Results:
Thirty-two cases of endocarditis in children were reported
to be 1.5 % of admissions. The average age was 4.6
±
2.5 years
(1–14). The female:male sex ratio was 1.5. Clinical presentation
was a common infectious syndrome. Impaired general condition
and congestive heart failure were present on admission in 14 cases,
respectively. The portal of entry was dental in 14 cases (43.7%), and
skin and ENT in 6 cases (18.7%) respectively. A peripheral vein
was implicated in 2 cases. In four other cases no portal of entry was
found. HIV serology was positive in 6 cases. Blood cultures were
positive in 26 cases, for streptococcus in 20 and staphylococcus in
6. Echocardiography revealed vegetation in all cases, localised to the
mitral valve in 14 cases. Multiple locations were found in 8 cases.
Underlying heart disease was dominated by rheumatic valve disease
(19 cases. Treatment consisted of antibiotics, antipyretic treatment
and that for heart failure as appropriate. Surgery was indicated in 3
patients as an emergency but they were unable to benefit because of
inadequate technical support. Four deaths (25%) occurred as a result
of septic shock.
Conclusion:
Infective endocarditis in children is common in our
practice. The common clinical syndrome is infectious. Streptococcus
and staphylococcus are the two organisms found. Surgical forms are
immediately lethal. The global prognosis remains poor.
1843: IMPACT OF SOUTH AFRICAN GUIDELINES ON THE
USE OF HIGH-SENSITIVITY TROPONINS: A PATHOLOGY
LABORATORY PERSPECTIVE
R Delport
1
, M du Plessis
2
1
Department of Chemical Pathology, University of Pretoria, South
Africa
2
Ampath, Pretoria, South Africa
Introduction:
Guidelines on the use of high-sensitivity cardiac
troponin (hs-cT) for the diagnosis of myocardial infarction (MI) in
South Africa have recently been published. The aim of the study was
to evaluate the effect of implementation of the guidelines on hs-cT
laboratory measurements.
