CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
43
1161: THE CIRCADIAN RYTHM OF BLOOD PRESSURE IN
NORMOTENSIVE CHILDREN WITH A FAMILY HISTORY
OF ESSENTIAL HYPERTENSION
Zubeyir Kilic
1
, Rabia Tutuncu Toker
1
, Pelin Kosger
1
, Birsen Ucar
1
,
Tevfik Demir
1
, Cengiz Bal
2
1
Deparment of Paediatric Cardiology, Faculty of Medicine, Eskisehir
Osmangazi University, Turkey
2
Department of Biostatistics and Medical Information, Eskisehir
Osmangazi University, Turkey
A family history of hypertension is a primary predictor of high blood
pressure (BP). In children and adolescents, some changes in cardio-
vascular structure and function may be seen independent of the level
of blood pressure and even before the blood pressure increases.
Aim:
The aim of this study was to evaluate blood pressure circadian
rhythms of normotensive children with a family history of essential
hypertension and investigate the relationship between target-organ
damage, future adult hypertension and this rhythm.
Methods:
Fourteen healthy children (19 girls, 21 boys) with hyper-
tensive parents (HP), and 20 controls (10 girls, 10 boys) with normo-
tensive parents (NP) were recruited. Mean age was 14
±
3.5 years in
girls and 15
±
4.5 years in boys (range 8–22 years). Age, gender and
body mass index did not differ between the two groups.
Results:
No difference was found in casual BP between the two
groups. In contrast, during ambulatory blood pressure monitoring
(ABPM), daytime systolic BP and systolic load were elevated in chil-
dren with HP (
p
<
0.05). Also mean systolic and diastolic blood pres-
sures were higher in children with HP compared to the control group
but it was not statistically significant. Increased thickness of left
ventricular posterior wall and left ventricular mass index have been
observed in children with HP (
p
<
0.05). BP circadian rythm in the
children with a family history of hypertension had more non-dipper
status, especially starting from the age of 20 (
p
<
0.05). Non-dippers
had significantly higher values of left ventricular mass index than
dippers and also a positive correlation has been found between night
systolic blood pressure and left ventricular mass index (
p
<
0.001).
Conclusion:
Early changes in ambulatory BP parameters were
present in healthy children of HP. The non-dipper normotensive chil-
dren with a family history of hypertension are thought to have target-
organ damage, especially after the age of 20 years, before clinical
findings of onset of hypertension.
1172: RIGHT VENTRICULAR APICAL EXCLUSION AS A
TREATMENT OF LARGE APICAL VENTRICULAR SEPTAL
DEFECT
José Caffarena
1
, Javier Orrit
1
, Javier Mayol
1
, Juan Carretero
2
, Lorenzo
Jiménez, Ricardo Ferreira
3
, Georgia Sarquella
2
, Joaquim Bartrons
2
,
Francisco José Cambra
4
, Fredy Prada
2
1
Cardiac Surgery, Hospital Universitari Sant Joan de Déu, Spain
2
Paediatric Cardiology, Hospital Universitari Sant Joan de Déu, Spain
3
Cardiac Surgery, Hospital Universitari Sant Joan de Déu, Spain
4
ICU, Hospital Universitari Sant Joan de Déu, Spain
Background:
Optimal management of muscular apical ventricular
septal defect (VSD) remains a challenge, especially when there is a
large apical defect that is not appropriate to be closed with a device.
Left apical ventriculotomy offers a good guarantee of correct closure
but has several mid- and long-term complications such as left ventric-
ular dysfunction, arrhythmias or apical aneurysms.
Methods:
Two patients with a diagnosis of large muscular apical
VSD, aged 13 and two months, respectively, were submitted to a tech-
nique of right ventricular apical exclusion. Two heterologous pericar-
dial patches were used in each case, the first one sutured between
the upper edge of the apical VSD and the septomarginal band and
the second one between the septomarginal band and the free edge
of the right ventricle (RV). The apex of the RV was then left on the
left ventricle side and the initial apical VSD did not connect the two
ventricles any more. This was performed through a right atriotomy
and through the tricuspid valve.
Results:
Both patients had a normal postoperative evolution and
were discharged without any complicactions. There was no residual
communication between the two ventricles. Normal RV functional
parameters were found during postoperative control echocardiog-
raphy. No echographic data indicating right ventricular dysfunction
were demonstrated after extensive examination, including lower
vena cava diameter respiratory changes, M-mode tricuspidal plane
excursion (TAPSE), E’ wave peak velocity on tricuspid annulus
(tissue Doppler imaging mode), standard Doppler and bidimensional
echocardiography.
Conclusion:
This technique for correction of apical complex VSD
offers very good initial results, avoiding the complications associ-
ated with left ventriculotomy or the necessity of a palliative approach
before surgery on low-weight patients. The short-term follow up did
not show any disturbance in RV function.
1207: SURGICAL MANAGEMENT OF PULMONARY
ARTERY SLING
Shu-Chien Huang
1
, En-Ting Wu
2
, Ching-Chia Wang
2
, Yih-Sharng
Chen
1
, Chung-I Chang
1
, Ing-Sh Chiu
1
1
Department of Surgery, National Taiwan University Hospital, Taiwan
2.
Department of Paediatrics, National Taiwan University Hospital,
Taiwan
Objectives:
Pulmonary artery sling is frequently associated with
tracheal and/or bronchial stenosis. A number of patients receive only
re-implantation or relocation of the left pulmonary artery while other
patients may require tracheoplasty for stenosis of the airway. We
studied the clinical outcomes with or without tracheoplasty.
Methods:
A total of 20 patients with a PA sling who received surgery
in our institute were included in this study. We reviewed the clinical
outcomes and the severity of trachea stenosis, and evaluated various
surgical strategies.
Results:
Among the 20 patients, all received left pulmonary artery
(LPA) re-implantation, and tracheoplasty was performed in 12
(60%). Of the 12 patients who received LPA re-implantation and
tracheoplasty, nine received slide tracheoplasty and eight survived.
One patient died of cytomegalovirus infection despite a patent
airway. Two patients had pericardial patch augmentation and both
died. One patient received a resection and end-to-end anastomosis
and survived. The patients without tracheoplasty all survived, but the
trachea diameter remained stenotic in the follow-up period.
Conclusions:
In this study cohort, approximately 60% of the patients
with PA sling received tracheoplasty. Slide tracheoplasty provided
acceptably good results for patients with PA sling and tracheal
stenosis.
1215: USE OF INHALED TREPROSTINIL IN VENTILATOR-
DEPENDENT INFANTS
Christina Phelps
1
, Julie Miller
2
, Jacqueline Magers
2
, Janet Simsic
1
1
Heart Centre, Nationwide Children’s Hospital, Columbus, Ohio,
USA
2
Clinical Pharmacy, Nationwide Children’s Hospital, Columbus,
Ohio, USA
Background:
Inhaled treprostinil is a tricyclic benzidine prostacy-
clin analog used in adults with pulmonary hypertension and NYHA
FC III and IV symptoms. We present two infants with pulmonary
artery hypertension treated with inhaled treprostinil.
Results:
SB was a 10-month-old male with repaired right-sided CDH
s/p tracheostomy who was ventilator and iNO dependent. Chest CT
at five months revealed small areas of scar and air trapping in the
left lung with overall normal aeration. His right lung was hypoplas-
tic with changes of CLD and air trapping. Serial echocardiograms
demonstrated elevated PAP. By eight months, despite treatment
with sildenafil, SB developed right ventricular (RV) dysfunction by
echocardiogram with iso-systemic PAP. Because of the high poten-
tial for V:Q mismatch with systemic therapy, SB was treated with
