CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
121
Results:
Echocardiography in PAH-CHD/NORMAL showed signifi-
cant RV dilatation (RV diameter (RVD)
p
<
0.0001), RV hypertrophy
(RV anterior wall (RVAW)
p
<
0.0001) and lower RV function (frac-
tional area change (FAC)
p
=
0.024). Comparing Post-TD/Pre-TD/
NO-SHUNT showed difference in median RVD 25/47/35 mm (
p
=
0.0001), with RVD
>
22 mm present in 24/100/60% patients (
p
=
0.0001); median RVAW 11/7.5/8.2 mm (
p
=
0.009), with RVAW
>
10
mm in 63.2/12.5/16.7% patients (
p
=
0.01), median FAC 60/43/41%
(
p
=
0.003), with decreased RV function FAC
<
40% present in
5.3/37.5/50% patients (
p
=
0.02).
Comparing Post-TD/Pre-TD/
NO-SHUNT showed significant differences in the following inva-
sive
parameters: median mean pulmonary arterial pressure (mPAP)
78/41/49 mmHg (
p
=
0.0014); median systolic pulmonary-to-systemic
pressure ratio (sPAP/sAoP) 1.06/0.61/0.6 (
p
=
0.0011), with suprasys-
temic sPAP present in 72.2/0/16.7% patients (
p
=
0.02); and median
pulmonary vascular resistance (PVR) 18/7.4/8.2WU (
p
=
0.08).
Conclusions:
Compared to NORMAL, in PAH-CHD the RV shows
compensatory hypertrophy and dilatation. Patients with various
cardiac shunt locations demonstrate different haemodynamics. Post-
TD patients are able to tolerate extreme PAP/ PVR, they show most
dominant RV hypertrophy but less severe RV dilatation and good RV
function. On the contrary, Pre-TD/NO-SHUNT present with a less
favourable picture. Defect location may therefore play an important
role, enabling better RV off-load and so preserving RV function -
which is crucial for patients’ long-term outcome.
893: NEUROPSYCHOLOGICAL ASSESSMENTS OF 40
ADOLESCENTS AFTER CONGENITAL HEART DEFECT
REPAIR
Urszula Stolarska-Werynska
2
, Piotr Werynski
1
, Andrzej Rudzinski
1
,
Marek Kacinski
2
1
Department of Pediatric Cardiology, Jagiellonian University Medical
College, Poland
2
Department of Pediatric Neurology, Jagiellonian University Medical
College, Poland
Congenital heart defects (CHD) are a risk factor in cognitive devel-
opment. A growing number of post-CHD adolescents increases inci-
dence of neurodevelopmental abnormalities.
Objective:
Neuropsychological assessment of adolescent’s post-
surgical and/or interventional procedures as a result of CHD in
childhood.
Material and methods:
We assessed
40 patients (pts) aged 17.6
±
19.1 years (28 with simple, 12 with complex CHD), who because
of age had been transferred to adult centres by means of Wechsler
Intelligence Scales and clinical trials assessing memory, attention,
praxis, abstract thinking and visuospatial functions.
Results:
Only
8 pts (1 post-dextro-transposition of the great arteries
(dTGA), 3 post-coarctation of the aorta (CoAo), 2 post-atrial septal
defect (ASD)
2
, 2 post-ventricular septal defect (VSD) repair) scored
normally, while the others demonstrated cognitive difficulties typi-
cal of organic central nervous system (CNS) dysfunction/damage.
Three pts (1 post-PDA, 1 post-VSD, 1 post-CoAo repair) showed
only visual memory impairment. Thirty-two pts revealed frontal
region dysfunctions, while 20 pts additionally showed visual memory
impairment (characteristic of right temporal and frontal dysfunc-
tion). In 1 pt with complex CHD (post-tetralogy of Fallot repair)
and in 8 simple CHD pts (2 post-PVS, 2 post-CoAo, 2 post-ASD
2
, 1
post-VSD, 1 post-AVS), visuospatial impairment was noted, typical
for temporoparieto-occipital lesions. In 12 complex CHD pts, the
number and severity of cognitive dysfunctions were greater: 11/12
pts had executive and learning dysfunctions, 10/12 disorders with
three error types (perseverative, confabulation, meaning changes),
8/12 visuospatial and visual memory disorders. Two pts had only
frontal dysfunction, one temporal, while others had both types of
dysfunction. In the post-simple CHD repair group, 71.4% revealed
disorders typical for frontal and 10.9% temporal, while 28.5% had
temporoparieto-occipital dysfunction. Most of these pts (85.7%)
committed only one type of error (confabulation).
Conclusions:
Of most commonly demonstrated neurodevelopmental
abnormalities, grown up congenital heart disease (GUCH) patients
show executive function impairment.
In post-simple CHD pts, frontal region dysfunctions are less
severe than in pts with post-complex CHD and isolated types of
cognitive dysfunctions are more common.
910: THE RELATIONSHIP BETWEEN BIRTHWEIGHT AND
OTHER ANTHROPOMETRIC PARAMETERS AND AORTIC
INTIMA-MEDIA THICKNESS AT ONE MONTH, IN UNSE-
LECTED BIRTH COHORT
Kate McCloskey
1,2,3
, Peter Vuillermin
1,2,4
, Anne-Louise Ponsonby
1,3
,
Michael Cheung
4
Michael Skilton
5
, John Carlin
1,3
, David Burgner
1,2,3
1
Murdoch Children’s Research Institute, Royal Children’s Hospital,
Parkville, Australia
2
Child Health Research Unit, Barwon Health, Australia
3
University of Melbourne, Australia
4
Deakin University, Melbourne, Australia
5
Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders,
University of Sydney, Australia
Background/hypothesis:
Evidence suggests that early-life fetal
programming can have long-term effects on the adult health. A
number of small studies report an association between intrauterine
growth restriction and a recently validated and reproducible marker
of early atherosclerosis - aortic intima-media thickness (aIMT) in
early life. However there are currently no aIMT data from an unse-
lected population of infants, nor on the relationship between aIMT
and body composition or growth parameters other than birth weight.
Materials and methods:
Infants are assessed as part of The Barwon
Infant Study, an unselected birth cohort of Australian mothers and
babies, recruited before 28 weeks’ gestation (
n
=
1 250). To date 651
babies have been recruited, with
>
80% participant retention to 12
months. Aortic IMT measurements have been obtained on
>
95%
of those babies attempted at 4 weeks of age. Birth weight, length,
head circumference and placental weight are recorded and adiposity
is assessed by standardised skinfold thickness measurements in the
first week of life. Maternal weight and weight change in pregnancy
is recorded, together with co-morbities such as gestational diabetes
and pre-eclampsia. At 4 weeks of age aIMT of the posterior wall of
the abdominal aorta is measured by trans-abdominal ultrasound using
standardised and reproducible methods.
Results:
Data on the first 500 babies will be available by early 2013.
We will present data on the relationship between placental weight,
birth weight, head circumference, length, skinfold thickness and the
4-week aIMT.
Conclusions:
This will be the largest study of the association
between birth weight and other growth parameters, determined by the
in utero
environment, and a validated early marker of atherosclerosis.
917: REACTIVE HYPERAEMIA INDEXAND DETECTION OF
ENDOTHELIAL DYSFUNCTION IN HIGH-RISK CHILDREN
Peter Jehlicka, Michal Huml, Tomas Votava, Renata Pomahacova, Jiri
Kobr, Ladislav Trefil
Charles University, Prague
Background:
Reactive hyperemic index (RHI) is considered as a
new indicator of endothelial function (EF). This plethysmographic
method is based on non-invasive assessment of endothelium-depend-
ent changes in vascular tone (PAT) in patient fingertips. Type 1 diabe-
tes mellitus (T1DM) is a well-known a risk factor for development
of premature cardiovascular disease. As a result of highly efficient
treatment protocols of acute lymphoblastic leukaemia (ALL) in chil-
dren, the number of children leukaemia survivors has dramatically
risen. Data on the premature manifestation of atherosclerosis (PMA)
in ALL children are insufficient in the literature.
Materials and methods
: Following approval by the institutional
review board 73 eligible participants were enrolled in the study (33
