CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
124
AFRICA
Yu-Chuan Hua
1
, Chun-An Chen
2
, Jou-Kou Wang
1,2
, Hsin-Hui Chiu
2
,
Chung-I Chang
3
, Ing-Sh Chiu
3
, Yih-Sharng Chen
3
, Chun-Wei Lu
2
,
Mei-Hwan Wu
1,2
1
Cardiac Children’s Foundation, Taiwan
2
Department of Pediatrics, National Taiwan University Hospital,
Taipei, Taiwan
3
Surgery, National Taiwan University Hospital, Taipei, Taiwan
Objectives
: To compare self-reported physical functioning with
the results of cardiopulmonary exercise test (CPX) in adults with
congenital heart disease (ACHD).
Patients and methods
: Between November 2010 and October 2011,
76 ACHD (
≥
18 years) received a questionnaire survey regarding
quality of life (QoL) and self-estimated exercise performance, as well
as a symptom-limited CPX on the same day. The QoL was investi-
gated using the Taiwanese version of the QoL questionnaire designed
by the World Health Organization, and the subscores of physical
domain were extracted. Self-estimated exercise performance was
defined as the subjective prediction of exercise capacity compared
to the general population and expressed as a percentage. Maximal
oxygen consumption (VO
2
max) in CPX was expressed as a percent-
age of predicted VO
2
max for age and sex to represent the actual
exercise capacity. Overestimation of exercise capacity was defined
as the percentage of predicted VO
2
max lower than self-estimated
exercise performance.
Results
: After excluding 10 patients (6 had premature termination of
CPX and 4 had missing questionnaire data), a total of 66 patients (age
31.8
±
11.7 years; 67% women) were studied; 70% of patients were
classified as having moderate to severe CHD. Overall, ACHD had
significantly decreased exercise capacity (VO
2
max: 65.4
±
13.2% of
the predicted value), which differed among different CHD severities
(
p
=
0.043). Although self-estimated exercise performance correlated
with actual exercise capacity (
r
=
0.345,
p
=
0.005), overestimation of
actual exercise capacity is common (59%), regardless of age, sex and
disease severity. In our ACHD cohort, physical QoL score was not
related to actual exercise test results. Furthermore, a higher physical
QoL score may paradoxically increase the probability of overestima-
tion of the actual exercise capacity in multivariate logistic regression
(odds ratio: 1.34,
p
=
0.039).
Conclusions
: Overestimation of actual exercise capacity is common
in ACHD. A higher self-reported physical functioning did not neces-
sarily predict a better exercise test result, and may be even more
frequently observed in patients who overestimated their own actual
exercise capacity.
1201: CAROTID ELASTOGRAPHIC ELASTIC-PRESSURE-
MODULUS: A NEW PREDICITIVE FACTOR OF VASCULAR
FUNCTION IN LONG-TERM CARDIOVASCULAR HEALTH
STATUS EVALUATION OF PATIENTS BORNWITH IUGR
Laurence Vaujois, Jean-Luc Bigras, Roch Maurice, Najat Chihab,
Anne-Monique Nuyt, Emile Levy, Anne Fournier, Nagib Dahdah
Sainte-Justine University Hospital Center, Montreal, Canada
Introduction
: Several studies have suggested that intrauterine
growth restriction (IUGR) increases the risk of cardiovascular
disease and early atherosclerosis. Early detection of vascular modula-
tion is essential for implementing early intervention.
Objective
: To assess cardiovascular health status of patients born
with IUGR at an earlier stage than adulthood using known and novel
non-invasive techniques.
Material and methods
: We evaluated 18 adolescents born with
IUGR and formerly evaluated
in utero
in our fetal echocardiographic
laboratory. Data were compared to those obtained in 17 controls
with normal fetal cardiovascular profile. Cases and controls were
assessed at 13.96
±
0.51 versus 14.72
±
1.02 years old. Work-up
included ascending aortic diameters and peak flows, pulse wave
transit time around the aortic arch with simultaneous blood pressure
(BP) recording. Aortic pulse wave velocity (PWV), input and char-
acteristic impedances (Zi, Zc), stiffness index and elastic modulus
of the ascending aorta (AA-Ep) were calculated. Common carotid
intima media thickness (CC-IMT) and elastographic elastic modulus
(CC-eEp) (a novel non-invasive method studying the carotid artery
wall response to stroke volume) were calculated.
Results:
IUGR subjects are shorter and smaller than controls, but
comparable in BMI. IUGR subjects yielded higher systolic BP. In
contrast to a previous report, classic biophysical properties of the
aorta were comparable to those in controls; aortic impedance indices
showed a supernormal adaptive response with a preserved stiffness
index. From the carotid artery perspective and despite a normal
CC-IMT, IUGR subjects had a significantly higher CC-eEp.
Conclusions
: IUGR subjects present higher systolic BP and CC-eEp
at adolescence, which is a probable precise predictive factor of vascu-
lar dysfunction. Our findings in the carotid arteries seem to detect
intrinsic anomaly of the homeostasis of its arterial wall.
1211: SURGICAL OUTCOMES IN ADULTS WITH CONGEN-
ITAL HEART DISEASE: SINGLE CENTRE EXPERIENCE
FROM THE DEVELOPINGWORLD
Michael Long
1
, Steven Brown
2
, Francis Smit
1
, Thabo de Huis
1
1
Department Cardiothoracic Surgery, University of the Free State,
Bloemfontein, South Africa
2
Department Paediatrics, University of the Free State, Bloemfontein,
South Africa
Background:
Lack of data exists on the spectrum and surgical
outcomes of congenital heart surgery (CHS) in adults in the develop-
ing world. With the number of adults requiring CHS being projected
to rise, we undertook this study to improve our understanding of this
patient population.
Materials and methods:
Data were collected of all patients 18
years and older with congenital heart disease, undergoing a surgical
procedure between January 1998 and May 2012 at our institution.
Categorisation of collected data was done according to the Society
of Thoracic Surgeons Congenital Heart Surgery database data collec-
tion form. Outcomes data were analysed and compared with available
European and developing world data.
Results:
A total of 161 procedures were performed in 157 patients.
Mean age at surgery was 30.1
±
11.3 years (47.3% male). Septal
defects and right heart lesions constituted two-thirds of the diagno-
ses. Diagnostic preoperative cardiac catheterisation was performed in
86.3% of patients. Incidence of preoperative risk factors was 18.7%,
with endocarditis and severe pulmonary hypertension being the
most frequent. Operative mortality was 1.2% (
n
=
2). Postoperative
complications occurred in 24.2% of patients. Re-operative proce-
dures constituted 26.3% of procedures performed, one-third of which
were repeat re-operative procedures. Right ventricle to pulmonary
artery conduit placement constituted 57% of the re-operations.
Conclusions:
Although the incidence of complications is high,
operative mortality is low in the setting of a tertiary referral centre
with dedicated congenital cardiac surgeons. The clinical profile of
our patient population was similar to that reported in a multicentre
European series. The spectrum of patients and incidence of re-opera-
tions did however differ from recently reported series from develop-
ing countries. Our utilisation of cardiac catheterisation as diagnostic
modality was excessive.
1217: COMPARING THE SPECTRUM OF HEART DISEASE
IN TWO CITIES IN SUB-SAHARANAFRICA UNDERGOING
SOCIO-ECONOMIC TRANSITION
Dike Ojji
1,2
, Simon Stewart
3,4
, Samuel Ajayi
1
, Manmak Mamven
1
,
Jacob Alfa
1
, Karen Sliwa
4,5
1
University of Abuja Teaching Hospital, Nigeria
2
University of Cape Town, Cape Town, South Africa
3
Baker IDI Heart and Diabetes Institute, Melbourne, Australia
4
University of the Witwatersrand, Johannesburg, South Africa
5
Hatter Institute for Cardiovascular Research in Africa, University of
Cape Town, Cape Town, South Africa
