CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
133
helical fibre angles become less steep, muscle contraction weakens
with disease, or torsion is excessively prolonged.When the aortic
valve closes, the right side of the ventricular septum (ascending
segment of left helix) contracts for 60 to 90 ms after relaxation begins
in the muscle on the LV side of the septum and free wall (descending
segment of right helix). Ascending segment recoil facilitates ventric-
ular suction and early LV filling. The 60 to 90-ms hiatus is essential
for normal function. In disease, excessive prolongation of torsion by
persistence of contraction of the LV free-wall spiral and circumferen-
tial fibres decreases the hiatus, impairs untwisting, leaving less time
for rapid early LV filling, a cardinal sign of diastolic heart failure.
For example, during forceful contraction in aortic stenosis, systolic
torsion is exaggerated but also prolonged so that it encroaches on the
early filling period after aortic valve closure. Suction cannot happen
if torsion persists.
Therefore the hallmarks of diastolic dysfunction – elevated LV
diastolic pressure despite a normal ejection fraction, and a delayed
fall of LV pressure after aortic valve closure – are both manifestations
of abnormal systolic muscle function leading to defective untwisting
and filling of the LV.
17: LOW RECURRENCE RATE IN TREATING ATRIOVEN-
TRICULAR NODAL RE-ENTRANT TACHYCARDIA WITH
TRIPLE FREEZE–THAW CYCLES
Muhammad Qureshi
1
, Christopher Ratnasamy
2
, Mary Sokoloski
4
,
Ming-Lon Young
3
1
University of Miami, Miami, FL, USA
2
Arkansas Children’s Hospital, Little Rock, AR, USA
3
University of Miami, Miami, FL, USA
4
Joe DiMaggio Children’s Hospital, Hollywood, FL, USA
Background:
Cryoablation is an alternative to radiofrequency
ablation in treating atrioventricular nodal re-entrant tachycardia
(AVNRT). However, its long-term effectiveness is in question when
compared to radiofrequency ablation. We reviewed the results of
cryoablation in children with AVNRT at our institute.
Methods:
We performed retrospective single-centre chart review of
consecutive patients
≤
18 years of age with AVNRT who underwent
cryoablation between January 2007 and August 2009. During cryoa-
blation, a 6-mm tip cryocatheter was used with temperature set to
–80°C. Test lesions were performed at the presumed slow pathway
location based on combined anatomical and electrophysiological
approaches. If successful, ablation was then continued with triple
freeze–thaw cycles (FTC) of 4 min each.
Results:
A total of 53 patients (age range: 6.1–18.4 years, mean:
13.6, median: 13.2) underwent slow pathway modification with
cryoablation. Acute success was achieved in 51 (96.2%) cases.
Transient atrio-ventricular block was seen in 19 (35.9%) cases, but
no patient had permanent heart block. Number of FTC was three in
47 (92.2%) patients. Less than three FTC were given in two patients
due to transient heart block and four FTC were given in two patients
with suspected catheter movement. Procedure duration was 177
±
56
min; fluoroscopic time was 14
±
11 min. Mean follow up was 30.7
±
10 (range 12–52, median 31) months. Recurrence of supraventricular
tachycardia was seen in only one (1.96%) patient.
Conclusion:
Triple FTC cryoablation lesions resulted in a compa-
rable low recurrence rate to RF ablation in treating AVNRT without
increased complications.
25: THE OUTCOME OF THE PATIENTSWITH RIGHTATRI-
AL ISOMERISM IS POOR
Marianne Eronen
1
, Kristiina Aittomaki
2
, Eero Kajantie
2
, Heikki
Sairanen
2
, Erkki Pesonen
2
1
Health Department , Social Insurance Institution of Finland, Finland
2
University Hospital of Helsinki, Finland
Background
: Right atrial isomerism is a heterotaxy syndrome with
disturbances in the left–right axis development, resulting in complex
heart malformations. Previously we have shown that in some families
with autosomal recessive inheritance, right atrial isomerism is associ-
ated with mutations in the growth/differentiation factor 1 (GDF1).
Methods and Results:
The outcome of the patients diagnosed with
this syndrome in Helsinki University Central Hospital between
January 1976 and December 2010 were reviewed. Among 32 patients
(girls 32%) the survival was 22% with a follow-up time of 13.8 years
(median, range 0.1–33 years). Extra-cardiac malformations occurred
in 91%, mostly aspenia. Cardiac defects included dextrocardia 44%,
single ventricle 66% and common atrio-ventricular valve in 100%
of cases. Transposition or double-outlet ventricle was seen in 56%
and 44%, respectively. Total anomalous pulmonary venous drainage
appeared in 75%. Pulmonary outflow obstruction was identified in
91%. Arrhythmias were evident in 28%. Two (6%) had atrio-ventric-
ularblock and pacemaker treatment. Surgery was performed on 78%
of patients, seven (22%) were inoperable. Biventricular repair was
not possible in any of the patients. In long-term follow up there was
no significant difference between the patients with total anomalous
pulmonary venous return or normal or partially anomalous venous
drainage (
p
=
0.5). Infants requiring their first surgical intervention
before four weeks of age had a mortality rate of 60% at five years
and those requiring surgery at four weeks or later had a mortality rate
of 80% at 15 years.
Conclusions:
Right isomerism is one of the most severe forms of
cardiac disease. The prognosis remains poor in spite of modern surgi-
cal techniques. Therefore, prenatal diagnosis and termination are
recommended or prompt treatment after delivery.
33: CARDIOVASCULAR DISORDERS IN ADOLESCENTs
WITH CHEST PAIN
Sri Endah Rahayuningsih
Department of Child Health, Faculty of Medicine, Padjadjaran
University, Hasan Sadikin, Bandung, Indonesia
Background:
Chest pain is one of the chief complaints that cause
parents to bring their children to the paediatrician, paediatric
cardiologist, or to the emergency room.
Chest pain in children and
adolescents can be caused by abnormalities of the heart, but more
often are due to musculoskeletal problems, gastrointestinal, lung and
idiopathic causes, or are psychogenic.
Aim:
To acknowledge
the involvement of cardiovascular abnormali-
ties in adolescents with chest pain.
Methods:
The subjects of this study were 25 adolescents with chest
pain who came to the Cardiac Centre, Hasan Sadikin General Hospital,
Bandung during the period January 2008 to January 2011. The pres-
ence of established cardiovascular disorders was based on history,
physical examination, electrocardiography and echocardiography.
Results:
We found 13/25 adolescents with chest pain had cardiovas-
cular abnormalities.
Of the 25 teens who came in with chest pain,
most showed normal electrocardiographic results, and only nine
had dysrhythmias and sinus tachycardia and eight a first-degree AV
block.
Echocardiography examination showed only four patients
with abnormal cardiac anatomy.
There was no correlation between
nutritional status and adolescents with cardiovascular abnormalities
or adolescents with chest pain (
p
=
0.206 and
p
=
0.632, respectively).
There was a positive correlation of gender and cardiovascular abnor-
malities in adolescents with chest pain (
p
=
0.007).
Conclusion:
There were cardiovascular abnormalities in adolescents,
with symptoms of chest pain in some cases. Female adolescents with
chest pain had no correlation with cardiovascular abnormalities.
36: THERAPEUTIC ROLE OF MOBILISED BONE MARROW
CELLS IN CHILDREN WITH NON ISCHAEMIC DILATED
CARDIOMYOPATHY
Omneya Ibrahim Youssef
1
, Nevin Mamdouh Habeeb
1
, Eman Saleh
El Hadidi
3
Department of Paediatrics, Faculty of Medicine, Ain Shams
University, Cairo, Egypt
