CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
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AFRICA
DSO and five of the 29 (17%) after CR had bradycardia. Of the 13
cases with bradycardia after DSO [complete atrio-ventricular block
(CAVB) in seven, advanced AVB in two, and sick sinus syndrome
(SSS) in four], 10 underwent permanent pacemaker implantation
(PMI). Among the four cases with SSS, two underwent PMI four to
10 years after DSO. Among the nine cases with AV block, four under-
went PMI soon after DSO. CAVB progressed in these four patients
and PMI was performed one to 13 years after DSO. One case already
had congenital CAVB, and for this case, PMI was performed at the
DSO. Five cases had CAVB soon after CR, and all five underwent
PMI.
Conclusion:
There was no significant difference in the incidence
of tachycardia and bradycardia between the DSO and CR groups.
Patients with ccTGA were found to have a high incidence of arrhyth-
mia after both DSO and CR. Therefore, close observation of patients
with ccTGA is essential.
123: JUST A HEADACHE? BRAIN ABSCESS IN RIGHT-TO-
LEFT SHUNT LESIONS
Michael Weidenbach, Sabrina Wolff, Robert Wagner, Martin
Kostelka, Ingo Daehnert
Department of Paediatric Cardiology, Heart Centre Leipzig, Germany
Background
: Although congenital heart disease is a major risk factor
to develop brain abscess in the paediatric population, the overall inci-
dence is low, becoming even lower nowadays with early correction of
right-to-left shunt lesions.
Case reports
: We encountered two adolescents with brain abscess
in recent years. The first one was a 14-year-old girl from Morocco
with tetralogy of Fallot. The child underwent corrective surgery
within a charity programme without any adverse event. Her major
complaints were headaches, which, according to her mother, was a
known, chronic problem. Just before her return to Morocco she had a
seizure that led to the diagnosis of a large temporal abscess that was
drained surgically. After four weeks of antibiotics she could return
home without any residuals.
The second patient was a 21-year-old man with functional univen-
tricular heart and Eisenmenger syndrome. Due to new onset of head-
aches he presented at our clinic on the weekend, was admitted and
was to be discharged on the following day. As in the young girl, he
did not have any fever, neurological deficits or elevated inflammatory
markers. Having the previous case in mind, he had an MRI, which
showed a brain abscess in the basal ganglia. Due to the location and
the reduced general condition, surgery seemed to be too risky. Initial
treatment included meropenem and vancomycin. Since repeated MRI
after 10 days showed progression, clindamycin was added for a total
of six weeks, leading to regression of the abscess.
Conclusion
: In immunocompetent patients congenital heart defects
with right-to-left shunt remain a major risk factor for brain abscess-
es. There should be a high index of suspicion in this population.
Conservative treatment is an option in high-risk cases or if abscess
location is unfavourable.
125: REFERENCE VALUES FOR QT AND QTC MEASURE-
MENTS AFTER BRISK STANDING IN HEALTHY (7–13
YEARS) PREPUBERAL SCHOOLCHILDREN
Luc Filippini
1
, Kawish Zoubin
1
, Pieter Postema
2
, Arthur Wilde
2
,
Rimke Vos
1
, Nico Blom
3
1
Juliana Children’s Hospital, The Hague, The Netherlands
2
AmsterdamUniversity Medical Centre,Amsterdam, The Netherlands
3
Leiden University Medical Centre, Leiden, The Netherlands
Background
:
Long QT syndrome (LQTS) is an inheritable cardiac
disorder that can lead to ventricular arrhythmias associated with
sudden death, especially in young and apparently healthy individuals.
LQTS is caused by mutations in cardiac ion channels, which decrease
cardiac repolarisation reserve and cause QTc prolongation. In
borderline cases risk assessment is difficult but important to prevent
sudden death. In adults the brisk standing test (BST) has been shown
to discriminate between normal individuals and genetically proven
LQTS patients. This research was undertaken to establish reference
values for prepuberal children (7–13 years of age) for QT duration
and QTc prolongation after brisk standing.
Methods:
Fifty-seven prepuberal (Tanner score
≤
3) healthy school-
children underwent a BST during continuous ECG registration.
The subjects rested in the supine position for two minutes, stood up
briskly and stayed in a vertical position for one minute upon which
they lay down quickly and rested for two minutes in a supine position.
QTc maximal, minimal and mean values were measured during the
pre- and post-standing supine resting position, as was QTc at maxi-
mal sinus tachycardia and shortest TP interval after brisk standing.
Results:
All 57 subjects were included in the measurements. Of
these, 29 were boys (age 10.2
±
1.1) and 28 girls (age 9.9
±
1.1).
Baseline characteristics and response to standing did not differ
between boys and girls. Whole group QTc prolongation at maximal
tachycardia at BST was significantly longer in children compared to
adults (79
±
26 vs 50
±
30 ms).
Conclusions:
QTc prolongation after brisk standing in children was
more pronounced than in adults. Using adult values for children
would therefore yield false positive results with the a risk of over-
diagnosis and over-treatment. Comparison of these BST reference
values with DNA-positive children seven to 13 years old is therefore
warranted.
129: MANAGEMENT AND OUTCOME OF ISOLATED
PARTIAL ANOMALOUS PULMONARY VENOUS CONNEC-
TION FROM THE LEFT UPPER LOBE
Asad Shah, Robert Jaquiss, Andrew Lodge
Duke University Medical Centre, Durham, NC, USA
Background:
An anatomical subset of partial anomalous pulmonary
venous connection (PAPVC) is venous drainage of the left upper lobe
(LUL) of the lung to the innominate vein via a vertical vein. The
operative approach, outcomes, and follow-up strategy for this lesion
are not well reported. Our objective was to describe the operative
approach and outcome for repair of LUL-PAPVC.
Methods:
All patients who underwent surgical repair of PAPVC
at our institution were retrospectively reviewed. The incidence of
LUL-PAPVC, postoperative imaging and complications, need for
re-intervention, and survival were analysed.
Results:
The incidence of LUL-PAPVC was 12% (
n
=
12) of all
PAPVC patients (
n
=
102). Median patient age was 14 (6.37) and six
patients were female (50%). The operative procedure involved medi-
an sternotomy, cardiopulmonary bypass, ligation of the vertical vein
at its insertion to the innominate vein, and anastomosis of the vertical
vein to the left atrium. There were no peri-operative or late deaths.
Postoperative echocardiography was performed in 92% (
n
=
11) of
patients, and the vertical vein to left atrium anastomosis was visual-
ised in 64% (7 of 11). Three patients (25%) had postoperative MRIs
performed, all with excellent visualisation of the anastomosis. There
were no cases of pulmonary venous obstruction, no imaging evidence
of pulmonary hypertension, and no patients required re-intervention.
Four patients (33%) had postoperative complications, including two
with atrial fibrillation, one with post-pericardiotomy syndrome, and
one with left phrenic nerve dysfunction. Median length of hospital
stay was 4 (3.5) days.
Conclusions:
PAPVC from the LUL to the innominate vein via a
vertical vein can be repaired using this technique, with low morbidity
and mortality, and without postoperative pulmonary venous obstruc-
tion. Pulmonary hypertension was not observed during follow up.
Postoperative imaging of LUL-PAPVC repair can be difficult, and
MRI should be considered as an alternative to echocardiography in
imaging these patients.
131: THE TARANAKI REGIONAL AREA PLAN TO SAVE
CHILDRENS’ LIVES (THE TARANAKI PROJECT)
