CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
150
AFRICA
Background:
Early diagnosis of Kawasaki disease (KD) is sometimes
difficult and critical to achieve the optimal treatment result, espe-
cially in incomplete or atypical KD. We investigated the correlation
of serum level of pro-B-type natriuretic peptide (pro-BNP) and the
incidence of echocardiographic abnormalities (especially mitral valve
regurgitation or pericardial effusion) in patients with KD to discover
whether pro-BNP level might be helpful in the early diagnosis of KD.
Methods:
Pro-BNP concentrations were measured and echocardi-
ography was performed in the acute stage of 96 patients with KD.
Abnormal pro-BNP level and echocardiographic findings were
classified into two categories and defined as follows: (1) significant
mitral valve regurgitations, (2) significant pericardial effusion.
Results:
In the KD patients, significant mitral valve regurgitations
were present in 20 patients (20.8%), significant pericardial effusion
in eight patients (8.3%). Pro-BNP level was correlated with echo-
cardiographic findings of myopericarditis (mitral valve regurgitation
or pericardial effusion). Receiver operating characteristic analysis
showed a high value of the area under the curve (0.78) for the detec-
tion of myopericarditis with a sensitivity of 69.6% and a specificity
of 75.5% for a cut-off value of 927.3 pg/ml.
Conclusions
Highly elevated baseline levels of pro-BNP in the acute
phase of KD are associated with the presence and extent of myoperi-
carditis and may be helpful in the diagnosis.
243: SUPRA-VALVULAR PULMONARY STENOSIS AFTER
ARTERIAL SWITCH OPERATION: EARLY IDENTIFICA-
TION OF PATIENTS AT HIGH RISK FOR RE-INTERVEN-
TION
David Horne
1
, Reeni Soni
2
, Ilan Buffo
2
, Brett Hiebert
3
, John Lee
1
,
Dion Pepelassis
2
1
Department of Surgery, Section of Cardiac Surgery, University of
Manitoba, Winnipeg, Canada
2
Department of Paediatrics, Section of Cardiology, University of
Manitoba, Winnipeg, Canada
3
Cardiac Sciences, St. Boniface Hospital, Winnipeg, Canada
Background:
Supra-valvular pulmonary stenosis (SVPS) is the most
common complication after the arterial switch operation (ASO) for
D-transposition of the great arteries (D-TGA) in neonates. While the
majority improve over time, some require re-intervention to relieve
symptomatic lesions. We hypothesised that early postoperative
echocardiography will predict which patients are at higher risk of
re-intervention for significant SVPS following ASO.
Methods:
A
s
ingle institution retrospective review of Manitoba
newborns (
n
=
63) who had ASO for D-TGA from 1991 to 2010 was
undertaken (independent of when, where and who performed their
surgery). First postoperative and most recent transthoracic echocar-
diograms (TTE) of all surviving patients (
n
=
59) were reviewed for
SVPS. Patients were categorised as needing re-intervention for SVPS
(re-intervention group) versus those who did not (no re-intervention
group). Univariate analysis using Fisher’s exact test was used to
analyse parameters. Significant TTE parameters (gradients
>
40
mmHg plus two or more levels of stenosis) were analysed using
the Kaplan-Meier method to calculate probability of freedom from
re-intervention.
Results:
Mean follow-up period was 9.3 years. First postoperative
TTE demonstrating two or more levels of stenosis, stenosis gradi-
ents
>
40 mmHg, both last-mentioned parameters combined, as well
as D-TGA plus VSD were all significantly more prevalent in the
re-intervention group. Patients who had gradients
>
40 mmHg and
stenosis at two or more levels, the five-year probability of freedom
from re-intervention for SVPS was 40% compared to 100% for those
without the two aforementioned parameters (log rank
p
=
0.0001).
Conclusion:
SVPS with multiple levels of stenosis causing a gradi-
ent
>
40 mmHg at initial TTE post-ASO allowed paediatric cardi-
ologists to identify patients at higher risk of future re-intervention
for supra-valvular pulmonary stenosis. These findings need to be
validated in a larger cohort.
245: RANDOMISED CONTROLLED TRIAL OF INTRAVE-
NOUS IMMUNE GLOBULIN IN ACUTE MYOCARDITIS IN
PAEDIATRIC AGE GROUP
Dinesh Yadav, Sheetal Agarwal, Pankaj Gupta, Sandeep Choudhary,
Mukesh Beniwal, Jhuma Sankar, NK Dubey
Department of Paediatrics and Neonatology, PGIMER and RML
Hospitals, New Delhi, India
Background:
Acute myocarditis is a life-threatening disease which
may progress to dilated cardiomyopathy. An autoimmune mechanism
has been postulated and immune-modulatory therapies tried with
little evidence to support it. The paediatric literature is scant, and
there are no randomised controlled studies of immunosuppressive
therapy in childhood myocarditis. Hence, this study was designed
to assess whether intravenous immunoglobulin (IVIG) improves left
ventricular function and survival in children with acute myocarditis.
Methods:
A prospective, randomised controlled trial was designed
in children with acute (
<
3 months) onset of congestive heart failure
and echocardiographic documentation of diminished left ventricular
function. Children were randomised to receive either IVIG (2 g/
kg) plus prednisolone (2 mg/kg/day) or prednisolone (2 mg/kg/day)
alone for six weeks’ duration. Left ventricular function was assessed
at seven days, one month, three months, six months and 12 months
after presentation. Primary outcomes included survival and recovery
of left ventricular function.
Results:
The baseline characteristics were comparable in both
groups. Of the 21 children with acute myocarditis, 12 (57.1%)
were treated with IVIG plus steroids and nine (42.8%) were treated
with steroids. All the patients received anti-congestive therapy and
inotropic support as required. Compared with the non-IVIG group,
those treated with IVIG had a smaller mean adjusted left ventricular
end-diastolic dimension (LVED) at six and 12 months (
p
=
0.01 and
p
=
0.009, respectively). Left ventricular ejection fraction (LVEF) was
also higher in IVIG group at six months but did not reach statistical
significance. However, at 12 months it was statistically significant
(
p
=
0.03). Patients treated with IVIG were more likely to achieve
normal left ventricular function (
p
=
0.02). Survival was similar in
both groups.
Conclusion:
Compared to steroids, IVIG was associated with signif-
icant improvement of left ventricular function in acute myocarditis at
the end of 12 months but without significant difference in survival
rate.
246: REPAIR OF TOTAL ANOMALOUS PULMONARY
VENOUS CONNECTION IN INFANCY-A SINGLE CENTRE
EXPERIENCE FROMWESTERN INDIA
Usha Pratap, Ranjit Jagtap, Vinayak Desurkar, Nilesh Juvekar, Anand
Nadkarni
Deenanath Mangeshkar Hospital, Pune, India
Background
: Repair of total anomalous pulmonary venous connec-
tions in infancy still carries a significant morbidity and mortality in
India. Here we report our experience from a single centre in western
India.
Methods:
Seventy-two patients were operated in our institute from
July 2006 to March 2012. There were 48 males and 21 females.
Median age was 89 days and median weight was 3.77 kg; 37% had
prior admissions in other hospitals, 84% were prepared with PDE
inhibitors and 38% needed emergency surgery.
Results
: Sixty-nine patients were included in the analysis, 75% of
patients had a delay in diagnosis and 42% deaths were due to pre-
operative infections. The mean age of surgery in the delayed group
was 115
±
84 days and in the timely diagnosed group was 54
±
49
days (
p
=
0.006). Preparation for more than two days significantly
reduced the mortality (
p
=
0.49), 40% had delayed sternal closure.
Mean ventilation was 109 hours; 98.5% of patients received anti-PH
medications and 38% received inhaled nitric oxide. Mean inotrope
score was 3618; 13% needed additional cardiac surgeries, 5.7%
needed additional non-cardiac surgeries, 37% had pre-operative
