CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
170
AFRICA
in cases with elevated NT-proBNP (18–20.5 vs 3.5–8%;
p
=
0.01–
0.12), with a trend towards an increased incidence of CA dilatation
(15–16.4 vs 5.3–5.8%;
p
=
0.08). After identifying the upper quartile
related to serum NT-proBNP level, 8/10 subjects had clinical and
echocardiographic findings suggestive of myocardial dysfunction.
Conclusion:
NT-proBNP is most likely the cause of hyponatraemia
during acute KD. It is associated with higher resistance to IVIG, and
higher incidence of CA lesions. The use of NT-proBNP may become
a cardinal biochemical marker in predictive scoring for IVIG resist-
ance, coronary outcome, and the extent of myocardial involvement.
481: SURGICAL CONGENITAL HEART DISEASE CATEGO-
RIES AND GENDER: DIFFERENT INCIDENCE, BUT SIMI-
LAR LONG-TERM SURVIVAL
Gunnar Erikssen
1
, Knut Liestãl
2
, Erik Thaulow
1
, Jan Ludvig
Svennevig
1
, Harald Lauritz Lindberg
1
1
Oslo University Hospital, Rikshospitalet, Norway
2
Department of Informatics, University of Oslo, Norway
Background
: Gender differences exist in the incidence of different
types of congenital heart disease (CHD), but there are few data on
differences between males and females in long-term survival after
corrective surgery.
Methods
: Between 1971 and 2010, the 6 769 patients aged 0–16
years who underwent corrective CHD surgery at Oslo University
Hospital, Rikshospitalet (80% of all CHD surgery in Norway), were
prospectively enrolled in the study. Primary CHD diagnoses (ICD
–9 or –10) were categorised according to a consensus-based severity
hierarchy. Date of first operation was registered. Complete all-cause
mortality data were recorded until 1 January 2012.
Results
: Of the total number of patients, 3 256 (48.1%) were female.
Median age at first operation was 0.8 years (mean 2.8, SD 3.8).
The incidence of atrial septum defect and patent ductus arteriosus
was highest in females (61.7 and 62.5%, respectively,
p
<
0.001).
The incidence of transposition of the great arteries (66.3% males),
tetralogy of Fallot (58.4%), double-outlet right ventricle (65.2%),
coarctation of the aorta (60.0%), interrupted aortic arch (56.6%)
and single-valve surgery (64.5%) was highest in males (
p
<
0.001).
Incidence of pulmonary atresia, truncus arteriosus, univentricular
hearts, ventricular septum defect and atrioventricular septum defect
was similar in males and females (
p
>
0.05). During up to 40 years of
follow up after surgery, female patients with coarctation of the aorta
had a slightly higher mortality rate than males (15.7 vs 10.1%,
p
=
0.05). Survival in the other diagnostic groups was similar.
Conclusion
: Despite substantial differences between males and
females in the incidence of different CHD types, survival after initial
corrective surgery within each diagnostic group was remarkably
similar.
483: SURGICALLY TREATED PULMONARY STENOSIS: 50
YEARS OF FOLLOW UP
Eva Amalie Nielsen, Vibeke Hjortdal
Department of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Denmark
Background:
The natural history of surgically relieved pulmonary
artery stenosis is not well described, since balloon valvuloplasty has
replaced surgery. We hypothesised that the incidence of morbidity
and mortality increase with increasing time and that more than 30%
of patients have been re-operated due to pulmonary regurgitation
before the age of 40 years.
Methods:
A retrospective follow-up study was done of the popu-
lation treated surgically for pulmonary artery stenosis at Aarhus
University Hospital from 1 January 1957 to 31 December 2000.
Patients were identified by their personal identification number; their
hospital records were reviewed and present status noted.
Results:
Of 87 patients, six were excluded due to missing informa-
tion. The age at primary surgery was less than 15 years in more
than 70% (
n
=
58) of the study population of 81 patients. Valvular
stenosis was the most common pathology, 84% (
n
=
68), the rest had
an infundibular stenosis. Three patients died (age 0 and 40 years,
and one unknown) resulting in a mortality of 2.4%. The mean age
for all patients at follow up was 32 years (range 4–79 years). At a
maximum follow up of 54 years and a mean follow up of 25 years,
18 (24%) required at least one re-intervention. Pulmonary valve
replacement due to pulmonary regurgitation was the most common
re-intervention (60%). Out of 19 patients older than 40 years and 15
patients between 30 and 40 years of age, 47 and 28% respectively,
have had a re-operation.
Conclusion:
With a mean long-term follow up of 25 years (maximum
54 years), re-intervention was necessary in 24% and almost half of the
patients reaching the age of 40 years had a re-operation. This retro-
spective study shows that there is a call for prolonged follow up and
re-intervention in patients operated for simple pulmonary stenosis.
484: CONGENITAL HEART LESIONS ASSOCIATED WITH
IMPORFORATED ANUS
Ahmad Azhar, Jamal Siddique
King Abdulaziz University, Jeddah, Saudi Arabia
Objectives:
We aimed in our study to determine the incidence and
type of associated congenital cardiac anomaly (CCA) in newborns
with imperforated anus (IA), the outcome of anorectal surgical recon-
struction in our centre, and to determine the need for performing
echocardiography in all patients with IA.
Methods:
The pre-operative echocardiography reports of all
cases born with imperforate anus and managed at King Abdulaziz
University Hospital, Jeddah, Saudi Arabia over a period of 11 years
(January 2000 to December 2010) were reviewed. The average
annual delivery rate of this hospital is 5 500.
Results:
During the study period, 61 patients with IA were diag-
nosed, which is an incidence of one per 992 live births. The rate of
CCA among IA subjects was 15 (24.6%). In 12 patients (19.6%), the
associated CCA was mild and reconstruction of the anorectum went
smoothly. Three patients (4.9%) had significant CCA and died.
Conclusion:
The incidence of imperforated anus in our hospital is
one per 992 live births and the association with CCA is 24.6%. The
majority of associated CCA with IA were of the mild type.
486: SINUS NODE DYSFUNCTION DUE TO MYOCARDITIS
Mohammed Numan, TharakanathaYarrabolu, Gurur Biliciler-Denktas
University of Texas, Paediatric Cardiology, USA
Introduction:
The most common ECG findings associated with
myocarditis are non-specific T-wave changes and tachyarrhythmias,
including sinus tachycardia, ventricular tachycardia and ventricular
fibrillation. Sinus node dysfunction in viral myocarditis has not
been reported in the literature. We report a case of viral myocarditis
complicated by sinus node dysfunction (SND), which resolved after a
few days with intravenous immunoglobulin (IVIG) treatment.
Case report:
A 17-year-old Caucasian male was hospitalised after a
four-day history of progressively worsening chest pain and dyspnoea.
On physical examination his vital signs were normal. Cardiovascular
system examination revealed no murmur or pericardial rub and no
signs of congestive heart failure. ECG showed ST elevation on the
lateral chest leads. Echocardiogram revealed mild pericardial effu-
sion, LV dilatation and mild–moderate depressed cardiac function
(EF 45%). Laboratory data were consistent with myocarditis. He had
an elevated creatinine kinase level (1 113 U/l), and CK MB was 84.9
ng/ml, troponin-T 4.900 ng/ml and myoglobin 211 ng/ml. Cardiac
MRI revealed diffuse myocarditis, global hypokinesia, and low
ejection fraction. Adenoviral and Coxsackie B
1
antibody titres were
mildly elevated. IVIG was started in the first day of hospitalisation.
On day three, telemetry showed badycardia with a rate of 28 and
sinus pauses of 6.7 s; 24-hour Holter revealed bradycardia with the
lowest rate 27, with frequent sinus pauses up to 6.1 s. On Day 10 the
