CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
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providing primary, secondary and tertiary interventions. Primordial
prevention and research priorities were overarching themes. These
components were developed into a conceptual framework scheme.
Conclusions:
Existing literature contains considerable lessons on
the design and implementation of comprehensive RF/RHD control
programmes. Fashioning these guidelines and programmatic experi-
ences into a conceptual framework scheme benefits clinicians, policy
makers and RHD advocates. Extending the framework may yield a
model to isolate and evaluate individual programme components.
542: IMPLANTABLE CARDIOVERTER DEFIBRILLATOR
THERAPY FOR PREVENTION OF SUDDEN CARDIAC
DEATH IN CHILDREN ANDYOUNG ADULTS IN MEXICO
Norma A Balderrabano-Saucedo
1
, Santiago Nava-Townsend
2
, Jose-
Luis Morales
2
, Luis Colãn-Lizalde
2
, Manlio F Mãrquez-Murillo
2
,
Jorge R Gømez-Flores
2
, Pedro Iturralde-Torres
2
1
Hospital Infantil de Mexico, Federico Gømez
2
InstitutoNacional de Cardiología Ignacio Chávez, Mexico
Background:
Children at risk for sudden cardiac death have a wide
variety of underlying cardiac diseases such as the broad spectrum
of congenital heart disease, inherited arrhythmogenic diseases, and
hypertrophic or dilated cardiomyopathy. Current data on paediatric
implantable cardioverter defibrillator therapy are derived from small
studies and retrospective multicentre studies. This single-centre study
was undertaken to review our experience with ICD implantation in
children and young adults with relatively different aetiologies.
Methods:
We retrospectively reviewed the records of the paediatric
patients who underwent cardioverter-defibrillator implantation at the
InstitutoNacional de Cardiología Ignacio Chávez between January
2005 and February 2011.
Results:
A total of 20 patients who underwent ICD implantation
during this period were included in this study. The median age was
15 years. Most of the patients had cardiomyopathy (
n
=
13) or ion
channel diseases (
n
=
6). Devices were implanted for either second-
ary (
n
=
15) or primary (
n
=
5) prevention. The selected ICD genera-
tor type was dual chamber in 12 patients, single chamber in seven
patients and biventricular in one. Six patients received 30 shocks.
Four of 15 patients (26%) from the secondary prevention group
experienced at least one appropriate shock during a median period of
3.4 years (range: 1.2 months to 6.5 years). Eight inappropriate shocks
were delivered in two patients from the secondary prevention group
during the median period of 3.4 years. The most important reason for
inappropriate shocks was T-wave over-sensing. No acute or chronic
complications occurred.
Conclusions:
The ICD was safe and effective in interrupting malig-
nant arrhythmias in children and young adults with a high risk of
sudden cardiac death. The occurrence of lead-related acute or chronic
complications was zero and the incidence of inappropriate shocks
was low. Careful programming is mandatory to reduce inappropriate
shocks.
547: CARDIAC RESYNCHRONISATIONTHERAPY IN CHIL-
DREN IN MEXICO
Norma A Balderrabano-Saucedo
1
, Santiago Nava-Townsend
2
, Jose-
Luis Morales
2
, Luis Colãn-Lizalde
2
, Manlio F Mãrquez-Murillo
2
,
Jorge R G
ó
mez-Flores
2
, Pedro Iturralde-Torres
2
1
Hospital Infantil de Mexico Federico G
ó
mez
2
InstitutoNacional de Cardiología Ignacio Chávez, Mexico
Background:
Cardiac resynchronisation therapy (CRT) is an impor-
tant management tool in adults with congestive heart failure (CHF).
The role of CRT in children is unclear. This study was undertaken to
review our initial experience of CRT in children.
Methods:
We initiated the CRT programme in children on January
2011; only two children have been included.
Results:
Case 1: a five-year-old girl was transferred because of
progressive LV dysfunction. At one year of age she underwent
a ventricular septal defect closure. One year later a permanent
VVI pacemaker was implanted for the treatment of AV block.
Echocardiography revealed cardiac asynchrony, altered diastolic
filling, mitral and tricuspid valve regurgitation, severe ventricular
dilatation and an ejection fraction of 16%. We implanted an epicar-
dial lead in the right atrial appendage and an epicardial lead in the
left ventricle as an upgrade to the existing epicardial right ventricular
lead. After 18 months of follow up no clinical improvement has been
seen. She is on a cardiac transplant list.
Case 2: a 16-year-old girl was transferred with the diagnosis of
idiopathic dilated cardiomyopathy and severe CHF. The NYHA class
was IV. Echocardiography showed severe left ventricular dilatation,
ejection fraction of 17% and cardiac asynchrony. We implanted a
biventricular pacemaker. Three endocardial leads were placed on the
right atrial appendage, the RV apex and on the LV posterolateral wall
via coronary sinus. After 14 months the NYHA class is I, the ejection
fraction is 40%, left ventricular volume and diameter have reduced
and asynchrony values have improved.
Conclusions:
CRT may have an important role in select paediatric
patients. Further work is necessary to delineate in which underly-
ing anatomical and pathophysiological condition it would be more
effective. In less developed countries there are financial restrictions
preventing this treatment and other new therapies from being offered
to all patients who could benefit from them.
548: EXTENSIVE MYOCARDIAL INFARCTION IN AN
11-YEAR-OLD GIRL: CASE REPORT
Damian Hutter
1
, Jean-Pierre Pfammatter
1
, Mladen Pavlovic
1
,
Alexander Kadner
1
, Florian Schanhoff
1
, Paul Mohaci
1
, Michele
Martinelli
1
, Claudia Boesch
1
, Bendicht Wagner
2
1
Centre of Congenital Heart Disease, University Hospital, Bern,
Switzerland
2
Paediatric Intensive Care Unit, University Children’s Hospital, Bern,
Switzerland
Myocardial infarct in childhood is very rare. Mostly it is associ-
ated with structural, hereditary or acquired disease. We report on an
11-year-old girl who presented after a near-drowning episode. The
child was in cardiopulmonary shock and had to be ventilated. Despite
volume and starting on catecholamines, her blood pressure remained
low. Primary echocardiogram revealed depressed myocardial func-
tion. Initial blood work showed a white blood cell count of 27 000,
abnormal I/T ratio, CK 7 000 U/l, CK-MB 688 ug/l, troponin 12 ug/l.
The girl’s history was unremarkable. Repeated echocardiogram after
four hours showed a severely reduced left ventricular function (EF
25–30%) with dyskinesia/hypokinesia along the free left ventricular
wall. The right ventricular systolic function remained normal. ECG
showed sinus tachycardia, deep Q waves in leads V3–V5, and ST
elevation in V1–V2. Based on these findings, we primarily diagnosed
acute myocarditis (DD acute vasculitis with coronary vasospasm,
hypoxic ischaemia after near drowning).
Within the following two days her LVEF recovered (EF 50–55%).
A sudden episode of nausea and vomiting on day three was followed
by ventricular tachycardia and ventricular fibrillation. Resuscitation
and rescue extracorporeal membrane oxygenation (ECMO) was initi-
ated. Coronary angiogram revealed an abnormally widely spread thin
network of coronary branching along the left coronary artery with a
discrete narrowing of the main stem. CT scan confirmed the diagno-
sis of a coronary anomaly with the left coronary artery coming from
the acoronary sinus.
Corrective surgery with an ‘unroofing’ of the intramural part and
creation of a neo-ostium of the LCA was performed. The patient was
weaned from ECMO on day five. However, despite regained normal
coronary flow, the LV function remained depressed (EF 20–25%).
After syx months, the patient underwent heart transplantation.
Conclusion:
The presence of segmental myocardial dyskinesia/
hypokinesia always implies further diagnostic imaging regardless of
the patient’s age.
