CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
186
AFRICA
Background:
Haemoptysis is a common cause of morbidity in
patients with Eisenmenger syndrome. We aimed to analyse the
predictors of haemoptysis in patients with Eisenmenger syndrome
and determine the underlying causes using computerised tomograph-
ic pulmonary angiogram (CTPA).
Methods:
Forty-one patients of Eisenmenger syndrome were stud-
ied; among them 24 had no haemoptysis and 17 patients had haemop-
tysis. The mean age of the patients was 23.7
±
7.9 years with a range
from 13–50 years. The patients with haemoptysis underwent CTPA
within one week of their index bleed.
Results:
No significant difference was found between patients with
and without haemoptysis in baseline demographic characteristics,
diagnosis, complexity of lesion, functional class, symptoms, and
parameters before and after 6 MWT. The only statistically significant
finding was the reduced 6 MWD in patients with haemoptysis (323.8
±
81.7 m) compared to patients without haemoptysis (385.2
±
92.6
m) (
p
=
0.03). The CTPA was abnormal in 13 patients and normal in
four. The most common extraparenchymal lesion was the presence of
collaterals (five patients). The more described cause of haemoptysis,
pulmonary thrombus, was seen in only one patient. One patient had a
pseudo-aneurysm from a branch of the left pulmonary artery, which
was closed with a coil. One patient was diagnosed to have miliary
tuberculosis. The most common intraparenchymal lesion was the
presence of mosaic pattern suggestive of recent pulmonary haemor-
rhage. Overall, seven patients underwent a therapeutic procedure
based on the finding of CTPA.
Conclusion:
Haemoptysis remains a major cause of morbidity in
patients with Eisenmenger syndrome. Haemoptysis occurs more
frequently in patients with greater exercise limitation. CT pulmonary
angiogram immediately following an episode of haemoptysis could
identify a potentially treatable cause in nearly half of the patients.
745: MITRAL VALVE REPAIR IN CHILDREN AND ADOLES-
CENTS WITH RHEUMATIC HEART DISEASE
Maria Cristina Ventura Ribeiro
1
, Cristina de Paula Quirino Mello
1
,
Larissa Ventura Ribeiro
2
, Maria Gabriela Melo Pereira
2
, Izabella
Marques Lira
1
, Fernando Moraes Neto
4
, Cleusa Lapa Santos
3
1
Paediatric Cardiology, Intituto de Medicina Integral Prof Fernando
Figueira Recife, Brazil
2
Faculdade de Ciencias Médicas, Universidade de Pernambuco, Brazil
3
Intituto de Medicina Integral Prof Fernando Figueira Recife, Brazil
4
Cardiac Surgery, Intituto de Medicina Integral Prof Fernando
Figueira Recife, Brazil
Background:
In Brazil, most of the interventions on the mitral
valve are secondary to rheumatic heart disease. Mitral valve repair,
compared with valve replacement, has many advantages. This work
aimed to analyse the results of mitral valve repair in the correction
of mitral regurgitation in children and adolescents with rheumatic
heart disease.
Methods:
Medical records from 29 patients with mitral regurgita-
tion submitted to mitral valve repair between 2002 and 2011 in the
Instituto de Medicina Integral Professor Fernando Figueira (IMIP)
were reviewed and supplemented by physical examination and echo-
cardiography. The age ranged from six to 16 years with a median of
10.9 years. The median postoperative period was 6.21 years (range at
least one to no more than 10 years).
Results:
Four (13.8%) patients still had severe mitral regurgitation
postoperatively, two of them requiring mitral valve replacement and
the other two are in clinical follow up. Two other patients required
valve replacement, one due to several mitral stenoses and other due
to major haemolysis. With the exception of four patients re-operated,
all others were in NewYork Heart Association functional class I. Six
(20.7%) patients had moderate mitral regurgitation and 17 (58,6%)
mild mitral regurgitation. In eight (27.6%) patients we detected mild
mitral stenosis, eight (27.6%) showed moderate mitral stenosis and
two had moderate to severe. The left ventricular systolic function
was decreased in four (13.8%) patients. Mild or moderate pulmonary
hypertension was present in 10.3%. There was no report of death.
Conclusions:
The present study demonstrates that valve repair is a
good option for surgical treatment of mitral regurgitation in rheu-
matic heart disease, showing an improvement in the clinical pattern
even in the late postoperative period.
747: MEASUREMENT OF EXERCISE CAPACITY AND
ECHOCARDIOGRAPHIC LEFT VENTRICULAR FUNC-
TION DURING SEMI-SUPINE STRESS-CYCLE ERGOM-
ETRY IN PATIENTS WITH ANOREXIA NERVOSA
Carolina Escudero
1
, James Potts
1
, Astrid De Souza
1
, Pei-Yoong Lam
2
,
Lindsay Williams
1
, Ramandeep Gill
1
, Kathryn Duff
3
, George Sandor
1
1
Children’s Heart Centre, British Columbia Children’s Hospital,
Vancouver, Canada
2
Division of Adolescent Health and Medicine, British Columbia
Children’s Hospital, Vancouver, Canada
3
Department of Sport Science, Douglas College, Vancouver, Canada
Background:
Patients with anorexia nervosa (AN) have altered
physiological responses to exercise. This study aimed to determine
the differences in exercise capacity and haemodynamic parameters
with exercise in patients with AN.
Methods:
This was a retrospective case–control study. Sixty-six
adolescent females with AN and 21 adolescent female controls exer-
cised on a semi-recumbent ergometer in three-minute, 20-watt incre-
mental stages to volitional fatigue. Heart rate (HR), blood pressure
(BP), and echo Doppler indices were measured pre-, at each stage,
immediately and three minutes post-exercise. Fractional shortening
(FS), peak aortic velocity (PAoV), mean velocity of circumferential
fibre shortening (MVCFc), wall stress (WS), cardiac index (CI), and
systemic vascular resistance (SVR) were calculated. Peak oxygen
consumption (VO
2
), minute ventilation (VE), respiratory exchange
ratio (RER), and arterial–venous oxygen difference (a-vO
2
) were
determined using open-circuit spirometry.
Results:
Patients with AN had a significantly lower BMI (16.7 vs
19.7 kg/m
2
,
p
<
0.001), total work (1 126 vs 1 914 J/kg,
p
<
0.001),
total test duration (13.8 vs 20.8 min,
p
<
0.001), peak VE (47.4 vs
72.0 l/min,
p
<
0.001), and VO
2
(31.3 vs 39.7 ml/min/kg,
p
<
0.001)
and higher RER (1.14 vs 1.06,
p
=
0.001) when compared to controls.
Systolic BP, diastolic BP, and PAoV were lower at pre-exercise,
increased with exercise, and were lower at peak exercise in AN vs
control subjects. HR, FS, MVCFc and CI showed no difference at
pre-exercise, increased with exercise, and were lower at peak exer-
cise in AN patients vs controls. WS decreased with exercise and was
lower in AN patients vs controls at pre-exercise and peak exercise.
SVR pre-exercise was lower in AN, decreased with exercise, and
there was no difference at peak exercise. The a-vO
2
increased with
exercise with no differences between groups.
Conclusions:
Adolescent patients with AN have decreased exercise
capacity and abnormalities in their haemodynamic parameters and
myocardial performance during exercise compared to controls.
751: CLINICAL ASPECTS OF 112 PATIENTS WITH ACUTE
RHEUMATIC CARDITIS IN A PAEDIATRIC HOSPITAL
Maria Cristina Ventura Ribeiro
1
, Luziene Bonates dos Santos
1
,
Larissa Ventura Ribeiro
2
, Rafaela Tavares
3
, Felipe Moreno
3
, Cleusa
Lapa Santos
4
1
Paediatric Cardiology, Intituto de Medicina Integral Prof Fernando
Figueira Recife, Brazil
2
Faculdade de Ciencias Médicas, Universidade de Pernambuco, Brazil
3
Intituto de Medicina Integral Prof Fernando Figueira Recife, Brazil
4
Cardiac Surgery, Intituto de Medicina Integral Prof Fernando
Figueira Recife, Brazil
Background:
Rheumatic fever is a universal disease and primarily
affects children in developing countries. The authors describe the
clinical aspects of 112 children and adolescents admitted to the cardi-
ology ward of the Hospital Instituto de Medicina Integral Professor
Fernando Figueira during the period 2004 to 2010.
