CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
206
AFRICA
Results:
Sicty (24.8%) of 242 patients who underwent valvuloplasty
at Tygerberg Hospital had CXRs available. The incidence of PH in
this cohort of patients with severe MS was 19%. Patients with PH had
higher pulmonary pressures (71.1 vs 55.7 mmHg;
p
=
0.04) and had
significantly smaller mitral valve areas (0.85 vs 0.99 cm
2
;
p
=
0.09).
Patients with PH also had higher peak transmitral pressure gradients
(30.1 vs 24.37 mmHg;
p
=
0.10). Although the mean transmitral
pressure gradients were higher in the patients with PH, this differ-
ence was not significant (17.43 vs 15.02 mmHg;
p
=
0.23). Patients
with PH were younger at the time of valvuloplasty (29 vs 38 years;
p
=
0.02). No difference was seen when comparing the lung functions
in terms of ventilatory and diffusion impairment. The data regarding
radiological reversibility was inconclusive.
Conclusion:
PH occurs more commonly in severe MS than currently
thought. Compared to patients without PH, they had more severe MS
and underwent valvuloplasty at a younger age. The data suggest that
PH is an irreversible process with little impact on lung function but
the numbers studied prospectively were too small to provide conclu-
sive evidence regarding the impact on lung function and reversibility.
1030: SCORE FOR QUANTIFICATION OF THE MORPHO-
LOGICAL AND FUNCTIONAL ECHOCARDIOGRAPHIC
FEATURES OF MITRAL VALVE IN PATIENTSWITH RHEU-
MATIC HEART DISEASE
Cleonice Mota, Carolina Capuruão, Alan Conde, Fãtima Rocha,
Zilda Meira
Division of Paediatric Cardiology, Federal University of Minas
Gerais, Brazil
Background:
Rheumatic heart disease (RHD) still challenges all
those involved in its diagnosis and in this context, a more accurate
assessment by echocardiography has added valuable information
about the functional and anatomic subtract of valvar and subvalvar
mitral apparatus (MV).
Objective:
To present an echocardiographic score to support the
evaluation of MV lesions.
Methods:
Out of 298 patients seen during the period of 2009–2010,
93 patients [duration of the disease:
x
(mean)
=
8.0
±
5.8 years; age at
first episode:
x
=
9.2
±
2.9 years] with a definitive diagnosis of RHD,
followed since the first episode and without surgical intervention,
were selected and underwent echo screening. The echo tapes were
reviewed by two other echocardiographists and the kappa statistic
was used for the assessment of inter-observer variability [kappa:
0.875 (95% CI: 0.775–0.974)].
Results:
The patients’ data were scored on a rating scale (1–15), to
quantify the severity of the mitral valve involvement. The quantifica-
tion included five groups of morphological and functional variables
and three degrees of severity. In the comparative analysis, the degrees
established for the classification of the scores of morphological/
functional features were associated with the corresponding degrees
of severity of the haemodynamic findings for mitral regurgitation (
p
=
0.00) and stenosis (
p
=
0.02).
Conclusion:
Considering the characteristic aspects of the morpho-
logical features of the mitral valve in patients with RHD, the stratifi-
cation by degree of commitment could represent additional support
for the echocardiographic evaluation.
1035: IMPROVING THE DIAGNOSTIC YIELD OF THE ECG
IN TACHYARRHYTHMIAS BY ROUTINELY PERFORMING
LEWIS LEAD RECORDINGS
Everhardus Smith, Hellmuth Weich, Anton Doubell
Division of Cardiology, Department of Medicine, Stellenbosch
University, South Africa
Background:
Determining the origin of tachyarrhythmias is a skill
required by all clinicians. Identifying the P wave is integral to making
a diagnosis in tachyarrhythmias. A diagnostic tool that is proposed as
an aid in this regard is doing Lewis leads, but there is little evidence
for this in the literature. As with any diagnostic tool one would expect
that its value is influenced by the users’ knowledge and experience.
Methods:
We prospectively studied patients presenting with a tachy-
cardia to the division of cardiology of Tygerberg Hospital over a six
month period. Both standard ECGs and Lewis leads were performed
in all cases. These ECGs were then analysed by three sets of partici-
pants, namely cardiologists, registrars and students. An initial diag-
nosis was made on the standard ECG only. A revised diagnosis was
then given based on the added information provided by the Lewis
lead in addition to the standard ECG. These answers were compared
to the definitive diagnoses and classified as correct, incorrect and
unsure (where a differential diagnosis was given).
Results:
More correct diagnoses were obtained in all groups with
the addition of Lewis leads. Cardiologists displayed a trend towards
improvement with Lewis leads (87–96%;
p
=
0.07). The registrar
group had the most marked improvement (64–82%;
p
=
0.0026).
Students did not improve significantly (52–54%;
p
=
0.8). Lewis
leads were of assistance to students in patients with regular rhythms
but not in irregular rhythms.
Conclusion:
Lewis leads are a valuable diagnostic tool to enhance
ECG interpretation. It aids clinicians in making accurate diagnoses
in tachyarrhythmias. The amount of benefit is dependent on the
user’s knowledge and expertise. Cardiologists and registrars may
benefit from routinely registering Lewis leads in tachyarrhythmias.
Inexperienced individuals should be wary of using Lewis leads in
irregular tachyarrhythmias. Students would benefit from specific
training in assessing Lewis leads.
1040: IMPACT OF AGE AND GENDER ON CARDIAC
PATHOLOGY IN CHILDREN AND ADOLESCENTS WITH
MARFAN SYNDROME
Goetz Mueller, Jeske Wild, Veronika Stark, Kristoffer Steiner, Florian
Arndt, Jochen Weil, Thomas Mir
Clinic for Paediatric Cardiology, University Heart Centre, Hamburg,
Germany
Background:
Cardiac pathologies are the major aspect in the treat-
ment strategies of Marfan syndrome (MFS). In this progressive
disease, less is known about manifestation and progression of cardio-
vascular symptoms in children. To define a certain decision regarding
therapeutic options, knowledge about onset of cardiovascular find-
ings in children is essential.
Methods:
From 1998 to 2011 patients with clinical features of MFS
were subject to a standardised diagnostic programme. Cardiovascular
findings were analysed concerning age at first clinical manifestation,
prevalence and gender differences, morbidity, mortality and treat-
ment during follow up.
Results:
MFS was diagnosed in 82 patients (46 male, mean age at
diagnosis 9.0
±
5.7 years). At first presentation, aortic root dilation
and mitral valve prolapse was found in 56.1 and 31.7%, whereas
pulmonary artery dilation and tricuspid valve prolapse were detected
in 22.0 and 17.1%. Aortic valve (2.4%) and mitral valve regurgita-
tion (22.0%) were significantly correlated with aortic root dilation
(
p
<
0.01) and mitral valve prolapse (
p
<
0.05) but without relevant
progression during childhood and adolescence. Because of progres-
sive aortic root dilation, medication was initiated in 41.5% of patients
(mean age 8.0
±
4.5 years). Aortic dissection did not appear. Aortic
root surgery in case of severe progression of aortic root dilation
was needed in 3.7% of patients (mean age 9.7
±
2.3 years). Gender-
specific differences concerning cardiovascular findings, progression
of disease or treatment did not appear.
Conclusion:
Comparable with adults, aortic root dilation was
the most frequent cardiovascular finding and was associated with
relevant morbidity and the aim of early prophylaxis. While aortic and
mitral valve regurgitation is of minor clinical relevance, manifesta-
tion at an early age and slow progression of cardiovascular findings
in childhood underline the necessity of repeated echocardiographic
examinations in cases of suspected MFS for early diagnosis and an
early start to prophylactic treatment.
