CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
220
AFRICA
Results:
Thirty-six children with SV underwent DKS at the time of
Glenn bidirectional CPC (
n
=
29) or Fontan total CPC (
n
=
7). The
underlying anatomy was double-inlet left ventricle (
n
=
19), double-
outlet right ventricle (
n
=
7), unbalanced atrio-ventricular septal
defect (
n
=
4) and other (
n
=
6). Prior palliation included pulmonary
artery band (
n
=
35), atrial septostomy (
n
=
9), and coarctation/arch
repair (
n
=
10). Median age at time of DKS was 8.7 months (range
3.5 months – 8.9 years) and median weight was 6.3 kg (range 5–27
kg). Overall survival was 87% at five years. Deaths were unrelated
to DKS or SVOT complications. Pressure difference between the
systemic ventricle and the aorta decreased from 14
±
15 mmHg pre-
operatively to 0 after DKS (
p
=
0.005). At last follow up, none of the
patients developed recurrent SVOT gradient; 73% of them had zero
or trivial aortic/neo-aortic valve regurgitation while 20 and 7% had
mild or moderate regurgitation, respectively. None of the patients had
evidence of compression of the left pulmonary artery or bronchus.
None of the patients had heart block requiring permanent pacemaker
insertion; 86% of the patients have reached or are suitable candidates
awaiting final palliation stage.
Conclusions:
DKS can be safely performed in conjunction with CPC
without added mortality hazard. It is very effective mitigating the
SVOTO risk with good durable semilunar valve function. Our data
support an aggressive approach of performing concurrent DKS with
CPC in children with SV pathologies at risk of developing SVOTO.
1197: DEVELOPMENT OFTHEVANGUARD DERMONSTRA-
TION SITE FOR RHD AMONG SCHOOL-AGED LEARNERS
IN THEWESTERN CAPE, SOUTH AFRICA
S Nkepu, ME Engel, C Lemmer, L Zühlke
Department of Medicine, Health Sciences Faculty, University of
Cape Town, South Africa
Background
: In South Africa, anecdotal information suggests that
rheumatic heart disease (RHD) is still the leading acquired heart
disease in young adults. Recent data on the prevalence of RHD
in school-aged learners remain scanty, with two earlier studies
suggesting an estimate around seven per 1
000. However this figure
is thought to be an underestimation given that the screening was
performed using auscultation, which is less sensitive than echocar-
diography.
Objective:
We have developed as part of ASAP, an echocardiog-
raphy-based RHD screening programme for learners within the
Vanguard community of the Western Cape. Outcomes include deter-
mining the prevalence of RHD, monitoring the disease progression
in scree-positve participants referred for appropriate follow up, and
evaluating the cost effectiveness of such a programme.
Methods
: We present the issues involved in the establishment of
the demonstration site, the lessons learned, and the ongoing chal-
lenges facing the research team, having screened in excess of 2
500
participants. In brief, we detailed our experience in five areas: engag-
ing the community on all levels; completing a situational analysis
and gathering background data, including sampling frame and the
random-sampling procedure; consent process; on-site data collec-
tion and management; post-screening responsibility and continued
community involvement.
Conclusion
: We concluded that screening for RHD is feasible in the
community setting using schools as the sample frame. We firmly
believe that our experience will serve as a meaningful resource for
other similar research programmes.
1200: EFFECTS OF ADRENERGIC RECEPTOR BLOCKER
TREATMENT ON RIGHT HEART FAILURE
Stine Andersen
1
, Asger Andersen
1
, Jacob Gammelgaard Schultz
1
,
Jan Møller Nielsen
1
, Sarah Holmboe
1
, Steffen Ringgaard
2
, Jens Erik
Nielsen-Kudsk
1
1
Department of Cardiology, Institute of Clinical Medicine, Aarhus
University Hospital, Denmark
2
MR centre, Aarhus University Hospital, Denmark
Background:
The late diagnosis and surgical management of left-to-
right shunt congenital heart disease (L-R shunt CHD)
causes
pulmo-
nary hypertension. To date there is no effective drug to decrease
pulmonary artery systolic pressure. Beraprost, an oral prostacyclin
analogue which works as a pulmonary artery vasodilator, was expect-
ed to decrease PASPS in children with L-R shunt CHD.
Methods:
A pretest–postest study was conducted on 17 subjects
aged two months to 16 years old, with VSD, ASD, PDA or a combi-
nation, who developed pulmonary hypertension. Patients with other
structural cardiac defects or with pulmonary infection were excluded.
Echocardiographic examinations were performed before and after
administration of beraprost 1 µg/kg/day bid for three months. V
max
TR, V
max
L-R, and PASP were measured and M-mode echo of the
pulmonary valve, including a wave, EF slope and mid-systolic
notch, was done. Adverse reactions were noted, and monitoring was
performed every two weeks.
Results:
V
max
TR decreased (0.7
±
0.79 m/s,
p
=
0.004), V
max
L-R
increased (0.6
±
0.64 m/s,
p
=
0.018) and PASP decreased (18.3
±
21.90 mmHg,
p
=
0,003). There was no significant change in wave,
EF slope and mid-systolic notch.
Conclusions:
There was a decrease in pulmonary artery systolic
pressure after administration of beraprost in children with L-R shunt
CHD who develop pulmonary hypertension.
1202: BICYCLE STRESS ECHOCARDIOGRAPHY IN CHIL-
DREN: FEASIBILITY, SAFETY AND DETERMINATION OF
INTER-OBSERVER VARIABILITY
Paolo Ciliberti
1
, McLeod Ian
1
, Cairello Francesca
1
, Giardini
Alessandro
1,2
, Jan Marek
1,2
1
Department of Cardiology, Great Ormond Street Hospital, London,
UK
2
Institute of Cardiovascular Science, University College London, UK
Background:
In the adult population, exercise-stress echocardi-
ography (ESE) is a well-validated technique providing a dynamic
evaluation of myocardial structure and function. In children, its use is
rather limited due mainly to a precipitously rapid drop in peak heart
rate after exercise. The aim of this study was to assess the feasibility,
safety and reproducibility of ESE using on-line scanning in a semi-
supine cyclo-ergometer protocol in a wide spectrum of children.
Methods:
Between July 2008 and April 2012, 42 patients (mean age
14.1
±
2.9) underwent a bicycle ESE. Two independent observers
without knowledge of any patient data interpreted all stress studies,
grading quality of each acquired image and presence of regional wall
motion abnormalities (RWMA).
Results:
ESE was successfully performed and well tolerated by all
patients. Rest HR was 82
±
13.6, peak HR was 153.4
±
19.7 (161.5
±
18.3 excluding heart transplant patients and patients on beta-block-
ers). Among 464 views acquired, the visualisation was optimal in 403
(87%), suboptimal in 32 (7%) and inadequate in 29 (6%). Among 10
patients with hypertrophic cardiomyopathy, we were able to assess
a significant left ventricular outflow tract gradient increase (
>
25
mmHg) during exercise in three patients (33%). ESE was performed
in 29 patients with congenital or acquired coronary abnormality
(Kawasaki disease, heart transplant recipients, congenital coronary
abnormalities, transposition of the great arteries after arterial switch
operation). In this group, RWMA were revealed in eight patients
(28%). The agreement between observers showed a
κ
-index of 0.7276
(95% CI
=
0.6497–0.8055) for the image quality and a
κ
-index of
0.5125 (95% CI
=
0.4782–0.5468) for the RWMA analysis.
Conclusions:
Bicycle-stress echocardiography performed by on-line
scanning during exercise is a feasible, safe and reproducible modality
in children. Further data to assess its diagnostic accuracy are however
needed.
1204: ASSOCIATED PULMONARY ATRESIA IS A SIGNIFI-
CANT RISK FACTOR FOR MORTALITY IN SYMPTOMAT-
IC NEONATES WITH EBSTEIN’S ANOMALY
