CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
227
1273: ASSESSMENT OF SYSTEMIC ENDOTHELIAL FUNC-
TION IN CHILDREN AND ADOLESCENTS WITH PULMO-
NARY ARTERIAL HYPERTENSION
Christian Apitz, Anna Werz, Ines Kock, Heiner Latus, Jochen
Kreuder, Dietmar Schranz
University Childrens Hospital, Giessen, Germany
Background:
Pulmonary endothelial function is known to be
affected in patients with pulmonary arterial hypertension (PAH).
We hypothesised that PAH is a progressive panvasculopathy, affect-
ing both pulmonary and systemic vascular beds, and that systemic
endothelial dysfunction correlates with pulmonary vascular changes.
Methods:
Systemic endothelial function was assessed by the vascu-
lar response to reactive hyperaemia and was recorded non-invasively
by peripheral arterial tonometry (EndoPAT) under standardised
conditions. Digital reactive hyperaemic index (RHI) was examined in
25 children and adolescents (mean age 21.1
±
10.1 years; 14 females)
with pulmonary arterial hypertension (IPAH,
n
=
13; PAH-CHD,
n
=
12; eight of them with Eisenmenger syndrome). Measurements were
compared with functional data assessed by echocardiography and
cardiac catheterisation.
Results:
Mean tricuspid annular plane systolic excursion (TAPSE)
was 20.9
±
4.6 mm. Mean pulmonary artery pressure (MPAP) of all
patients was 68
±
27.4 mmHg, and ratio of pulmonary vascular resist-
ance to systemic vascular resistance 1.0
±
0.6. Vasodilator response
to acetylcholine (mean pulmonary flow ratio) was 2.1
±
2.2. Mean
RHI was lower in IPAH (1.6
±
0.6) and Eisenmenger patients (1.5
±
0.4) compared to PAH-CHD without Eisenmenger patients (2.1
±
0.7) (
p
=
0.04). RHI correlated with TAPSE (
p
=
0.001). There was
no correlation between RHI and pulmonary endothelial function
assessed by vasodilator response to acetylcholine.
Conclusions:
Systemic endothelial function may be impaired in
children and adolescents with IPAH and Eisenmenger syndrome
and correlates with RV systolic function. However, according to our
data there was no relation between systemic vascular changes and
pulmonary endothelial function, therefore, different mechanisms
may contribute to their pathogenesis and progression.
1279: CONTRIBUTION OF ATRIOVENTRICULAR PLANE
DISPLACEMENT TO LEFT AND RIGHT VENTRICULAR
STROKEVOLUME INHEALTHY SUBJECTSAND PATIENTS
WITH PULMONARY REGURGITATION
Sigurdur Sverrir Stephensen
1,2
, Katarina Steding-Ehrenborg
1
, Hakan
Arheden
1
, Einar Heiberg
1
, Marcus Carlsson
1
1
Department of Clinical Physiology, Skane University Hospital, Lund
University, Lund, Sweden
2
Department of Paediatric Cardiology, Skane University Hospital,
Lund University, Lund, Sweden
Background:
Atrio-ventricular plane displacement (AVPD) contrib-
utes to 60% of left ventricular (LV) stroke volume (SV) and 80% of
right ventricular (RV) SV in healthy subjects. However, there are no
data in patients with RV volume overload. The aim was to quantify
the physiological effect of RV volume overload on the contribution
of AVPD to ventricular pumping.
Methods:
MRI was performed in 29 healthy subjects and 22 patients
with moderate-to-severe pulmonary regurgitation (PR) due to surgi-
cally corrected tetralogy of Fallot or pulmonary stenosis (mean age
23.5
±
13.1 years). LVSV and RVSV were calculated by delineation
of the endocardium of both ventricles in diastole and systole. The
longitudinal contribution to the SV was calculated for both ventricles
using a previously described method, using AVPD and the epicardial
area of the basal part of the ventricle.
Results:
In the patient group, regurgitant fraction was 44
±
10%
and RV end-diastolic volumes (EDV) were increased (278
±
84 ml)
compared to LVEDV (154
±
56 ml,
p
<
0.0001). The contribution of
the AVPD to the LVSV did not differ between healthy subjects (59
±
2%) and patients with PR (56
±
13%,
p
=
0.244). However, the contri-
bution of AVPD to the RVSV was significantly lower in patients with
PR (46
±
8%) compared to healthy subjects (78
±
2%,
p
<
0.0001).
Conclusion:
Patients with PR had normal longitudinal contribution
to LVSV, but decreased longitudinal contribution to RV pumping
compared to healthy subjects. This was caused by decreased AVPD
in volume overloaded RVs, which only in part was compensated for
by an increased RV area. Instead, increased septal movement towards
the RV and radial contraction of the free wall contributed to the major
part of the RVSV in patients with volume overload due to PR.
1280: CARDIAC PACING IN PATIENTS WITH ‘YE OLD’
FONTAN-KREUTZER ATRIOPULMONARY CONNECTION
Ricardo Gomez
1
, Tomasa Centella
1
, Maria Jesus Lamas
1
, David
Cabestrero
1
, Ana Coca
2
, Elena Alvarez
2
, Elvira G Lestache
3
,
Inmaculada Sanchez
3
1
Congenital Heart Surgery Unit, Ram
ó
n y Cajal University Hospital,
Spain
2
Paediatric Intensive Care Unit, Ram
ó
n y Cajal University Hospital,
Spain
3
Paediatric Cardiology Unit, Ram
ó
n y Cajal University Hospital,
Spain
Background:
Atrial arrhythmias are frequent and represent an
important complication in the long-term follow up of patients with
atrio-pulmonary connection. The loss of A-V synchrony is clearly
associated with a worsening of the functional status and failure of the
univentricular circulation.
Methods:
From 1975 to December 2011, 75 patients with atrio-
pulmonary connection were followed up at our Institution; 48
patients (64%) developed arrhythmias. Eleven patients (range 5–41
years) needed a pacemaker because of sinus node disfunction (five
patients), A-V block (three) and atrial tachyarrhythmias (three).
Results:
A DDDR pacemaker was implanted in five patients, VVIR
pacemakers in four and an AAI pacemaker was implanted in two
patients. Seven devices were endovenously placed and four were
epicardial. The measured mean parameters at implantation in the
atrium and the ventricle, respectively, were: threshold 1.18 and 0.925
mV at 0.5 ms; P wave 1.64 and R wave 11.18; impedance 615 and
725 Ohms. For ventricular stimulation, four intravenous leads were
placed in the coronary sinus, three bipolar contact epicardial leads
and two unipolar contact epicardial leads. Regarding the atrial leads,
five were endocavitary active fixation leads and two bipolar contact
epicardial leads. Mean follow up was 7.7 years (9 months to 23.7
years). There has been one late death in a conversion procedure to
TCPC. Functional status has improved in all the remaining cases.
Conclusions:
The use of the appropriate devices to control frequent
atrial arrhythmias in these patients improved the functional class,
thus delaying the need for a conversion procedure or heart transplant.
It is mandatory to use adequate techniques to achieve the goal of
maintaining A-V synchrony in these patients.
1284: MITRAL VALVE REPAIR IN CHILDRENWITH RHEU-
MATIC HEART DISEASE
Yogesh Sathe, Prabhu, Muthukumarvel, Prashant Shah
Paediatric Cardiac Surgery, India
Introduction
: Rheumatic heart disease (RHD) is common in rural
India. The mitral valve is the most common valve involved in RHD.
Children with rheumatic mitral valve disease present with either
mitral regurgitation or stenosis. Mitral valve repair and its results
have been studied at our centre.
Methods
: This was a retrograde single-centre study from March 2009
to June 2012. The total number of patients was 90, with 41 male and
49 female, ranging in age from from five to 18 years. Mean age was
10.6 years; 79 patients had mitral regurgitation while 11 had mitral
stenosis; 76 patients underwent mitral valve repair while 14 required
mitral replacement. Mitral repair: 11 patient had chordal shortening,
17 had neochordal formation, and 25 required thining of the leaflet.
Suture annuloplasty was done in 32 patients while 35 had ring annu-
