Cardiovascular Journal of Africa: Vol 24 No 1 (February 2013) - page 234

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013 232 AFRICA
Background: Acute rheumatic fever (ARF) and chronic rheu-
matic heart disease (CRHD) remain one of the leading causes of
acquired heart disease in children, especially in developing countries.
Malaysia, being a developing country, should share the same disease
burden. A literature search revealed several articles on rheumatic
heart disease from Malaysia. Two retrospective reviews in a single
centre reported 42 patients over four years and 313 patients over 30
years.
Methods: We conducted a retrospective review of the records of all
patients with a diagnosis of ARF or CRHD in our hospital from July
2011 to July 2012.
Results: There was a total of 20 patients. The male-to-female ratio
was 1.5:1. The racial breakdown was 18 Malay, one Chinese and one
Indian. A total of 12 patients had ARF, one patient had Sydenham
chorea with mild mitral regurgitation on echocardiographic exami-
nation, and seven patients had CRHD. Of the 12 patients with ARF,
two were under five years old, seven were five to nine years and
three were over 10 years old. The patient with Sydenham chorea was
a Malay boy of 9.5 years. Of the 12 patients with ARF, six had their
first attack of ARF with carditis, five had acute-on-chronic rheumatic
heart disease, and one patient had ARF with no carditis. Of the 11
patients who presented with acute rheumatic carditis, seven (63.3%)
were in NYHA functional class I or II, one (9.1%) in class III and
three (27.3%) in class IV. One patient required intubation and ventila-
tion. All 11 patients had mitral valve involvement, five with severe
mitral regurgitation. Eight patients also had aortic valve involvement,
two with severe aortic regurgitation on echocardiographic examina-
tion.
Conclusions: Rheumatic heart disease is not uncommon in Malaysia.
A quarter of patients with acute rheumatic carditis presented with
severe congestive cardiac failure.
1342: POOR EFFICACY OF DRUG THERAPY FOR PDA
CLOSURE IN INDIAN PRETERM BABIES
Sanju Yadav1, Dinesh Yadav1, Sheetal Agarwal1 , Ajay Dudeja2,
Mukesh Beniwal1, NK Dubey1, Arti Maria1 , Pankaj Gupta1
1Division of Paediatric Cardiology and Division of Neonatology,
Kalawati Saran Children’s Hospital, New Delhi, India
2Department of Paediatrics and Neonatology, Kalawati Saran Children
Hospital, New Delhi, India
Background: Ibuprofen is being used as an alternative to indometha-
cin in the medical management of PDA. Due to a paucity of data on
the efficacy of these drugs for PDA closure in India, a study was
designed to assess and compare their efficacy for PDA closure in
preterm Indian neonates.
Methods: A prospective, randomised, controlled study on clinically
diagnosed and echocardiographically confirmed haemodynamically
significant PDA in preterm neonates was designed. Patients were
randomly assigned to receive either oral ibuprofen at a dosage of
10, 5, 5 mg/kg every 24 hours or three doses of oral indomethacin
(0.20–0.25 mg per kg 24 hourly) starting on the third day of life or
when diagnosed. A second course of ibuprofen/indomethacin was
given if the PDA failed to close within 48 hours of the first course.
Surgical ligation was considered if the PDA did not close after two
courses of treatment. Patients were monitored for complications such
as oliguria, bleeding, NEC, IVH, oxygen dependency and gastroin-
testinal side effects.
Results: The baseline characteristics were comparable in both
groups. Of the 83 children with PDA, 57.8% received oral ibuprofen
and 42.1% received oral indomethacin. The overall closure rate of
PDA was 60 and 65.7% in the ibuprofen and indomethacin groups,
respectively, however in babies with postnatal age three to five days,
the closure rate was 69.2 and 100%, respectively. Complications were
similar in both the groups.
Conclusion: The efficacy of both drugs was similar. However, the
overall closure as well as the closure in the subset of patients with
postnatal age three to five days in the ibuprofen group was much
lower than reported in the international literature. Cytochrome P450
enzyme causes increased plasma clearance of the drug, which is
negligible at birth and increases with postnatal age. Poor closure in
our study could have been because of genetic differences in the in
the Indian population affecting the pharmacokinetics of the drugs.
1343: LONG-TERM FOLLOW UP (40 YEARS) OF PATIENTS
POST NEONATAL INTERVENTION FOR CONGENITAL
CRITICAL AORTIC STENOSIS AT A SINGLE CENTRE
Michelle Carr1, Xavier Iriat1, Paolo Ciliberti1, Ian Sullivan1, Graham
Derrick1, Martin Kostolny1, Victor Tsang1,2, Catherine Bull1,2, Jan
Marek1,2
1Department of Cardiology, Great Ormond Street Hospital, London,
UK
2Institute of Cardiovascular Science, University College London, UK
Background: Survival with congenital critical aortic valve stenosis
(CAS) can be successfully achieved by surgical or catheter interven-
tions. Long-term outcome and follow up remains uncertain.
Methods and Results: A 40-year (1970–2010) review was carried
out of 96 patients requiring intervention for neonatal (< 30 days)
CAS. Surgery (SX) was undertaken in 61 patients and balloon dila-
tion (BD) in 35 patients. Before 2000, SX was more common (56/63
cases), while BD was favoured after 2000 (28/33 cases). Follow-up
data were available for 88 patients. There were 29 (32.9%) reported
deaths, early death (< 90 days) accounted for 22 (25%) patients.
Early death accounted for four of the five deaths since 2000. Twenty
(22.7%) patients died without any further intervention, one patient
had a heart transplant and another had a single-ventricle palliation.
Discussion: Overall free survival rate at five, 10 and 20 years was
73, 73 and 61%, respectively. Of the 57 remaining survivors, 52
(87%) had at least one re-intervention, with further re-interventions
required in 21 (36.8%) patients. There were 33 aortic valve replace-
ments (AVR) in 32 patients, 31 (35.2%) patients had a Ross or Ross-
Konno procedure. Freedom from AVR at five, 10 and 20 years was
78, 63, and 44%, respectively. The median time interval between
initial procedure and AVR for the BD group was 1.32 years (mean
3.9 ± 4.7, range 1 day – 14.4 years). This was shorter than for the SX
patient group: 8.9 years (mean 7.24 ± 5.1, range 1 day – 16.5 years).
For patients presenting for the initial procedure since 2000, AVR was
undertaken in 14/34, with a median time to AVR of 1.3 years.
Conclusions: This study highlights the acute and long-term mortal-
ity associated with neonatal CAS. Catheter-based intervention has
become more common but is still associated with early mortality.
Re-intervention is highly likely in survivors, over 50% of survivors
requiring surgical AVR, and a trend towards earlier surgical AVR at
our institution in recent years.
1344: ASSOCIATION OF MODIFIED BLALOCK–TAUSSIG
SHUNT AND SCOLIOSIS IN CHILDREN WITH CONGENI-
TAL HEART DISEASE
Jing-Ming Wu1, Min-Ling Hsieh 1, Jieh-Neng Wang1, Hok-Keong
Chang2, Wen-Lan Yen3 , Yu-Jen Yang1 , I-Ming Jou1
1National Cheng Kung University Hospital, Taiwan
2Specilaist Hospital, Johor, Malaysia
3Cheng Ching Hospital, Taichung, Taiwan
Background: Previous literature reviews have shown congenital
heart disease highly related to scoliosis. The operative methods such
as median sternostomy and lateral thoracotomy were predisposed
to the development of scoliosis. Nowadays, long-term follow up
for these patients is possible with the improved survival rate of
congenital heart disease patients. The role of Blalock–Taussig shunt
in scoliosis has not yet been reported as a risk factor in these patients.
Methods: A retrospective review of spinal deformity in congenital
heart disease patients who received Blalock–Taussig shunt, open-
heart surgery or lateral thoracotomy was performed in the National
Cheng Kung University Hospital from December 1989 to December
2005. Serial chest roentgenograms were taken before and after