CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
233
the operation in 221 patients, to assess for spinal deformity. The
curvature of the spinal deformity was defined by Cobb’s angle.
Comparison of the scoliosis was made between the operative meth-
ods and type of congenital heart disease. Follow up was done up to
five years or longer.
Results:
A total of 45 patients had scoliosis, with curvature greater
than 10 degrees. Most of them (93.3%) were cyanotic heart disease
patients. The patients who received Blalock–Taussig shunts were
relatively high if compared to median sternostomy and lateral thora-
cotomy. There was a clinically significant correlation (
p
<
0.05).
Conclusions:
Blalock–Taussig shunt may be one of the risk factor
for scoliosis in patients with congenital heart disease. The prevalence
of scoliosis increased in patients with cyanotic heart disease and
treated with modified Blalock–Taussig shunt.
1352: ECHOCARDIOGRAPHIC ANALYSIS BY 3D, TISSUE
DOPPLER, AFI, STRAIN, SR OF THE RIGHT AND LEFT
VENTRICULAR DYSFUNCTION IN SURGICALLY
REPAIRED PATIENTS WITH TETRALOGY OF FALLOT
Ana Maria Susana De Dios, Romina Carugati, Fernanda Biancolini,
Julio Cesar Biancolini, Victorio Luccini, Ackerman Judith, Manso
Paula, Martinez Ines, Florencia Levantini, Damsky Barbosa Jesus
Department of Pediatric Cardiology, Pedro de Elizalde Children’s
Hospital, Argentina
Objectives:
Our study focuses on echocardiographic assessment of
the right and left ventricular systolic function in response to volume
overload resulting from pulmonary regurgitation in surgically treated
patients with tetralogy of Fallot.
Methods and results:
We included 63 patients with severe pulmo-
nary regurgitation after surgical correction of tetralogy of Fallot.
Automatic function image (AFI) by two-dimensional speckle track-
ing, left ventricular longitudinal strain and strain rate in right (RV)
and left (LV) ventricle were recorded. X age: 14
±
4 y; surgical
correction was done at X:2.7
±
1 y; follow-up X:11.8
±
6 y, divid-
ing them into 3 groups: 1) RV
<
100 ml/m
2
, 2) RV 100-120 ml/m
2
,
3) RV:
>
120 ml/m
2
The first group showed a decrease in RV medial
tissue – Doppler: velocity systolic (S’) and diastolic (E’) waves and
IVA m/s2, minimal dysfunction in AFI RV, and depressed strain and
SR medial RV. The second group showed basal and medial dysfunc-
tion of RV and basal of LV. The third group: RV
>
120 ml/m
2
tissue
Doppler S’
<
0.05 m/s, and E’ wave and IVA m/s2 included inversion
E/A ratio, IVA m/s
2
, RV and LV decrease. AFI RV and LV show
severe dysfunction, strain and SR RV basal and medial positive and
LV basal and medial the same.
Conclusions:
Echocardiographic analysis offers great possibilities
for assessment of right and left ventricular dysfunction, identify-
ing in particular, as well as timing and selection of patients for
re-intervention.
1353: PERI-OPERATIVE RISK FACTORS FOR IN HOSPI-
TAL DEATH OR RETRANSPLANTATION IN PAEDIATRIC
HEART TRANSPLANT RECIPIENTS
Rachel Vanderlaan, Cedric Manhiot, Jennifer Conway, Brian
McCrindle, Anne Dipchand
Hospital for Sick Children, Toronto, Ontario, Canada
Introduction:
While advances in surgical techniques and immuno-
suppression regimens have contributed substantially to the success
of paediatric heart transplantation (HTx), increased understanding of
peri-operative risk factors associated with death or retransplantation
(ReTx) could potentially improve survival to hospital discharge.
Methods:
Peri-operative risk factors were explored in 226 paediatric
HTx recipients between 1995 and 2010.
Results:
Mortality prior to hospital discharge occurred in 20 patients
(9%), a further five patients (2%) underwent ReTx for early primary
graft failure of whom one died peri-operatively. Death or ReTx
in nine patients (36%) occurred
<
48 hours of HTx secondary to
primary graft failure (
n
=
4), operative complications (
n
=
3) or
multisystem organ failure (
n
=
2), including 4/5 ReTx. Death or ReTx
>
48 hours was secondary to primary graft failure (
n
=
6), infections
(
n
=
4), multisystem organ failure (
n
=
3), rejection (
n
=
2) and post-
operative complications (
n
=
1). In a multivariable regression model,
factors associated with increased hazard of peri-operative death or
ReTx were earlier year of HTx (HR: 1.2,
p
=
0.001), peri-operative
use of factor VIIa (HR: 32.9,
p
=
0.001), postoperative chest re-open-
ing (HR: 11.0,
p
=
0.001), postoperative use of extracorporeal life
support (HR: 7.7,
p
<
0.001), rejection prior to discharge (HR: 6.0,
p
=
0.03), donor negative rhesus factor (HR: 6.2,
p
=
0.001), and higher
donor BMI (HR: 1.033/kg/m
2
,
p
=
0.001). UNOS status 1 (vs status
2) at the time of HTx was associated with increased hazard of death
or ReTx from causes other than primary graft failure (71 vs 27%,
p
=
0.05), implying that patients on life support are at risk of death from
non-cardiac causes despite receiving a HTx.
Conclusions:
Important peri-operative risk factors for early death
or ReTx post paediatric HTx include surrogates of poor graft func-
tion or bleeding, and early rejection. Understanding risk factors that
impact on peri-operative outcomes may help with difficult decisions
around the timing of listing for primary HTx and appropriateness of
relisting for ReTx.
1354: A SMARTPHONE APP TO OPTIMISE INTER-STAGE
HOME MONITORING FOR INFANTS WITH SINGLE
VENTRICLE
Girish Shirali, Dawn Tucker, Richard Stroup, Brent Kevern
Children’s Mercy Hospital, Kansas City, MO, USA
Background
: While the surgical results of the Norwood procedure
have improved dramatically over the past two decades, post-discharge
interstage morbidity and mortality remain a significant problem.
While interstage home monitoring is widely employed to try to mini-
mise adverse interstage events, the need for data entry and interpreta-
tion by the family lead to a system that is imperfect at many levels.
Advances in technology may facilitate improvements in automating
home monitoring. We explored the use of an iPad and wireless tech-
nologies to help build an optimal solution for interstage monitoring.
Methods
: We started with standard devices that are in current usage
for interstage monitoring (pulse oximeter and weight scale). We
constructed an iPad application that uses Bluetooth and other wire-
less technologies to automate the upload of data from these devices
to the iPad. The iPad camera is used to obtain a 10-second video of
the patient. Family members are responsible for entering intake and
output manually. All data is automatically transmitted to the hospital
servers and integrated with the electronic medical record (EMR).
Machine learning algorithms that have been developed within the
EMR help trend measurements and to triage clinical scenarios. The
ability to view videos of the patient in a non-linear manner promises
to yield important and previously unavailable insights as well as be
of educational value for both providers and families.
Results
: The prototype application has been developed and is func-
tional. Its integration with an EMR system (Cerner) has been vali-
dated; validation with other EMR systems is in progress.
Conclusions
: The ability to use a consumer device for automated
interstage home monitoring could be an important advance in the
care of these fragile and high-resource infants. Such technology
could also be used for other high-risk children with congenital or
acquired heart disease.
1357: A POPULATION-BASED STUDY OF PAEDIATRIC
IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION
FROMAUSTRALIA AND NEW ZEALAND
Michelle Rose
1
, Clare O’Donnell
2
, Ingrid King
1
, Suzanna Vidmar
1
,
Robert Justo
3
, Andrew Bullock
6
, Gary Sholler
5
, Malcolm Richardson
8
,
Megan Sherwood
5
, Robert Weintraub
1
1
The Royal Children’s Hospital Melbourne, Australia
2
Starship Hospital, Auckland, New Zealand
