CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
235
normal volunteers served as control subjects.
Results:
To date 23 subjects with GORD have been studied.
ST-segment changes were noted in 12 out of 23 and five showed
ischaemia on MIBI scanning. In the IHD group, 21 out of 35 showed
ST changes, with 33 of the 35 showing changes consistent with
ischaemia on MIBI scanning. Other ECG changes were frequent
during acid installation. Only three subjects showed no changes on
the ECG monitoring.
Conclusion:
Acid reflux produced ischaemic changes on the ECG
recording and may have lowered the threshold for angina and coro-
nary events. We present evidence to suggest that coronary vascular
changes may arise from oesophageal stimulation and may lead to the
development of myocardial ischaemia.
1377: SUCCESSFUL SURGICAL CORRECTION OF TYPE II
TRUNCUS ARTERIOSUS AT THREE YEARS OF AGE
Amitabha Chattopadhyay, Debasree Gangopadhyay, Biswajit
Bandyopadhyay, Hemant Nayak, Navdeep Singh, Prashant Thakur,
Mahua Roy, Rhitajyoti Sengupta, Mrinalendu Das, Debasis Das
Department of Paediatric Cardiology and Paediatric Cardiac Surgery,
India
Background
: Truncus arteriosus is an uncommon congenital cardiac
malformation. The condition presents in early infancy with features
of pulmonary overcirculation as the neonatal pulmonary hyperten-
sion regresses. We report the clinical case of a girl from rural Bengal
whose first presentation to a paediatric cardiac facility took her three
long years after birth.
Methods
: Initial clinical examination and investigations showed
cardiomegaly, with biventricular enlargement and pulmonary pleth-
ora. On echocardiography she was diagnosed to have type II truncus
arteriosus with mild truncal valve regurgitation.Cardiac catheterisa-
tion was done for operability, which showed pre-oxygen pressures of
the aorta and pulmonary artery to be 100/56/75 and 84/49/69 mmHg.
Post oxygen aortic and pulmonary artery pressures were 105/60/80
and 72/40/50 mmHg, respectively, which showed a drop of 20 mmHg
in the mean PA pressures post oxygen, depicting operability.
She underwent corrective surgery with closure of VSD with a flap
technique and reconstruction of the right ventricular outflow tract
with a 16-mm valved conduit. Postoperatively she was managed with
inhaled nitric oxide, sildenafil and bosentan. She required prolonged
ventilation and inotropic support. Her recovery was good and echo-
cardiography on the 27th postoperative day documented good biven-
tricular contractility, estimated pulmonary arterial systolic pressure
of 34 mmHg and mild truncal valve regurgitation.
Conclusion
: Most of the world literature on surgical correction of trun-
cus arteriosus report surgery at a very young age, which is explained by
the early irreversible change of pulmonary vasculature these patients
develop if they remain uncorrected. Our patient along with few other
published reports testify to the fact that meaningful surgical outcome
is still possible in a select subset of patients with this condition who
present late, if they are chosen carefully on clinical grounds.
1378: VASCULAR MECHANICS AT REST AND DURING
EXERCISE AFTER ARTERIAL SWITCH OPERATION FOR
COMPLETE TRANSPOSITION OF THE GREAT ARTERIES
Robin Hay-Son Chen, Wilfred Hing-sang Wong, Yiu-fai Cheung
Department of Paediatrics and Adolescent Medicine, Queen Mary
Hospital, Hong Kong University, Hong Kong
Background:
Progressive neo-aortic root dilatation and regurgita-
tion after arterial switch operation (ASO) for complete transposi-
tion of the great arteries (TGA) are well documented. We tested the
hypothesis that neo-aortic stiffness is increased and is associated with
neo-aortic dilatation in patients after ASO. We further explored the
changes in mechanics of the neo-aorta during exercise stress.
Methods:
Thirty patients (22 males) aged 16.2
±
2.1 years and 22
healthy controls (15 males) were studied. Central and peripheral
arterial pulse-wave velocity (PWV), carotid (c-AI) and radial (r-AI)
augmentation indices and central systolic blood pressure (CsBP)
were assessed by applanation tonometry. Dimensions of the aortic
annulus, sinus, sinotubular junction, ascending aorta, and right
carotid artery dimensions were determined at rest and during exercise
by two-dimensional echocardiography. Aortic strain, distensibility,
aortic and carotid stiffness indices were calculated.
Results
: At rest, patients compared with controls had higher c-AI,
heart–carotid PWV, CsBP, and r-AI (all
p
<
0.05), while brachial–
ankle arterial PWV were similar. During rest and exercise, patients
had significantly lower aortic strain and distensibility, and greater
systolic blood pressure, and aortic and carotid stiffness were signifi-
cantly different (
p
<
0.05). Aortic root dimensions at all levels were
significantly greater in patients compared with controls (all
p
<
0.05).
Patients with aortic dilatation had higher CsBP and aortic stiffness at
rest, and lower aortic strain and distensibility at rest and at submaxi-
mal exercise (all
p
<
0.05). Linear regression models identified rest-
ing aortic distensibility (
β =
–0.57,
p
=
0.005) and age at operation (
β
=
0.40,
p
=
0.005) as significant determinants of aortic sinus
z-
score.
Significant aortic regurgitation was identified in 18.8% (6/32) of
patients, in whom significantly higher
z
-scores for the aortic annulus
and sino-tubular junction were found (both
p
<
0.05).
Conclusions:
In adolescents late after ASO for TGA, aortic root
dilatation and regurgitation were prevalent and were associated with
stiffening of the central arteries at rest and during exercise.
1379: PRESENTATION AND TREATMENT OUTCOME OF
TAPVC IN AN OLDER POPULATION: A SINGLE-CENTRE
EXPERIENCE FROM INDIA
Amitabha Chattopadhyay, Debasree Gangopadhyay, Biswajit
Bandyopadhyay, Hemant Nayak, Navdeep Singh, Prashant thakur,
Mahua Roy, Rhitajyoti Sengupta, Mrinalendu Das, Debasis Das
Department of Paediatric Cardiology and Paediatric Cardiac Surgery,
India
Background:
TAPVC is a rare congenital heart disease that is diag-
nosed in the neonatal period or in infancy. This study investigated the
spectrum of presentation and treatment outcome of an Indian cohort
who presented after five years of age with TAPVC.
Methods
: Isolated TAPVC cases were identified from our institu-
tional database between 2003 and 2012. We reviewed the medical
records of 12 patients who belonged to the age group specified, and
analysed the data.
Results:
A total of 98 patients were diagnosed with TAPVC. Of these,
12 patients (12.24%) presented after five years. Median presenting
age was 13.25 years (range 5–30 years) with eight males (66.66%)
and four females (33.33%). Unobstructed supracardiac TAPVC was
the most common diagnosis, and shortness of breath on exertion the
most common presenting complaint.
All patients were investigated
with ECG, chest X-ray, and echocardiography pre- and postopera-
tively. All were in sinus rhythm pre- and postoperatively except one
who had transient atrial fibrillation in the immediate postoperative
period. TAPVC with moderate pulmonary arterial hypertension was
the most common echocardiographic diagnosis pre-operatively. All
the patients underwent rerouting of the pulmonary veins and closure
of the ASD with the flap technique. One patient died 40 days after
the operation from sepsis and multi-organ failure. Mean duration
of ventilation was 20 hours. Median duration of hospital stay after
surgery was 10.5 days.
The postoperative period was uneventful for
all except one who required longer duration of inotropic support and
ITU stay. Only one patient required oral sildenafil for PAH postop-
eratively. The median duration of follow up was 25.5 months (range
1–83 months). Three patients were lost to follow up. All patients were
asymptomatic during follow up and were in sinus rhythm.
Conclusion:
Patients diagnosed late with TAPVC were those who are
naturally selected for better survival. Operative outcome was good
with complete reversal of PAH in the majority of patients.
