CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
247
Methods:
Multi-centre study using STE, TDI and CE to examine
66 thalassaemia patients (incl. 14 children) and 132 age-, gender-,
height- and weight-matched controls. STE will provide strain
and strain rate for each of the 16 heart segments. All data will be
compared across iron overload stratifications and between patients
and healthy controls. STE performed before and after the blood trans-
fusion (usually 4 units of packed red blood cells) in all patients will
help to quantify the effect of the increase of cardiac pre-load on STE.
Data acquisition
is performed on Philips IE33 machines and is
currently under way. Each echocardiography study is de-identified
and will be assessed by 3 different experienced cardiologists utilising
the latest release of the Philips QLab Software (version 9) to test for
inter-observer variability. The examiners will save their results in an
electronic worksheet (Ms Excel), which will be analysed automati-
cally. A custom-made software package will extract relevant data (i.e.
global and regional, longitudinal and radial, end-systolic strain and
peak systolic strain rate) and prepare for statistical analysis (SPSS).
All measurements will be correlated with T2* magnetic resonance
imaging (MRI) data for all adult patients. T2* MRI measures
myocardial iron-load.
Results/conclusions:
Available in January/February 2013.
1507: RHEUMATIC MITRAL VALVE DISEASE IN CHIL-
DREN: A BIG PROBLEM IN A DEVELOPING COUNTRY
Euclides Tenorio, Cleusa Lapa, Cristina Ventura, Fernando Moraes,
Carlos Moraes
The Medical Institution Prof. Fernando Figueira, Recife, Pernambuco,
Brazil
Rheumatic valvular heart disease remains a serious problem of public
health in developing countries, being a common cause of morbity and
mortality and responsible for half of the cardiovascular internments
among children in Brazil.
Objective:
This study was to assess the long-term results of mitral
valve repair in children with chronic rheumatic heat disease.
Method:
From January 2002 through July 2012, 163 patients under-
went mitral valve surgery at our institution;70 (42.94%) underwent
mitral valve reconstruction, 62 (38.05%) submitted to mitral valve
replacement with a bioprosthesis, and 31 (19.21%) underwent a
second replacement. The age varied from 3 to 16 years (mean age
at surgery was 11.5
±
3.5 years. Ninety-two (56.44%) children were
female; 88 children (54%) were in the New York Heart Association
functional Class III and 49 (30%) in Class IV. Reparative procedure
included posterior leaflet extension with a pericardial patch in 46
(65.7%), and 24 patients (34.3%) received a Carpentier ring.
Results:
In the groups of valve repair there was one early death
caused by a metabolic disturbance and two children needed reopera-
tion. One had a rupture of the plasty at 24 hours after surgery and
another presented with severe haemolysis in the postoperative period;
both were given mitral valve replacement. The period of follow-up
extended from 6 months to 10 years. In the group of valve replace-
ment the durability of the bioprosthesis was 16–60 months (mean 33
months).
Conclusion:
Mitral valve repair in children with rheumatic heart
disease is feasible and provides acceptable long-term results. In
spite of the short bioprosthesis durability, in our poor population the
socio-economic level must be considered in the choice of the valve
substitute.
1511: ESTABLISHING RHEUMATIC HEART DISEASE
CONTROL PROGRAMME IN SUDAN: ACHIEVEMENTS
AND CHALLENGES
Sulafa Ali
1,2
, Abdelmoniem Elseed
2
1
Sudan Heart Institute and University of Khartoum, Faculty of
Medicine, Department of Pediatrics and Child Health, Sudan
2
University of Khartoum, Faculty of Medicine, Department of
Pediatrics and Child Health, Sudan
Introduction:
Rheumatic heart disease (RHD) continues to have a
significant burden on the health of young people in Sudan with a
prevalence of 10 per 1 000. Control programmes were initiated by
the World Health Organization based on awareness and secondary
prevention in 1990.
Materials and methods:
The authors, inspired by the experience
of the Pan African Society of Cardiology (PASCAR) and the RHD
Group of the World Heart Federation, last meeting in Dubai May
2012, initiated a RHD control programme initiative based on the
Awareness, Surveillance, Advocacy and Prevention (ASAP) initiative
of the PASCAR.
Results:
Primary prevention protocol is based on research done
locally that validated a clinical algorithm for diagnosis of bacte-
rial pharyngitis. The programme included protocols for primary and
secondary care physicians as well as health assistants, conducting
workshops for their training. We initiated awareness programmes for
physicians, medical students, school staff and the public, and initiated
a local registry with more emphasis on the primary prevention aspect.
The project was approved after long discussions with Ministry of
Health and the scientific societies (Sudan Heart Society and the
Sudanese Association of Pediatricians). It is included in the School
and Adolescent Health Program.
Conclusion:
The paper throws light on the achievements and diffi-
culties of this project.
1513: UNDERDIAGNOSED CARDIOMYOPATHIES IN THE
PAEDIATRIC AGE
Sulafa KM Ali
1,2
1
Sudan Heart Institute, Sudan
2
University of Khartoum, Faculty of Medicine, Department of
Pediatrics and Child Health, Sudan
Introduction:
The commonest type of paediatric cardiomyopathy
(CMP) is the dilated type (DCMP) which constitutes 70–80% of
cases.
Materials and methods:
In this report we reviewed 2 series of
patients with other types of CMP which are not commonly reported
but we believe that they are underdiagnosed.
Results:
The first is known as tropical restrictive CMP or endo-
myocardial fibrosis (EMF). We found that EMF represented 18%
of cases of CMP seen at a tertiary centre. We reviewed the clinical
and echocardiographic features of patients with EMF and discussed
differentiation of this entity from diseases that can mimic it. The
second type of CMP is non-compaction CMP (NCCMP) which has
recently gained a lot of attention and is thought to be underdiagnosed.
We describe a series of 52 patients in Arab/African patients and it
was found that NCCMP represented at least 20% of cases of CMP.
Within this disease we reported unique clinical and echocardiograph-
ic associations. Female preponderance, a relapsing course and mitral
valve regurgitation were distinctive features of NCCMP in our area.
Conclusion:
We need to increase the awareness of physicians about
these types of CMP so that appropriate treatment and counselling
can be instituted.
1520: CLINICAL AND ECHOCARDIOGRAPHIC FEATURES
OF CHILDREN WITH RHEUMATIC HEART DISEASE AND
THEIR SERUM CYTOKINE PROFILE
Sulafa KM Ali
1,2
, Inaam Nooreldaim Eldaim
1
, Samia Osman
3
, Sahar
Bakhite
2
1
Sudan Heart Institute, Sudan
2
University of Khartoum, Sudan
3
Jafar Ibn Ouf Hospital, Minstry of Health, Sudan
Introduction:
Acute rheumatic fever (ARF) and rheumatic heart
disease (RHD) constitute important public health problems in devel-
oping countries.
Materials and methods:
Children with ARF and RHD seen at
Children’s Hospital, Sudan from May 2008 to 2009 were examined
