CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
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for the worse and he succumbed to the ensuing illness 5 days after
the trauma, despite stabilisation measures and before any surgical
intervention could be undertaken.
Conclusions:
Traumatic VSD, though rare, should be considered
in cases of acute congestive cardiac failure in otherwise well,
active children with a history of blunt trauma to the chest and all
such patients should undergo careful echocardiographic evaluation.
Prompt surgical intervention has been reported to be life-saving in
similar cases.
1799: COMPLETE REPAIR OF TETRALOGY OF FALLOT IN
LATE DIAGNOSED PATIENTS
Maria Joao Baptista
1,3
, Maria Ana Sampaio
2,3
, Monica Rebelo
2,3
,
Manuel Ferreira
2,3
, Leonidia Airosa
3
, Rui Rodrigues
2
, Miguel Sousa
Uva
2,3
, Albino Pedro
2.3
, Manuel Pedro Magalhaes
2,3
, Antonio Filipe
Junior
3
1
Hospital S João, Porto, Portugal
2
Hospital da Cruz Vermelha, Lisbon, Portugal
3
Clinica Girassol, Luanda, Angola
Aim:
In most centres worldwide, correction of tetralogy of Fallot is
performed before 9 months of age. However, in developing countries,
early repair may be difficult because of many factors, including
facilities for the diagnosis. The purpose of this study was to evaluate
the early results of surgical repair of tetralogy of Fallot in patients
older than a year, in one hospital performing congenital heart surgery
in Angola.
Methods:
A retrospective analysis was performed of early results of
surgical repair in paediatric patients older than 1 year, between June
2011 and June 2012 in one single hospital. Data were gathered from
patients’ records, preoperative cardiac catheterisation or TC studies,
operative intervention and pre- and post-operative two-dimensional
echocardiographic scans. Patients submitted to systemic-to-pulmo-
nary shunt were excluded.
Results:
In our hospital, 55 patients were treated (male-to-female
ratio 1.03:1) with a mean age of 6.4 years (range 13 months to 19
years). Early extubation occurred in the majority of patients (mean 9
hours, range 3–35 hours). Most patients did not present with signifi-
cant post-operative lesions, except for residual interventricular shunt
in 4 cases, mild or moderate pulmonary regurgitation in 6 patients,
and mild obstruction of right ventricle outflow in 14 cases. Pleural
effusion occurred in 5 patients, with good response to medical treat-
ment. No deaths occurred.
Conclusion:
We demonstrated good early results of complete repair
of tetralogy of Fallot in paediatric patients with late diagnosis in
Angola. The late results follow-up must be evaluated, but this prelim-
inary study reinforces the value of the establishment of local assess-
ment to early diagnosis and treatment of congenital heart diseases in
developing countries.
1801: INTERRUPTED AORTIC ARCH: 10 YEARS OF EXPE-
RIENCE IN THE SURGICAL TREATMENT
Jorge Luis Cervantes Salazar, Samuel Ramírez Marroquín, Alfonso
Buendía Hernández, Juan Calderón-Colmenero, Lizbeth Gómez
Martínez
Instituto Nacional de Cardiología, Mexico
Introduction:
The interruption of the aortic arch is a rare malforma-
tion, representing less than 1% of cases of congenital heart disease,
and is associated with 90% mortality if not treated before 1 year of
age; death occurs as a combination of the increase of a short circuit
form the left to right, ventricular failure and closure of the ductus
arteriosus, resulting in hypoperfusion, renal failure and metabolic
acidosis. Initial treatment is to maintain a patent ductus arteriosus
with prostaglandin administration. Surgical correction is the defini-
tive treatment and must be performed to confirm the diagnosis.
Method:
A retrospective, longitudinal, observational, descriptive
study of all patients with interrupted aortic arch was performed who
underwent surgery for correction of this pathology in the NIC, in the
period between January 2000 and December 2010.
Results:
Of 20 patients, 16 (80%) presented with type B interruption,
3 (15%) with interruption type A and 1 patient (5%) with interruption
type C. The average age at which surgery was performed was 2.9
months (range 3 days to 7 months). The surgical technique used was
end-to-end anastomosis. One patient died (5%). At follow-up, the rest
of the patients are asymptomatic and without reintervention.
Conclusions:
Despite late referral of many patients with interrupted
aortic arch, surgical results and developments, assessed by monitor-
ing, are similar to those reported in the world literature.
1803: PERSISTENT LEFT SUPERIOR VENA CAVA DRAIN-
ING INTO LEFT ATRIUM WITH NORMAL CORONARY
SINUS
Zouizra Zahira, El Haouati Rachid, Boukaidi Yassine, Boumzebra
Drissi
Ibn Tofail Hospital, University Hospital Mohammed VI, Marrakech,
Morocco
The most common variation in the thoracic systemic venous system
is a persistent left superior vena cava draining into a coronary sinus.
A rare anomaly is a persistent left superior vena cava connecting
directly to the left atrium. In this situation it is believed that the coro-
nary sinus must be absent.
We report an unusual case of a left superior vena caval drainage
to the left atrium with normal coronary sinus, which was a preopera-
tive finding during surgical closure of an atrial septal defect in an
11-year-old patient. We rerouted left superior vena caval flow into
the right atrium using intra-atrial baffle. The postoperative course
was uneventful.
In this case report, we discuss embryological development, clini-
cal profile and surgical techniques to treat this condition.
1806: NORMAL CARDIOVASCULAR RESPONSES TO
TREADMILL EXERCISE TEST IN HEALTHY BRITISH
CHILDREN
Rhiannon Davies
1,2
, Lindsay Antonio D’Silva
1,2
, Dirk G Wilson
1
,
Amos Wong
1
, Orhan Uzun
1
1
University Hospital of Wales, Department of Paediatric Cardiology,
Cardiff, UK,
2
Swansea University, College of Engineering, Swansea, UK
Background:
Normal cardiovascular responses to exercise in child-
hood are not well defined. Maximum normal blood pressure response
to exercise in childhood is overestimated which makes assessment of
hypertensive response in disease situations rather difficult.
Aim:
To assess normal cardiovascular responses to exercise in
healthy British children.
Method:
A retrospective review was carried out on all children who
underwent exercise testing (Bruce test using a treadmill protocol) at
a tertiary institution between 2003 and 2010. One hundred and thirty-
seven healthy children (80 males, 57 females) aged 9–16 years were
included in the study.
Results:
Minimum exercise duration was 12 minutes across the
spectrum regardless of age and gender. Although lower VO2max
values were attained in females compared to male subjects, there was
little change throughout adolescence years. All subjects achieved
over 85% of maximum predicted heart rate for age. Younger subjects
showed quicker heart rate recovery compared to older individuals.
Maximum blood pressure did not exceed 155 mmHg in any age
group. Rate pressure product was lower in males compared to
females in most age groups but similar in 13–14-year-old group. All
values were summarised in a table.
Conclusions:
Exercise duration in healthy children is minimum 12
minutes. 85% of maximum heart rate response is more achievable in
children than maximum predicted heart rate hence it may be more
preferred in clinical decision making. Maximum blood pressure
