AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 10 Repairing the valve (Horizontal Plication), removal of residual or extra portions of the mitral valve should be done. Surgical septal myectomy is the therapeutic gold standard for the treatment of drug-refractory disabling symptoms in HOCM caused by LVOT obstruction. Alcohol septal ablation for HOCM has been proposed as a less-invasive alternative to surgical myectomy, although its role in the management of HOCM associated with SAM requires further investigations. Submission ID: 7 SUBAORTIC STENOSIS: A GRATIFYING SURGICAL TREATMENT FOR A RARE AILMENT DR.PREMANAND PONOTH THE KAREN HOSPITAL, NAIROBI Background This is a rare heart disease with an unclear etiology and variable clinical presentation. which result in left ventricular outflow tract obstruction. The etiology of the stenosis ranges from a discrete subaortic membrane to tunnel type narrowing of the entire left ventricular outflow tract which results in left ventricular outflow obstruction. Reports of a familial incidence, suggest a genetic predisposition. Discrete subaortic stenosis (DSS) is the most basic form. SAS usually develops during the first decade of life and might appear as an isolated lesion or in association. Methods Between 2022 and 2023 we had two cases of subaortic stenosis of varying pathology. The pediatric patient of 4 years had dicreate sub aortic membrane causing palpitation, which was diagnosed on cardiac evaluation. The child had mild MR, normal LV. The adult patient aged 28 years has subaortic ridge causing chest discomfort with DOE, NYHA class III. The peak gradient across the aortic valve was 90mm of Hg, the echo evaluation was otherwise normal. Both the patient had resection of the subaortic pathology on cardiopulmonary bypass and had uneventful recovery. Results Both patients are on regular follow up. The adult patient the mean gradient was 4 mm of Hg and peak of 12 mm of Hg. The pediatric patient is on follow-up with the concerned paed cardiologist. Conclusion Sub Aortic Stenosis with subaortic membrane, should be differentiated from aortic stenosis of other etiology. Resection of SAM carries long-term benefits. Routine septal myectomy appears to be associated with a low risk of recurrence. The timing of intervention is debatable. Many centres supported waiting until the gradient reaches a peak echocardiographic measurement of 25–30 mmHg, or AI or LVH develops. Myectomy may serve to disrupt this circumferential ring of genetically predisposed cells. Recurrence still remains a problem, especially in the presence of a predisposing associated congenital heart defect. Freedom from re-operation is about 85% at 15 years, regular echocardiographic follow-up is adviced. Submission ID: 8 PREVALENCE AND FACTORS ASSOCIATED WITH UNDERNUTRITION AMONG CHILDREN WITH CONGENITAL HEART DISEASE AT THREE TERTIARY HOSPITALS IN NAIROBI, KENYA SHAMSA YAHYA1, DEL-ROSSI S. QUADROS1, NAOMI GACHARA1 1DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH, AGA KHAN UNIVERSITY HOSPITAL, NAIROBI, KENYA Background Children with Congenital heart disease (CHD) have a high burden of undernutrition. Factors associated with undernutrition include type and complexity of heart defect, late diagnosis, timing of surgical correction, lack of adequate nutritional support as well as other associated clinical comorbidities. Methods A cross-sectional study conducted between July 2021 and March 2022 at three tertiary care hospitals in Nairobi, Kenya; The Aga Khan University Hospital, Nairobi, Kenyatta National Hospital and Mater Hospital. Objective was to establish the prevalence and factors associated with undernutrition among children with CHD. Undernutrition included any child who had at least one indicator of stunting, wasting, underweight or thinness using relevant WHO standard Z-scores. Univariate and multivariate logistic regression analysis was done to assess for associated factors. Results Of the 242 children recruited, 116 were undernourished, a prevalence of 47.9% (95% CI: 41.5%-54.4%) with 35.5% (n=86) being underweight, 25.6% (n=62) were wasted, 17.4% (n=42) were stunted and 8.3% (n=20) had thinness. In the multivariate analysis, children who were undernourished were 2.8 times more likely to receive nutritional support than those who were well nourished (p=0.001,OR: 2.88; 95% CI:1.57-5.34). The type of CHD was not significantly associated with undernutrition (p=0.847, OR:0.94; 95% CI: 0.48-1.84), however, children with comorbidities were 3.2 times more likely to be undernourished (p<0.001, OR: 3.26; 95% CI:1.61-6.84). Other factors that were not statistically significantly associated with undernutrition were sociodemographic factors, presence of pulmonary hypertension, surgical correction of defect, age at diagnosis. Conclusion and recommendations The prevalence of undernutrition among children with CHD is high, therefore, the need for nutritional rehabilitation as part of the multidisciplinary care given to these children. Submission ID: 9 LATE DIAGNOSIS OF CHD AND ITS ASSOCIATED FACTORS IN KENYA: AN ANALYTIC CROSS-SECTIONAL STUDY MERCY NG’ENO1, DEL-ROSSI S. QUADROS1 , NAOMI GACHARA1, ISAAC KIHURANI1 AND GERALD YONGA2 1DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH, AGA KHAN UNIVERSITY HOSPITAL, NAIROBI, KENYA AND 2NON- COMMUNICABLE DISEASE RESEARCH TO POLICY UNIT, AGA KHAN UNIVERSITY, NAIROBI, KENYA Introduction Burden of congenital heart disease (CHD) in Africa is generally underestimated mainly due to significant under-reporting and earlyrelated fetal and neonatal mortality. Methods A cross-sectional study on paediatric patients with CHD, aged 0–18 years, seen over a 5-year period, between January, 2011 and December, 2016. The objective was to determine the prevalence and factors associated with late diagnosis of CHD seen at three tertiary care hospitals in Kenya (Aga Khan University Hospital Nairobi, Mater Hospital, and Kenyatta National Hospital). Patients were stratified into those diagnosed late (>1 year of age) and those diagnosed early (<1 year of age). Multiple logistic regression analysis was done to determine factors associated with late diagnosis. Results The study enrolled 411 patients, with equal gender distribution. Prevalence of late diagnosis (>1 year of age) of CHDwas 60.6% (95% CI 55.7–65.3). Median age at diagnosis was 15 (IQR 5–48) months.
RkJQdWJsaXNoZXIy NDIzNzc=