CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 19 AFRICA Kshs. 11,470.94, with the mean length of hospital stay (LOS) of 10.1 (7.1). RHD incurred the highest costs, Kshs. 15,299.08 (13,196.89), then IHD, Kshs. 12,966.47 (6656.49), and DCM, Kshs.12,268.08 (7,816.12). Cost of medications was the leading driver, β = 0.56 (0.55 – 0.56), followed by inpatient fees (admission and daily bed charges), β = 0.27 (0.27 – 0.28) and laboratory investigations, β = 0.19 (0.18 – 0.19). Conclusion Cor pulmonale, CM, RHD and HHD were the major causes of HF. The overall direct medical cost of hospitalization was extremely expensive compared with the average monthly household income in Kenya. Widespread insurance cover is therefore recommended to cushion families against such catastrophic health expenditures beside public health measures aimed at addressing primary causes of HF. Submission ID: 27 SUB-AORTIC VULVULAR STENOSIS MIMICKING HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HOCM) MUGO PN, NGUNGA LM, MOHAMED J AGAKHAN UNIVERSITY HOSPITAL, NAIROBI Background 17 years’ old female presented with a 3 years’ history of progressively worsening dyspnea, currently in NYHA 3. She had no history of recurrent throat infections, joint pains, tremors or skin changes. She had no family history of cardiomyopathy. She was on metoprolol 25mg od and digoxin 0.125mg OD. On examination she was stable with normal vital signs. She was not pale and had no pedal edema. Cardiovascular system examination revealed pulses parvus et tardus, normal JVP, Grade 5/6 mid-systolic ejection murmur loudest at the second right intercostal space radiating to both carotids. The murmur remained unchanged with valsalva. Chest was clear on auscultation and the abdomen was not distended and there was no hepatomegaly. Methods An ECG revealed normal sinus rhythm with a rate of 90 beat/min, left atrial enlargement and left ventricular hypertrophy. (Figure 1) Transthoracic Echocardiogram revealed a sub-aortic membrane 1cm below the aortic valve just above the LVOT. There was severe concentric left ventricular hypertrophy more marked at the septum with a septal thickness of 1.8cm (Figure 2). There was mild systolic anterior motion of the mitral valve with flow acceleration across the LVOT. Although the aortic valve was tri-leaflet and structurally normal, the Doppler pattern appeared similar to that seen in aortic stenosis (maximum pressure gradient of 156mmHg and mean pressure gradient of 86 mmHg) but the characteristic late peaking associated with dynamic obstruction was absent. (Figure 3) There was mild aortic regurgitation and mild mitral regurgitation with a markedly enlarged left atrium. The LV systolic function and RVSP were normal. A Cardiac CT Scan confirmed the presence of a sub-aortic membrane measuring 9mm below the aortic valve and concentric LVH with maximal thickness of 17 mm at the septum resulting in LVOT obstruction. There was no concomitant coronary artery disease and no other cardiac congenital abnormalities. The patient was presented in a multidiplinary heart team meeting which recommended cardiac MRI to further evaluate the hypertrophy followed by surgical resection of the membrane and septal myectomy. Conclusion This case reminds the clinicians to carefully evaluate for alternative causes of LVOT obstruction especially sub-aortic membrane as a cause of symptoms mimicking HOCM. Figure 3 – Continuous Doppler Tracing across the aortic valve showing elevated mean and maximum pressure gradients with no late peaking characteristic of dynamic obstruction Figure 1 – ECG showing normal sinus rhythm, rate of 90 beat/min, left atrial enlargement and left ventricular hypertrophy. Figure 2 – Parasternal Long Axis view showing a sub-aortic membrane 1cm below the aortic valve severe concentric left ventricular hypertrophy more marked at the septum Submission ID: 28 TRANSCATHETER CLOSURE OF UNLIGATED VERTICAL VEIN IN POST OPERATIVE TAPVC REPAIR CAUSING PHYSIOLOGICAL LEFT TO RIGHT SHUNT RAJESH KUMAR Purpose Device closure of unligated vertical vein in post TAPVC repair Method 3 patients with mean age of 7 and mean weight of 14kgs presented with NYHA class II symptoms. Echo showed RA, RV volume overload with no venous obstruction with mild to moderate PAH with an unligated vertical vein draining Findings All 3 patients underwent CT which revealed a dilated vertical vein cath study shows mean Pre procedure step up of 10 +_ 2 % mean
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