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Indications for Revision Pulmonary Valve Replacement Surgery in Paediatric Patients with Post-operative Pulmonary Incompetence
S236
Abstracts
ABSTRACTS
86 ± 3 ml, p = 0.06), LV ejection fraction (56 ± 1% vs 56 ± 2%, p = 0.86) or exercise capacity (% predicted Wpeak : 88 ± 3% vs 92 ± 4%, p = 0.50 and; % predicted VO2peak : 88 ± 3% vs 84 ± 3%, p = 0.43). For the group as a whole, fractional PR was 32 ± 15% and bi-ventricular ejection fractions (EF) were maintained (LV: 57 ± 7% and RV: 50 ± 7%). Fibrosis was rarely detected in the RV body (n = 1) and more frequently in the RVOT (n = 33, no difference between groups). Conclusions: Exercise capacity, stroke volume and biventricular contractile function were maintained with RVEDVi above compared to below the currently recommended cut-off for PVR surgery. Optimal timing for PVR thus remains unclear, given these observations. doi:10.1016/j.hlc.2011.05.579 576 Indications for Revision Pulmonary Valve Replacement Surgery in Paediatric Patients with Post-operative Pulmonary Incompetence L. Gnanendran 1,∗ , O. Jones 2 1 University 2 Sydney
of New South Wales, Sydney, NSW, Australia Childrens’ Hospital, Sydney, NSW, Australia
Background: The timing of revision pulmonary valve replacement (PVR) surgery in paediatric patients with post-operative pulmonary incompetence (PI) is critical in determining cardiovascular outcomes. Our study will identify echocardiographic predictors for the need for a cMRI in such patients, and hence subsequent PVR. Methods and results: Echocardiography and cMRI data were collected on 19 patients followed up at Sydney Children’s Hospital. Patients were aged between 10 and 21 years, with the mean age of echocardiography being 15.9 years and the mean age of cMRI being 17.6 years. √ PI severity was a significant predictor of RVIDd/ BSA with Pearson’s correlation coefficient of 0.668 and Rsquare value of 0.446 (P = 0.002). ROC analysis revealed √ a cut-off value of RVIDd/ BSA = 22.5 for predicting PI disease with a sensitivity of 0.8 and specificity of 1.0 (P = 0.003). PI severity is a marginally significant predictor of RVIDd/BSA with Pearson’s correlation coefficient of 0.596 and R-square value of 0.355 (P = 0.007). A cut-off value of RVIDd/BSA = 17.5 was obtained for predicting PI disease with a sensitivity of 0.8 and specificity of 1.0 (P = 0.003). √ Neither RVIDd/ BSA nor RVIDd/BSA showed correlation with age at the time of echocardiography. Novel TDI tools, RV IVA and RV MPI demonstrated no correlation with PI severity. √ Conclusions: RVIDd/ BSA and RVIDd/BSA should be reinstated as reliable echocardiographic tools for selecting relevant patients for cMRI. In particular, cut-off values of √ RVIDd/ BSA = 22.5 and RVIDd/BSA = 17.5 are predictive of PI disease and indicate the need for further investigations. The clinical utility of TDI measurements, RV IVA and RV MPI deserve further study. doi:10.1016/j.hlc.2011.05.580
Heart, Lung and Circulation 2011;20S:S156–S251
577 Infant Withdrawal Following Cardiac Surgery—Treat Mother’s Distress J. Re 1,2,3,∗ , C. Franich-Ray 2,3 , S. Menahem 2,4 , S. Dean 1 , C. Paul 2,3 , J. Taffe 1 , A. Guedeney 5 1 School of Psychology, Psychiatry and Psychological Medicine,
Monash University, Australia Childrens Research Institute, Australia 3 Royal Children’s Hospital, Australia 4 Foetal Cardiac Unit, Monash Medical Centre, Australia 5 Denis Dideros University & APHP, Paris, France 2 Murdoch
Congenital heart disease (CHD) affects 1% of infants and carries a significant morbidity and mortality. Considerable parental distress accompanies the infant’s diagnosis and treatment. The current study, part of a longitudinal, staged project, aimed to explore the nature of maternal distress and any association with the developing mother–infant relationship. No known studies have reported on infants with CHD and infant social withdrawal. A cohort of 22 mother–infant pairs where infants had cardiac surgery in the first weeks of life, were evaluated for psychological well-being at two months of age. Medical and surgical outcomes were reviewed. Mothers completed a questionnaire including standardised measures of maternal distress (depression, stress and anxiety). Infant measures included the Bayley-III Screening Test and Infant Social Withdrawal Scale (ADBB). Results: The cardiac diagnoses varied from an isolated VSD to HLHS. Very high levels of maternal distress were found and almost half of the infants were socially withdrawn. An association between maternal distress and infant withdrawal emerged. Conclusion: This study found that both mothers and infants experienced considerable distress, likely to have implications for the developing relationship. It also demonstrated an association between maternal distress and infant withdrawal showing cardiac infants to be at substantially increased risk of social withdrawal. However, it is unknown to what extent infant withdrawal may influence mothers’ responses, and what interactive effects there may be for mother and baby; further research is necessary. The findings also highlighted an urgent need for psychological services for these mothers and infants. doi:10.1016/j.hlc.2011.05.581 578 Isolated Foetal Cardiac Asymmetry as a Predictor of Postnatal Coarctation of the Aorta L. D’Orsogna ∗ , J. Sharpe, D. Kothari Maternal Fetal Medicine Service, KEMH, Perth, Australia Background: Foetal cardiac asymmetry with no other intra-cardiac abnormality may be an indicator of postnatal coarctation of the aorta (CoAo). Our aim was to assess the
Abstracts
ABSTRACTS
86 ± 3 ml, p = 0.06), LV ejection fraction (56 ± 1% vs 56 ± 2%, p = 0.86) or exercise capacity (% predicted Wpeak : 88 ± 3% vs 92 ± 4%, p = 0.50 and; % predicted VO2peak : 88 ± 3% vs 84 ± 3%, p = 0.43). For the group as a whole, fractional PR was 32 ± 15% and bi-ventricular ejection fractions (EF) were maintained (LV: 57 ± 7% and RV: 50 ± 7%). Fibrosis was rarely detected in the RV body (n = 1) and more frequently in the RVOT (n = 33, no difference between groups). Conclusions: Exercise capacity, stroke volume and biventricular contractile function were maintained with RVEDVi above compared to below the currently recommended cut-off for PVR surgery. Optimal timing for PVR thus remains unclear, given these observations. doi:10.1016/j.hlc.2011.05.579 576 Indications for Revision Pulmonary Valve Replacement Surgery in Paediatric Patients with Post-operative Pulmonary Incompetence L. Gnanendran 1,∗ , O. Jones 2 1 University 2 Sydney
of New South Wales, Sydney, NSW, Australia Childrens’ Hospital, Sydney, NSW, Australia
Background: The timing of revision pulmonary valve replacement (PVR) surgery in paediatric patients with post-operative pulmonary incompetence (PI) is critical in determining cardiovascular outcomes. Our study will identify echocardiographic predictors for the need for a cMRI in such patients, and hence subsequent PVR. Methods and results: Echocardiography and cMRI data were collected on 19 patients followed up at Sydney Children’s Hospital. Patients were aged between 10 and 21 years, with the mean age of echocardiography being 15.9 years and the mean age of cMRI being 17.6 years. √ PI severity was a significant predictor of RVIDd/ BSA with Pearson’s correlation coefficient of 0.668 and Rsquare value of 0.446 (P = 0.002). ROC analysis revealed √ a cut-off value of RVIDd/ BSA = 22.5 for predicting PI disease with a sensitivity of 0.8 and specificity of 1.0 (P = 0.003). PI severity is a marginally significant predictor of RVIDd/BSA with Pearson’s correlation coefficient of 0.596 and R-square value of 0.355 (P = 0.007). A cut-off value of RVIDd/BSA = 17.5 was obtained for predicting PI disease with a sensitivity of 0.8 and specificity of 1.0 (P = 0.003). √ Neither RVIDd/ BSA nor RVIDd/BSA showed correlation with age at the time of echocardiography. Novel TDI tools, RV IVA and RV MPI demonstrated no correlation with PI severity. √ Conclusions: RVIDd/ BSA and RVIDd/BSA should be reinstated as reliable echocardiographic tools for selecting relevant patients for cMRI. In particular, cut-off values of √ RVIDd/ BSA = 22.5 and RVIDd/BSA = 17.5 are predictive of PI disease and indicate the need for further investigations. The clinical utility of TDI measurements, RV IVA and RV MPI deserve further study. doi:10.1016/j.hlc.2011.05.580
Heart, Lung and Circulation 2011;20S:S156–S251
577 Infant Withdrawal Following Cardiac Surgery—Treat Mother’s Distress J. Re 1,2,3,∗ , C. Franich-Ray 2,3 , S. Menahem 2,4 , S. Dean 1 , C. Paul 2,3 , J. Taffe 1 , A. Guedeney 5 1 School of Psychology, Psychiatry and Psychological Medicine,
Monash University, Australia Childrens Research Institute, Australia 3 Royal Children’s Hospital, Australia 4 Foetal Cardiac Unit, Monash Medical Centre, Australia 5 Denis Dideros University & APHP, Paris, France 2 Murdoch
Congenital heart disease (CHD) affects 1% of infants and carries a significant morbidity and mortality. Considerable parental distress accompanies the infant’s diagnosis and treatment. The current study, part of a longitudinal, staged project, aimed to explore the nature of maternal distress and any association with the developing mother–infant relationship. No known studies have reported on infants with CHD and infant social withdrawal. A cohort of 22 mother–infant pairs where infants had cardiac surgery in the first weeks of life, were evaluated for psychological well-being at two months of age. Medical and surgical outcomes were reviewed. Mothers completed a questionnaire including standardised measures of maternal distress (depression, stress and anxiety). Infant measures included the Bayley-III Screening Test and Infant Social Withdrawal Scale (ADBB). Results: The cardiac diagnoses varied from an isolated VSD to HLHS. Very high levels of maternal distress were found and almost half of the infants were socially withdrawn. An association between maternal distress and infant withdrawal emerged. Conclusion: This study found that both mothers and infants experienced considerable distress, likely to have implications for the developing relationship. It also demonstrated an association between maternal distress and infant withdrawal showing cardiac infants to be at substantially increased risk of social withdrawal. However, it is unknown to what extent infant withdrawal may influence mothers’ responses, and what interactive effects there may be for mother and baby; further research is necessary. The findings also highlighted an urgent need for psychological services for these mothers and infants. doi:10.1016/j.hlc.2011.05.581 578 Isolated Foetal Cardiac Asymmetry as a Predictor of Postnatal Coarctation of the Aorta L. D’Orsogna ∗ , J. Sharpe, D. Kothari Maternal Fetal Medicine Service, KEMH, Perth, Australia Background: Foetal cardiac asymmetry with no other intra-cardiac abnormality may be an indicator of postnatal coarctation of the aorta (CoAo). Our aim was to assess the