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P2-64 CEREBRAL OXYGEN SATURATION IN CONGENITAL HEART DISEASES
98
Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
Conclusions: CCVDs, when CVRSAs are included, have a higher prevalence in school-aged children than indicated in the literature. CVRSAs are mostly undiagnosed and can cause significant morbidities. Echocardiography appears to be a sensitive tool for screening of CVRSAs. Awareness and cost- effective screening strategies are necessary for timely diagnosis and treatment of CVRSAs.
(statin) is possible to be one of the alternative therapeutic strategy for the early onset of atherosclerotic change in the chronic stage of KD.
P2-63 EFFECT OF EXERCISE ON CHILDREN WITH ISOLATED ABERRANT SUBCLAVIAN ARTERY
P2-61 VASCULAR ENDOTHELIAL DYSFUNCTION AND OXIDATIVE STRESS IN ADULT PATIENTS WITH THE HISTORY OF KAWASAKI DISEASE
Kenji Hamaoka, Ayumi Niboshi, Sei-Ichiro Ozawa, Tomoyo Yahata, Maiko Fujii, Akiko Hamaoka, Koichi Sakata. Department of Pediatric Cardiology And Nephrology, Kyoto Prefectural University of Medicine Graduate School Of Medical Science, Kyoto, JAPAN
Sheng-Ching Chan 1 , Sheng-Ling Jan 2,3 , Yun-Ching Fu 2,3 , Betau Hwang 3,4 . 1 Department of Nursing, Ta-Jen University, 2 Department of Pediatrics, Taichung Veterans General Hospital and 3 Medical College, National Yang-Ming University, 4 Department of Pediatrics, Taipei Veterans General Hospital, Taiwan.
P2-62
Background: The aberrant right subclavian artery (aRSCA) is the most common congenital anomaly of the aortic arch, occurring in about 0.5 to 2.9% of the general population. Most cases are asymptomatic and found incidentally. Surgical intervention is indicated in patients with significant symptoms. This prospective study is to estimate the possibility of exercise-induced esophago-tracheal compression (EIETC) in children with isolated aberrant subclavian artery (aSCA) and assess the necessary revision of surgical indication in them with EIETC. Methods: A total 40 (22F/18M) children with aSCA, aged from 6.9 to 14.9 y/o, were enrolled into this study. They received a protocol of pulmonary function test (PFT) and treadmill exercise test (TET). Results: Thirty-eight patients with left aortic arch and isolated aRSCA and two with right arch and isolated aLSCA. All of them were asymptomatic except some nonspecific manifestations, including frequent URI in 12 (30%), pneumonia in 5 (12.5%), asthma in 2 (5%), easy regurgitation and feeding problems in 7 (17.5%) and trivial dysphagia in 8 (20%). None had inspiratory stridor or failure to thrive during infant period. Most of them (70%) had a good school performance and all without attention deficiency. All of them received barium esophagogram and echocardiography as an initial evaluation, and the first 18 patients had received magnetic resonance angiography or computed tomography to confirm this anomaly. There was no complication in this study. All of them could achieve 80% target heart rate. Two (5%) patients felt mild dysphagia after exercise, but none had dyspnea. There were no significant changes of pulmonary function comparison of before and after exercise. Conclusion: Barium esophagogram and echocardiography are useful and adequate for diagnosis of aSCA. There was no evidence of EIETC in patients with isolated aSCA. Surgical treatment is not a good candidate for an asymptomatic patient. Keywords: Isolated aberrant subclavian artery, Pulmonary function test, Treadmill exercise test, Vascular ring.
EFFECT OF HMG-COA REDUCTASE INHIBITORS (STATIN) ON EARLY ONSET OF ATHEROSCLEROTIC CHANGE IN KAWASAKI DISEASE PATINNTS
P2-64
Introduction: Long-term clinical issues in Kawasaki disease (KD) concern the coronary artery lesions which involve aneurysmal formation, thrombotic occlusion, progression to ischemic heart disease, and premature atherosclerosis. To evaluate the possibility of the early development of atherosclerosis in KD, we examined vascular endothelial function and oxidative stress in adult KD patients. Methods: We evaluated 2 age-matched groups: 35 adult KD patients (KD group) (mean age, 27.0 years: mean age after the onset, 24.1 years), and 36 healthy adults (control group). To assess the endothelial function, flow-mediated dilatation (%FMD) of the brachial artery and urinary nitrites and nitrates (NOx) were examined. We also evaluated the levels of adhesion molecules, thrombinantithrombin III complex (TAT), von Willebrand factor, and tissue plasminogen activator-plasminogen activator inhibitor-1 complex. In addition, we measured urinary 8-isoprostane as an oxidative stress marker and high-sensitive C-reactive protein (hs-CRP) as a chronic inflammatory marker. Results:%FMD was significantly reduced in KD group (KD 10.4±2.6%; control 14.4±5.2%), particularly in the patients with coronary lesions. TAT values were also higher in KD group than in control group. Urinary 8-isoprostane/creatinine values were significantly higher in KD group than in control group (KD 760.2±596.9 pg/mg Cre control 512.0±272.1 pg/mg Cre). Hs-CRP was significantly elevated in KD patients with coronary aneurysms. Conclusions: This study revealed that the adult patients with a history of KD had systemic vascular endothelial dysfunction and were under oxidative stress. It is suggested that KD is possible to be one of the risk factors for early onset of atherosclerosis.
Kenji Hamaoka, Sei-ichiro Ozawa, Ayumi Niboshi, Tomoyo Yahata, Maiko Fujii, Koichi Sakata. Division of Pediatric Cardiology and Nephrology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan Introduction: Recently, it has been recognized that the vascular endothelial dysfunction and oxidative stress as the risk factors for early onset of atherosclerosis were indicated even during the chronic stage in Kawasaki disease (KD). In this study, we clinically evaluated the effect of HMG-CoA reductase inhibitors (statin) on the clinical findings associated with the early onset of atherosclerotic changes in the chronic stage of KD. Methods: Five KD patients (6∼25 year-old), who had the significant coronary stenotic lesions and reduced%FMD of the brachial artery as a marker of the vascular endothelial function, increased baPWV as a marker for arterial stiffness, or higher value of hs-CRP as a chronic inflammatory marker, were enrolled in this study. Subjects were assigned to 6 months of treatment with Fluvastatin (0.5 mg/kg/day). The changes in %FMD, baPWV, hs-CRP and serum level of total cholesterol were evaluated. Results: With Fluvastatin treatment during 6 months,%FMD improved from 11.3±2.28 (mean±SD) to 13.8±2.68, baPWV from 1190±279 (cm/sec) to1022±190, hs-CRP from 0.13±0.05 (mg/dl) to 0.018±0.008. Patients had not clinically significant decrease (from 168±10.3 (mg/dl) to 147±8.3) in serum level of total cholesterol. No adverse events or symptoms were observed in all patients. Conclusions: In this study, it was suggested that HMG-CoA reductase inhibitors
CEREBRAL OXYGEN SATURATION IN CONGENITAL HEART DISEASES
Hsing-Yuan Lee, Pi-Chang Lee, Betau Hwang, C.C. Laura Meng. Department of Pediatrics, Armed Force Tao-Yuan General Hospital; Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan, ROC Backgrounds: Near-infrared spectroscopy (NIRS) is a relatively new and noninvasive optical technology for monitoring the intra-cerebral oxygen saturation. We want to know the brain oxygen saturation and oxygen utilization in the children with different congenital heart diseases. Objective: The purpose of this study was to identify the brain oxygenation in the children with different congenital heart diseases by using NIRS. Methods: From October 2005 to Augest 2006, a total of 112 patients less than 16 years old were study during transcutaneous catheterization. The patients had pulse oximetry on their right thrumb for monitoring arterial saturation (SaO2) and NIRS on their left forehand for monitoring brain oxygen saturation (ScO2). The cerebral O2 extration (CEO2) was calculated as SaO2–ScO2. The data was separated and compared according to different diagnoses. All clinic data and ScO2 was analyzed by multivariable regression test. Results: The SaO2, ScO2 and CEO2 in normal cardiac anatomy patients were 98.7±0.9, 64.4±2.9 and 34.4±3.5 respectively, which were similar as the patients with atrial septal defect(ASD), ASD s/p septal occlusion, ventricular septal defect, patent ductus arteriosus(PDA), PDA s/p ductal occlusion, Tetralogy of Fallot (TOF) s/p total correction. SaO2 was significant lower in patients with TOF, single
Abstract of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13–16 December, 2007 ventricle (SV), and SV s/p bidirectional Glenn shunt (BDG) (p<0.001). Sco2 was significantly decreased in patients with TOF and SV s/p BDG (p<0.001). SaO2 was positively linear regression with ScO2 (R=0.569, p<0.001). Conclusion: The heart anatomy and arterial oxygen saturation affect the cerebral oxygen saturation in patients with congenital heart disease.
P2-65 SUCCESSFUL FONTAN COMPLETION IN A PATIENT WITH NONCOMPACTION MYOCARDIUM
Yoshinori Miyahara, Shingo Kasahara, Ko Yoshizumi, Shigeru Sakurai, Kozo Ishino, Shunji Sano. Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan Noncompaction myocardium is a rare cardiomyopathy characterized by numerous prominent trabeculations and intratrabecular recesses of left ventricular myocardial wall. Patients with noncompaction myocardium usually accompany other congenital cardiac malformations. We present an adult case of tricuspid atresia with noncompaction myocardium that has caused progressive dyspnea and cyanosis. This patient underwent a staged-Fontan surgery that consists of a bidirectional Glenn shunt followed by a total cavopulmonary connection. Operations were successfully carried out and the patient made an uneventful recovery. This case report is the initial description of Fontan completion in a patient with noncompaction myocardium.
P2-66 NATURAL HISTORY OF ARRHYTHMIA IN CHILDREN AND ADOLESCENTS THAT UNDERWENT ATRIOVENTRICULAR NODE REENTRY TACHYCARDIA ABLATION
Michal Orczykowski 1 , Lukasz Szumowski 1 , Paweł Derejko 1 , Piotr Urbanek 1 , Ewa Szufladowicz 1 , Robert Bodalski 1 , Joanna Zakrzewska 1 , Wanda Kawalec 2 , Maria Knecht 2 , Katarzyna Bieganowska 2 , Franciszek Walczak 2 . 1 Institute of Cardiology, Warsaw-Anin, 2 The Childrens Memorial Health Institute, Poland Introduction: Atrioventricular node reentry tachycardia (AVNRT) is a common form of SVT. Ablation is considered to be a safe procedure even in young patients (pts). However the best age to perform the procedure is still discussed. The analysis of natural arrhythmia history might be helpful in that decision. The aim of our study was to analyze natural history of the AVNRT and associated arrhythmias in pediatrics patients. Methods: 36 under aged pts (mean age 16,4; 12-18 years) (23 female (F) 64%) underwent non-pharmacological treatment of AVNRT (years 1988-2006). The results of 12 lead ECG Holter, ECG monitoring, and an echocardiography study were analyzed. Results: The most common AVNRT type was slow/fast (s/f- 97%). 6 pts (16,5%) had 2 types of AVNRT (5 pts – s/f and s/mid, 1pts s/f and f/s type), 1 pts only f/s type. 7 pts (19,4%), (6F) had have WPW syndrome. The mean age of first heart palpitations and first documented AVNRT was 9,9 yrs and 11,7 yrs respectively. MAS episodes were observed in 8 (22%, 5F) pts. In the whole group mean HR during AVNRT was 214 beat/minute. 5 teen-agers had more than 4 AVNRT attacks per day. 8 pts had have attacks lasting more than 5 (5-12) hours. 2 pts (6%) had Ebstein anomaly, 4 (11%) mitral prollaps. None of the pts had major complications during or after procedure. Conclusion: Ablation of AVNRT can be performed safely and successfully even in pediatric patients. MAS episodes in teen-agers group occurred frequently. In pts with AVNRT WPW is commonly observed (19.4%).
99
P2-67 ARRHYTHMIA IN PATIENTS WITH EBSTEIN ANOMALY AND RADIOFREQUENCY CATHETER ABLATION
Lukasz Szumowski 1 , Michal Orczykowski 1 , Ewa Szufladowicz 1 , Robert Bodalski 1 , Piotr Urbanek 1 , Paweł Derejko 1 , Roman Ke.pski 1 , Wanda Kawalec 2 , Maria Knecht 2 , Katarzyna Bieganowska 2 , Franciszek Walczak 1 . 1 Institute of Cardiology, Warsaw-Anin, 2 The Childrens Memorial Health Institute, Poland Introduction: In patients (pts) with Ebstein anomaly exists a complex electroanatomical substrate for recurrent arrhythmia – atrioventricular reentry tachycardia (AVRT), atrial fibrillation (AF) and life-threatening ventricular tachyarrhythmia. Aim: Assessment of the presence and type of arrhythmia in pts with Ebstein anomaly who underwent RF ablation. Group and Methods: 802 pts with WPW syndrome, mean age 35,4 years, underwent non-pharmacologcal treatment (years 1988-2006). 15 of them (2%), 8 female (F), (mean age 26,4 yrs) and 7 male (M) (mean age 34,7 yrs) had Ebstein anomaly. The results of 12 lead ECG Holter, ECG monitoring, electrophysiological tests and an echocardiography study were analyzed. Results: 15 pts had have 24 accessory pathways (AP), in 4 pts (27%) it was “ wide” AP. 7 pts (46%) had have 2 AP, 1 (6%)-3 APs. In 14 pts (93%) rightsided AP, in 1 pts (7%) left-sided AP was observed. 12 pts (80%) had have overt WPW syndrome, 2 pts (13%) intermittent, 1 (7%) concealed. 12 pts (80%) had ortodromic AVRT, 3 (20%) antydromic. 2 pts had AF, 2 AT, 2 AVNRT, 1 AFL. 2 pts (13%) had have episodes of AVRT, AF and AT. 2 (13%) had AVRT and AVNRT. 1 pts with primary VF had have 3 APs and had intermittent long QT. Conclusions: In analyzed pts with Ebstein anomaly multiple APs occurred frequently or APs were wide. In 50% of pts with Ebstein anomaly existed more than one type of arrhythmia.
P2-68 NATURAL HISTORY OF ARRHYTHMIA IN CHILDREN AND ADOLESCENTS WITH WOLF-PARKINSON-WHITE SYNDROME THAT UNDERWENT RF ABLATION
Michal Orczykowski 1 , Lukasz Szumowski 1 , Ewa Szufladowicz 1 , Paweł Derejko 1 , Piotr Urbanek 1 , Robert Bodalski 1 , Roman Ke.pski 1 , Wanda Kawalec 2 , Maria Knecht 2 , Katarzyna Bieganowska 2 , Franciszek Walczak 1 . 1 Institute of Cardiology, Warsaw-Anin, 2 The Childrens Memorial Health Institute, Poland Introduction: In Wolff-Parkinson-White (WPW) syndrome might lead to life threatening arhythmias. Degeneration of atrioventricular reentrant tachycardia (AVRT) into atrial fibrillation, resulting in a rapid ventricular response over the accessory pathway might degenerate to ventricular fibrillation. The literature reports that 12% to 27% of survivors of ventricular fibrillation and WPW had no prior tachyarrhythmias. The aim of our study was to analyze natural history the occurence of WPW and associated arrhythmias in pediatric patients depedence on sex, age, AP and other factors. Methods: 144 under aged pts (mean age 15 years; 1-18years; 74 male) underwent non-pharmacological treatment of WPW (years 1988-2006). The results of 12 lead ECG Holter, ECG monitoring, and an echocardiography study were analyzed. Results: The most common was overt AP (54,8%), intermittent and concealed occurred in 14,6% and 27% respectively. 18 pts (12,5%, 10 M) had have 2 AP, 1 pt had 3 AP. 4 pts had have antidromic AVRT, 140 pts ortodromic AVRT. The mean age of first AVRT episode was 9,2 yrs. First AVRT occurred under age of 5 in 10% of the pts. 21 pts (14,6%) had episode of AF (15M, mean age 14). 7 pts had AVNRT, 8 pts had AFL – (mean age of first episode 10 years). Aborted SCD was documented in 6 pts (4,1%) (2M, 2F). VF occurred during TAP in one, and another 5 pts VF was related to exercise/emotion. 15 (11%) had Ebstein anomally, 10 (7%) valvular heart disease. 3 (2%) heart failure,AF occurred most frequently in overt APs – 81,3% (intermittent – 11%, and concealed – 7,7%) Conclusion: AF is a frequent arrhythmia in young pts with WPW, and might lead to aborted SCD.
Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
Conclusions: CCVDs, when CVRSAs are included, have a higher prevalence in school-aged children than indicated in the literature. CVRSAs are mostly undiagnosed and can cause significant morbidities. Echocardiography appears to be a sensitive tool for screening of CVRSAs. Awareness and cost- effective screening strategies are necessary for timely diagnosis and treatment of CVRSAs.
(statin) is possible to be one of the alternative therapeutic strategy for the early onset of atherosclerotic change in the chronic stage of KD.
P2-63 EFFECT OF EXERCISE ON CHILDREN WITH ISOLATED ABERRANT SUBCLAVIAN ARTERY
P2-61 VASCULAR ENDOTHELIAL DYSFUNCTION AND OXIDATIVE STRESS IN ADULT PATIENTS WITH THE HISTORY OF KAWASAKI DISEASE
Kenji Hamaoka, Ayumi Niboshi, Sei-Ichiro Ozawa, Tomoyo Yahata, Maiko Fujii, Akiko Hamaoka, Koichi Sakata. Department of Pediatric Cardiology And Nephrology, Kyoto Prefectural University of Medicine Graduate School Of Medical Science, Kyoto, JAPAN
Sheng-Ching Chan 1 , Sheng-Ling Jan 2,3 , Yun-Ching Fu 2,3 , Betau Hwang 3,4 . 1 Department of Nursing, Ta-Jen University, 2 Department of Pediatrics, Taichung Veterans General Hospital and 3 Medical College, National Yang-Ming University, 4 Department of Pediatrics, Taipei Veterans General Hospital, Taiwan.
P2-62
Background: The aberrant right subclavian artery (aRSCA) is the most common congenital anomaly of the aortic arch, occurring in about 0.5 to 2.9% of the general population. Most cases are asymptomatic and found incidentally. Surgical intervention is indicated in patients with significant symptoms. This prospective study is to estimate the possibility of exercise-induced esophago-tracheal compression (EIETC) in children with isolated aberrant subclavian artery (aSCA) and assess the necessary revision of surgical indication in them with EIETC. Methods: A total 40 (22F/18M) children with aSCA, aged from 6.9 to 14.9 y/o, were enrolled into this study. They received a protocol of pulmonary function test (PFT) and treadmill exercise test (TET). Results: Thirty-eight patients with left aortic arch and isolated aRSCA and two with right arch and isolated aLSCA. All of them were asymptomatic except some nonspecific manifestations, including frequent URI in 12 (30%), pneumonia in 5 (12.5%), asthma in 2 (5%), easy regurgitation and feeding problems in 7 (17.5%) and trivial dysphagia in 8 (20%). None had inspiratory stridor or failure to thrive during infant period. Most of them (70%) had a good school performance and all without attention deficiency. All of them received barium esophagogram and echocardiography as an initial evaluation, and the first 18 patients had received magnetic resonance angiography or computed tomography to confirm this anomaly. There was no complication in this study. All of them could achieve 80% target heart rate. Two (5%) patients felt mild dysphagia after exercise, but none had dyspnea. There were no significant changes of pulmonary function comparison of before and after exercise. Conclusion: Barium esophagogram and echocardiography are useful and adequate for diagnosis of aSCA. There was no evidence of EIETC in patients with isolated aSCA. Surgical treatment is not a good candidate for an asymptomatic patient. Keywords: Isolated aberrant subclavian artery, Pulmonary function test, Treadmill exercise test, Vascular ring.
EFFECT OF HMG-COA REDUCTASE INHIBITORS (STATIN) ON EARLY ONSET OF ATHEROSCLEROTIC CHANGE IN KAWASAKI DISEASE PATINNTS
P2-64
Introduction: Long-term clinical issues in Kawasaki disease (KD) concern the coronary artery lesions which involve aneurysmal formation, thrombotic occlusion, progression to ischemic heart disease, and premature atherosclerosis. To evaluate the possibility of the early development of atherosclerosis in KD, we examined vascular endothelial function and oxidative stress in adult KD patients. Methods: We evaluated 2 age-matched groups: 35 adult KD patients (KD group) (mean age, 27.0 years: mean age after the onset, 24.1 years), and 36 healthy adults (control group). To assess the endothelial function, flow-mediated dilatation (%FMD) of the brachial artery and urinary nitrites and nitrates (NOx) were examined. We also evaluated the levels of adhesion molecules, thrombinantithrombin III complex (TAT), von Willebrand factor, and tissue plasminogen activator-plasminogen activator inhibitor-1 complex. In addition, we measured urinary 8-isoprostane as an oxidative stress marker and high-sensitive C-reactive protein (hs-CRP) as a chronic inflammatory marker. Results:%FMD was significantly reduced in KD group (KD 10.4±2.6%; control 14.4±5.2%), particularly in the patients with coronary lesions. TAT values were also higher in KD group than in control group. Urinary 8-isoprostane/creatinine values were significantly higher in KD group than in control group (KD 760.2±596.9 pg/mg Cre control 512.0±272.1 pg/mg Cre). Hs-CRP was significantly elevated in KD patients with coronary aneurysms. Conclusions: This study revealed that the adult patients with a history of KD had systemic vascular endothelial dysfunction and were under oxidative stress. It is suggested that KD is possible to be one of the risk factors for early onset of atherosclerosis.
Kenji Hamaoka, Sei-ichiro Ozawa, Ayumi Niboshi, Tomoyo Yahata, Maiko Fujii, Koichi Sakata. Division of Pediatric Cardiology and Nephrology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan Introduction: Recently, it has been recognized that the vascular endothelial dysfunction and oxidative stress as the risk factors for early onset of atherosclerosis were indicated even during the chronic stage in Kawasaki disease (KD). In this study, we clinically evaluated the effect of HMG-CoA reductase inhibitors (statin) on the clinical findings associated with the early onset of atherosclerotic changes in the chronic stage of KD. Methods: Five KD patients (6∼25 year-old), who had the significant coronary stenotic lesions and reduced%FMD of the brachial artery as a marker of the vascular endothelial function, increased baPWV as a marker for arterial stiffness, or higher value of hs-CRP as a chronic inflammatory marker, were enrolled in this study. Subjects were assigned to 6 months of treatment with Fluvastatin (0.5 mg/kg/day). The changes in %FMD, baPWV, hs-CRP and serum level of total cholesterol were evaluated. Results: With Fluvastatin treatment during 6 months,%FMD improved from 11.3±2.28 (mean±SD) to 13.8±2.68, baPWV from 1190±279 (cm/sec) to1022±190, hs-CRP from 0.13±0.05 (mg/dl) to 0.018±0.008. Patients had not clinically significant decrease (from 168±10.3 (mg/dl) to 147±8.3) in serum level of total cholesterol. No adverse events or symptoms were observed in all patients. Conclusions: In this study, it was suggested that HMG-CoA reductase inhibitors
CEREBRAL OXYGEN SATURATION IN CONGENITAL HEART DISEASES
Hsing-Yuan Lee, Pi-Chang Lee, Betau Hwang, C.C. Laura Meng. Department of Pediatrics, Armed Force Tao-Yuan General Hospital; Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan, ROC Backgrounds: Near-infrared spectroscopy (NIRS) is a relatively new and noninvasive optical technology for monitoring the intra-cerebral oxygen saturation. We want to know the brain oxygen saturation and oxygen utilization in the children with different congenital heart diseases. Objective: The purpose of this study was to identify the brain oxygenation in the children with different congenital heart diseases by using NIRS. Methods: From October 2005 to Augest 2006, a total of 112 patients less than 16 years old were study during transcutaneous catheterization. The patients had pulse oximetry on their right thrumb for monitoring arterial saturation (SaO2) and NIRS on their left forehand for monitoring brain oxygen saturation (ScO2). The cerebral O2 extration (CEO2) was calculated as SaO2–ScO2. The data was separated and compared according to different diagnoses. All clinic data and ScO2 was analyzed by multivariable regression test. Results: The SaO2, ScO2 and CEO2 in normal cardiac anatomy patients were 98.7±0.9, 64.4±2.9 and 34.4±3.5 respectively, which were similar as the patients with atrial septal defect(ASD), ASD s/p septal occlusion, ventricular septal defect, patent ductus arteriosus(PDA), PDA s/p ductal occlusion, Tetralogy of Fallot (TOF) s/p total correction. SaO2 was significant lower in patients with TOF, single
Abstract of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13–16 December, 2007 ventricle (SV), and SV s/p bidirectional Glenn shunt (BDG) (p<0.001). Sco2 was significantly decreased in patients with TOF and SV s/p BDG (p<0.001). SaO2 was positively linear regression with ScO2 (R=0.569, p<0.001). Conclusion: The heart anatomy and arterial oxygen saturation affect the cerebral oxygen saturation in patients with congenital heart disease.
P2-65 SUCCESSFUL FONTAN COMPLETION IN A PATIENT WITH NONCOMPACTION MYOCARDIUM
Yoshinori Miyahara, Shingo Kasahara, Ko Yoshizumi, Shigeru Sakurai, Kozo Ishino, Shunji Sano. Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan Noncompaction myocardium is a rare cardiomyopathy characterized by numerous prominent trabeculations and intratrabecular recesses of left ventricular myocardial wall. Patients with noncompaction myocardium usually accompany other congenital cardiac malformations. We present an adult case of tricuspid atresia with noncompaction myocardium that has caused progressive dyspnea and cyanosis. This patient underwent a staged-Fontan surgery that consists of a bidirectional Glenn shunt followed by a total cavopulmonary connection. Operations were successfully carried out and the patient made an uneventful recovery. This case report is the initial description of Fontan completion in a patient with noncompaction myocardium.
P2-66 NATURAL HISTORY OF ARRHYTHMIA IN CHILDREN AND ADOLESCENTS THAT UNDERWENT ATRIOVENTRICULAR NODE REENTRY TACHYCARDIA ABLATION
Michal Orczykowski 1 , Lukasz Szumowski 1 , Paweł Derejko 1 , Piotr Urbanek 1 , Ewa Szufladowicz 1 , Robert Bodalski 1 , Joanna Zakrzewska 1 , Wanda Kawalec 2 , Maria Knecht 2 , Katarzyna Bieganowska 2 , Franciszek Walczak 2 . 1 Institute of Cardiology, Warsaw-Anin, 2 The Childrens Memorial Health Institute, Poland Introduction: Atrioventricular node reentry tachycardia (AVNRT) is a common form of SVT. Ablation is considered to be a safe procedure even in young patients (pts). However the best age to perform the procedure is still discussed. The analysis of natural arrhythmia history might be helpful in that decision. The aim of our study was to analyze natural history of the AVNRT and associated arrhythmias in pediatrics patients. Methods: 36 under aged pts (mean age 16,4; 12-18 years) (23 female (F) 64%) underwent non-pharmacological treatment of AVNRT (years 1988-2006). The results of 12 lead ECG Holter, ECG monitoring, and an echocardiography study were analyzed. Results: The most common AVNRT type was slow/fast (s/f- 97%). 6 pts (16,5%) had 2 types of AVNRT (5 pts – s/f and s/mid, 1pts s/f and f/s type), 1 pts only f/s type. 7 pts (19,4%), (6F) had have WPW syndrome. The mean age of first heart palpitations and first documented AVNRT was 9,9 yrs and 11,7 yrs respectively. MAS episodes were observed in 8 (22%, 5F) pts. In the whole group mean HR during AVNRT was 214 beat/minute. 5 teen-agers had more than 4 AVNRT attacks per day. 8 pts had have attacks lasting more than 5 (5-12) hours. 2 pts (6%) had Ebstein anomaly, 4 (11%) mitral prollaps. None of the pts had major complications during or after procedure. Conclusion: Ablation of AVNRT can be performed safely and successfully even in pediatric patients. MAS episodes in teen-agers group occurred frequently. In pts with AVNRT WPW is commonly observed (19.4%).
99
P2-67 ARRHYTHMIA IN PATIENTS WITH EBSTEIN ANOMALY AND RADIOFREQUENCY CATHETER ABLATION
Lukasz Szumowski 1 , Michal Orczykowski 1 , Ewa Szufladowicz 1 , Robert Bodalski 1 , Piotr Urbanek 1 , Paweł Derejko 1 , Roman Ke.pski 1 , Wanda Kawalec 2 , Maria Knecht 2 , Katarzyna Bieganowska 2 , Franciszek Walczak 1 . 1 Institute of Cardiology, Warsaw-Anin, 2 The Childrens Memorial Health Institute, Poland Introduction: In patients (pts) with Ebstein anomaly exists a complex electroanatomical substrate for recurrent arrhythmia – atrioventricular reentry tachycardia (AVRT), atrial fibrillation (AF) and life-threatening ventricular tachyarrhythmia. Aim: Assessment of the presence and type of arrhythmia in pts with Ebstein anomaly who underwent RF ablation. Group and Methods: 802 pts with WPW syndrome, mean age 35,4 years, underwent non-pharmacologcal treatment (years 1988-2006). 15 of them (2%), 8 female (F), (mean age 26,4 yrs) and 7 male (M) (mean age 34,7 yrs) had Ebstein anomaly. The results of 12 lead ECG Holter, ECG monitoring, electrophysiological tests and an echocardiography study were analyzed. Results: 15 pts had have 24 accessory pathways (AP), in 4 pts (27%) it was “ wide” AP. 7 pts (46%) had have 2 AP, 1 (6%)-3 APs. In 14 pts (93%) rightsided AP, in 1 pts (7%) left-sided AP was observed. 12 pts (80%) had have overt WPW syndrome, 2 pts (13%) intermittent, 1 (7%) concealed. 12 pts (80%) had ortodromic AVRT, 3 (20%) antydromic. 2 pts had AF, 2 AT, 2 AVNRT, 1 AFL. 2 pts (13%) had have episodes of AVRT, AF and AT. 2 (13%) had AVRT and AVNRT. 1 pts with primary VF had have 3 APs and had intermittent long QT. Conclusions: In analyzed pts with Ebstein anomaly multiple APs occurred frequently or APs were wide. In 50% of pts with Ebstein anomaly existed more than one type of arrhythmia.
P2-68 NATURAL HISTORY OF ARRHYTHMIA IN CHILDREN AND ADOLESCENTS WITH WOLF-PARKINSON-WHITE SYNDROME THAT UNDERWENT RF ABLATION
Michal Orczykowski 1 , Lukasz Szumowski 1 , Ewa Szufladowicz 1 , Paweł Derejko 1 , Piotr Urbanek 1 , Robert Bodalski 1 , Roman Ke.pski 1 , Wanda Kawalec 2 , Maria Knecht 2 , Katarzyna Bieganowska 2 , Franciszek Walczak 1 . 1 Institute of Cardiology, Warsaw-Anin, 2 The Childrens Memorial Health Institute, Poland Introduction: In Wolff-Parkinson-White (WPW) syndrome might lead to life threatening arhythmias. Degeneration of atrioventricular reentrant tachycardia (AVRT) into atrial fibrillation, resulting in a rapid ventricular response over the accessory pathway might degenerate to ventricular fibrillation. The literature reports that 12% to 27% of survivors of ventricular fibrillation and WPW had no prior tachyarrhythmias. The aim of our study was to analyze natural history the occurence of WPW and associated arrhythmias in pediatric patients depedence on sex, age, AP and other factors. Methods: 144 under aged pts (mean age 15 years; 1-18years; 74 male) underwent non-pharmacological treatment of WPW (years 1988-2006). The results of 12 lead ECG Holter, ECG monitoring, and an echocardiography study were analyzed. Results: The most common was overt AP (54,8%), intermittent and concealed occurred in 14,6% and 27% respectively. 18 pts (12,5%, 10 M) had have 2 AP, 1 pt had 3 AP. 4 pts had have antidromic AVRT, 140 pts ortodromic AVRT. The mean age of first AVRT episode was 9,2 yrs. First AVRT occurred under age of 5 in 10% of the pts. 21 pts (14,6%) had episode of AF (15M, mean age 14). 7 pts had AVNRT, 8 pts had AFL – (mean age of first episode 10 years). Aborted SCD was documented in 6 pts (4,1%) (2M, 2F). VF occurred during TAP in one, and another 5 pts VF was related to exercise/emotion. 15 (11%) had Ebstein anomally, 10 (7%) valvular heart disease. 3 (2%) heart failure,AF occurred most frequently in overt APs – 81,3% (intermittent – 11%, and concealed – 7,7%) Conclusion: AF is a frequent arrhythmia in young pts with WPW, and might lead to aborted SCD.