480A ABSTRACTS - Pediatric Cardiology JACC March 19,2003 Doppler echocardiography provides observations that could be of assistance during AV defect repair. POSTER SESSION 1094 Pediatric Cardiology I Monday, March 31, 2003, 9:00 a.m.-l 1:OO a.m. McCormick Place, Hall A Presentation Hour: 9:00 a.m.-10:OO a.m. 1094-155 Acute Hemodynamic Effects of New lnotropic Agent(Colforsin Daropate) in Pediatric Patients With Left to Right Shunt Disease Motofumi lemura, Teiji Akagi, Yoshie Mizumoto, Yoko Sugahara, Wakako Himeno. Yasukl Maeno, Mashiro Ishii, Toyojiro Matsuishi, Kurume Uwersity, Kurume, Japan Background: Colforsin daropate(Colf) is new positive inotropic agent which having vasodilating effects. These effects are mediated by an increase in intracellular c-AMP concentration caused by the stimulating action of Golf on adenylate cyclase, and not through beta-adrenoreceptor. Such characteristics may have advantage in treatment of left to right(LR) shunt disease. Objective: To evaluate the hemodynamic effects of Golf, 15 patients( age;5.2L5,9yrs) with L&hunt disease(VSD:ASD=7:8) and 10 controls underwent Colf(0.5uglkglmin) infu- sion challenge examination during catheterization, and compared to dopamine(DOA) infusion(5,lOug/kg/min). Result: In the control group, Golf significantly increased of cardiac index (2.79iO.54 to 2.939.54) as same efficacy as DOA(lOug). Hemodynamic effects in LR shunt group was shown in table. No significant hemodynamic responses were observed between ASD and VSD patients in our study protocol. Conclusion: Those data suggested that Golf had similar positive inotropic effect as DOA(lOug) without increasing of shunt ratio in patients with LR shunt disease. Such elm- ical features may play an important role for treatment of congestive healt failure in this setting. Control DOA 5u DOA IOU COlf 0.5u HR 100.1+6.4 100.2+5.9 110.4+8.8’ 110.7+7.1’ RA(m) 3.520.4 4.2iO.5 4.420.6 2.7fl.3 PCWP 8.2+0.9 8.3+0.9 7.9+0.9 6.3+0.8’ PA(m) 23.49.7 25.2&X9’ 30.7+5.1’ 22.824.1 AC)(m) 75.5fi.6 75.39.3 85.6+3.5* 78.2~3.1 QpiCk 2.35s.26 2.390.25 3.68+0.80’ 2.04+0.18 FtP/RS 0.13+0.05 0.11+0.02 0.12+0.02 0.11+0.02 ‘,pc0.05 versus control 1094-156 Myocardial Acceleration During lsovolumic Contraction as a New Index of Right Ventricular Contractile Function and Its Relation to Pulmonary Regurgitation in Patients After Repair of Tetralogy of Fallot Manatomo Tovono, Kenti Harada, Masamlchi Tamura, Fumio Yamamoto, Akita University School of Medicine, Akita, Japan Background: Myocardial acceleration during isovolumic contraction (IVA) obtained from tissue Doppler imagmg (TDI) is a new noninvasive index of right ventricular (RV) contrac- tile function that is unaffected by the shape of the ventricle and loading conditions. In this study. we assessed the utility of IVA to measure RV contractile function in patients after repau of tetralogy of Fallot (TOF) Methods: We examined 18 TOF patients (6.2 * 2.4 years) with significant PR but no sig- nificant RV outflow obstruction (gradients .z POmmHg) and 27 age-matched healthy chil- dren. Using TDI, Peak myocardial velocities during isovolumic ContractIon (IVV) and systolic ejectlon (S) were measured at the base of RV free wall from an apical 4.chamber view. IVA was calculated by dividing IVV by the time interval from onset of the wave dur- ing isovolumic contraction to the time at peak velocity of this wave. The grading of the degree of PR (mild, moderate, and severe) was based on color Doppler findings. Results. TDI measurements are shown in the Table. S, IVV, and IVA in each TOF patient group were significantly lower than those I” controls. However, S and IVV in the TOF patients remained constant regardless of severity of PR. There was a stepwise decrease in IVA from mild to severe PR. There was also a significant relationship between IVA and degree of PR (-0.82, p r: 0.0001). Conclusion: IVA may be an effective means of assessing RV contratiile function in the TOF patients with various degree of PR. Control (n = 27) Pulmonary Regurgitation Mild Moderate Severe (n = 5) (n = 7) (n = 6) S (cmlsec) 11.7 * 2.7 7.0 * 0.7* 6.6 f 1.6’ 6.7 f 1.7’ IVV (cm/six) 8.1 zt 1.6 6.1 zt 1.0’ 5.3 + 0.6* 5.1 * 1.2 IVA (cm/se@ 258 * 35 192 * 5’ 155 * 22’7 129t 16’t# ‘p < 0.01 vs control, tp < 0.01 vs mild PA, #p < 0.05 vs moderate PR 1094-l 57 Right Ventricular to Coronary Artery Communications in Pulmonary Atresia: A New Anatomic-Functional Classification and Its Utility in Predicting Immediate and Long-Term Outcome Subash C. Reddy, Lee B. Beerman, Sang C. Park, William H. Neches, Children’s Hospital of Pittsburgh, Pittsburgh, PA Background:The poor outcome in patients(pts) with pulmonary atresia(PAT) and right ventricle to coronary artery communications(RVCC) may be related to the fact that a sig- nlficant portion of the left ventricular myocardium is dependant upon perfusion from these communicatlons.Current definition of RVCC is qualitative and subjective. Therefore,we propose a new classification scheme for RVCC and test its utility in predicting the out- come. Methods: Charts of pts with PAT and RVCC between 1974.2002 were reviewed.The demographic, hemodynamic, angiographiwumber and type of opera- tiowimmediate outcome and the latest follow-up data were collected. The RVlaortic angiograms were analyzed for RVCC patterns and were classified as types 0,1,2,3,and 4.TypeO:faint retrograde filling of the secondary branches with no filling of the main coro- nary arieries.Typel :retrograde filling of one of more main coronary arteries with out any luminal stenosis.irregularities, and with no retrograde filling of the ascending aoria(AA).Typs2:type 1 with luminal dilation and irregularities,with retrograde filling of the AA.type3:type 2 with stenosis in one or more main coronary arteriestype 4: Type 2 or 3 with Interruptions in one or more main coronary arteries. Results: Of 28 pts with PAT and RVCC,26 had angiograms for analysisWe found RVCC type 0 in 5 pts,type 1 in 2,type 2 in 7,type 3 in 7, and type 4 in 5 pts. Two pts died before any surgical intervention and 26 pts had a shunt procedure.There were 2 post-operative deaths and 9 late deaths.The remaining 15 pts are alive and had further operations(biventricular repair in 1 ,I .5 ventric- ular repair in 1 ,Fontan in 10, Glen in 1 and shunt in Ppts).Acturial survival including in hospital and late deaths was 65%,40%,and 20% at 5,10,and 20 years respectively.Mor- t&y was assoctated with RVCC types 3 and 4(P&O5). Conclusions: The long-term out- come of pts with PAT and RVCC is poor with a significant correlation between the types of RVCC and mortality.Left ventricular perfusion imaging of pts with RVCC types 3 and 4 may help develop specific treatment strategies and better risk stratiflcatlon. 1094-I 58 Occult Myocardial Injury in Otherwise Healthy Newborns Valeriano C. Simbre. II, Robert A. Sinkin, Sema Hart, Nader Rifai, Stuart R. Lip&z, Linda Reubens. Tina M. Lipinczyk. David Wilk, Steven E. Lipshultz, University of Rochester Sch. of Medicine & Dentistry, Rochester, NY Hypothesis: Since the perinatal period is a time of the greatest pediatric myocardial stress, we proposed that the neonatal myocardium will sustain a greater injury from a similar Insult than an older myocardium, demonstrating clinically occult myocardial injury. Methods: Prospective study to identify whether otherwise healthy newborns without known cardiac disease had evidence of myocardial injury. The Elecsys Troponin T STAT Immunoassay identified cTnT values of z-0.01 ngiml as elevated. C-reactwe protein (hsCRP) was measured by N High Sensitwtty CRP assay, and CK-MB was assayed by ACS:180 CK-MB assay (z-5.5 nglml elevated). Results: Consent was obtained on 27 neonates (median bw 3.3 kg; median gestational age 39.7 wk; 93% AGA; median LOS 3 days). Median umbilical cord cTnT was 0.030 ng/ ml (0.005-0.420 @ml); median neonatal serum cTnT was 0.068 ng/m1(.005-0.437 ngl ml). Serum cTnT was elevated in 76% of patients (Pts) with umbilical cord samples with 93% of Pts with neonatal samples, occasionally at myocardial infarction levels. Pts with elevated CK-MB also had cTnT elevations. Myocardial injury was more common in other- wise healthy neonates than in older such children (6%). and was associated with lower 1 minute Apgar score?, (r-0.85, PcO.001). a younger gestational age (r=-0.53, P=O.O4), increased LOS (r=0.52. P=O.O46). non-white race (P=O.OOES), and elevated hsCRP (r=0.79, P=O.OOOE). a marker of generalized inflammation. Elevated hsCRP correlated