CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
8
AFRICA
86: THE APPLICATION OF ALL-AUTOLOGOUS THREE-
SINUS REPAIR (MODIFIED BROM OR MYERS TECH-
NIQUE) TO SUPRAVALVULAR PULMONARY STENOSIS
Toshiki Fujiyoshi, Koji Kagisaki, Takaya Hoashi, Isao Shiraishi,
Hajime Ichikawa
National Cerebral and Cardiovascular Center, Oosaka, Japan
Background:
Various surgical techniques have been proposed
to repair supravalvular pulmonary stenosis (SVPS) in paediatric
populations. Whereas growth potential should be promised, exces-
sive expansion under the presence of undiminished high pulmonary
arterial pressure should be avoided. We applied all-autologous three-
sinus repair, the so-called modified Brom or Myers technique, to
SVPS and examined mid-term outcomes.
Methods:
Between March 2010 and March 2012, 15 patients (eight
males, median age 12 months) with SVPS underwent all-autologous
three-sinus repair. Thirteen patients (87%) had previously undergone
pulmonary artery banding to treat high pulmonary vascular resist-
ance. Two patients (13%) had Noonan syndrome associated with
valvular pulmonary stenosis. Follow up was complete in all patients
and the median follow-up period was 13.5 months (range: 1 month
to 2.4 years). The data were presented as mean
±
standard deviation
(range).
Results:
There was no mortality. The diameter of the stenotic part at
the main pulmonary artery increased from 47.0
±
14.1% (29.1–70.0)
of the normal pulmonary artery diameter at pre-operative evaluation
to 108.4
±
31.7% (58.9–148.1) at six months, then 110.8
±
15.0%
(87.7–134.1) at one year after the operation. Estimated pressure
gradient across the main pulmonary artery decreased from 76.2
±
12.2 mmHg (57.8–108.2) at the pre-operative evaluation to 11.3
±
12.0 mmHg (1.4–49.0) at six months, then 6.7
±
5.5 mmHg (2.0–
19.4) at one year after the operation. Only one patient showed more
than 25 mmHg estimated pressure gradient across the main pulmo-
nary artery, and after careful follow up, was found to have Noonan
syndrome. No pulmonary insufficiency was observed.
Conclusions:
Mid-term outcomes after supravalvular pulmonary
stenosis by all-autologous three-sinus repair were acceptable.
Although long-term follow up is mandatory, application of this tech-
nique may provide symmetry and growth of the reconstructed main
pulmonary artery.
96: THE LONGEVEITY OF CLASSICAL BLALOCK-
TAUSSIG SHUNT FOR PALLIATION OF TETRALOGY OF
FALLOT: A CASE REPORTAND REVIEW OF THE LITERA-
TURE
Uzodimma Adiuku-Brown, Humphrey Anyanwu
Department of Surgery, University of Nigeria Teaching Hospital,
Nigeria
Background:
Tetralogy of Fallot (TOF) is a common cyanotic
congenital heart disease. Total surgical correction may be preceded
by a temporary palliative systemic–pulmonary shunt procedure. We
describe here a patient with TOF who has survived on a classical
Blalock-Taussig (BT) shunt for 31 years.
Methods:
The medical record of a patient who had a BT shunt
performed 31 years ago was reviewed. An electronic search was
made on the PUBMED database of the National Library of Medicine
using the search term ‘classical Blalock-Taussig shunt’. The articles
were reviewed and a manual search was performed to review other
articles of interest found in their references. The review was to
examine other reports on the longevity of the classical BT shunt in
the management of TOF.
Results:
The patient is a 34-year-old male diagnosed with TOF and
he had a classical BT shunt in 1981 at the age of three years, with
subsequent improvement in symptoms. He has been followed up
since then. The last review on 5 September 2011 showed features
suggestive of multi-infarct dementia and a mild left-sided cerebrovas-
cular accident with a patent shunt. He has not been able to afford total
correction. The search yielded 394 articles which were reviewed.
Conclusion:
Although the use of the classical BT shunt for pallia-
tion of TOF is declining, it may still be useful in sub-Saharan Africa
where access to standard cardiac care is difficult.
98: TAILOR-MADE BICUSPID PTFE VALVE IN RVOT
RESECTION: EARLY EXPERIENCE
Ganapathy Subramaniam
1
, Neville Solomon
1
, CS Muthukumaran
2
,
Prasad Manne
2
, Kothai Krishnan
2
,
1
Apollo Children’s Hospital, Chennai, India
2
Lotus Hospital, Hyderabad, India
Background
: The reconstruction of RVOT using monocuspid or
bicuspid valves has been shown to reduce the degree of early pulmo-
nary regurgitation and help smooth the postoperative recovery. The
long-term result with a bicuspid PTFE pulmonary valve is claimed
to be better than with a monocuspid valve. The described method of
reconstruction requires a lot of ‘eyeballing’. We describe a standard-
ised technique of construction of a bicuspid PTFE valve tailored to
the anatomy of the patient, with good early results.
Methods
: Twenty-five patients with a diagnosis of TOF had implan-
tation of a bicuspid valve when they needed a transannular patch
for RVOT reconstruction. An outflow tract 2 mm larger than the
recommended size was used to design the valve. A piece of silk
with a small clip as the marker of the required diameter was used
to measured the width of the PTFE membrane needed, the 0.1-mm
PTFE membrane was folded and the silk thread with marker was
used to measure the width of the required bicuspid valve. The length
of the PTFE membrane was also measured using a piece of sillk
thread from the point of implantation of the valve to the tip of the
ventriculotomy incision. The PTFE was sutured using 6-0 prolene
suture to the outflow tract. The width of the pericardium needed
to patch was measured using a silk thread to measure the required
length and cutting the length of the posterior wall of the RVOT tract.
A rectangular piece of autologous unfixed pericardium was used for
the RVOT reconstruction.
Results
: Two patients had moderate PR, the other 23 had trivial to
mild PR early postoperatively and it remained the same at one week
and at one month of follow up. There was no mortality in this series
and all patients were discharged home after a median stay of two days
in ICU and five days in hospital.
Conclusion
: Fashioning of a bicuspid PTFE valve using tailored
measurements provides gratifying early results. Long-term follow up
is required to evaluate pulmonary competence in the long run.
99: CORRECTED TRANSPOSITION WITH BIVENTRICU-
LAR OUTFLOW OBSTRUCTION MANAGEMENT BY
RELIEF OF SUBAORTIC OBSTRUCTION
Neville Solomon
1
, Ganapathy Subramaniam
1
, Prasad Manne
2
, CS
Muthukumaran
2
1
Apollo Children’s Hospital, Chennai, India
2
Lotus Hospital, Hyderabad, India
Background
: Congenitally corrected transposition of the great arter-
ies (CCTGA) is more often associated with subpulmonary obstruc-
tion and very rarely, subaortic obstruction. We report a rare variant
of CCTGA with both subaortic and subpulmonary obstructions with
no intra-cardiac shunts.
Method
s: This was a predominantly asymptomatic three-year-
old child who presented with systolic ejection murmur grade 4/6
along the left parasternal border. Transthoracic echocardiography
confirmed CCTGA, mitral valve accessory tissue attached to the left
ventricular outflow tract (LVOT) causing moderate to severe LVOT
obstruction (peak gradient 4 m/s peak). The mucle-bound right
ventricle (RV) showed severe infundibular obstruction (peak gradi-
ent 50 mmHg). The subaortic obstruction was relieved, leaving the
subpulmonary obstruction untouched.
Result
: The child had an uneventful postoperative recovery. The
LVOT gradient was now less than 8 mmHg, and the RVOT was
