CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
128
AFRICA
increased LOS (
p
<
0.001), with utilisation of diagnostic evaluation
of non-cardiac causes (
p
<
0.001). Increased LOS was not associated
with adverse clinical outcome (
p
=
0.72).
Conclusions
: Adult CHD patients require admissions for both
cardiac and non-cardiac reasons. Older age group and endocardi-
tis were associated with increased LOS. Non-cardiac conditions
required interdisciplinary resources and involved increased LOS.
Understanding their diverse acute needs may be possible to improve
care and outcome for these patients.
1491: MICROALBUMINURIA IN CHILDREN WITH
CONGENITAL HEART DISEASE: SENSITIVE MARKER OF
CYANOTIC NEPHROPATHY
Seiko Kuwata, Clara Kurishima, Hirofumi Saiki, Hirotaka Ishido,
Satoshi Masutani, Hideaki Senzaki
Saitama Medical Center, Saitama Medical University, Japan
Background
: As a result of advances in cardiovascular surgery in
congenital heart disease (CHD), a large number of patients with CHD
are now entering adulthood, and are facing many problems. Renal
dysfunction is one such problem. Microalbuminuria is a sensitive
marker of early-stage renal impairment, and microalbumin-creatinine
ratio (
µ
ALB/Cre) is reported to be a useful predictor of future cardio-
vascular events. We investigated whether early-stage renal impair-
ment assessed by
µ
ALB/Cre already exists in children with CHD,
and examined the determinants inducing
µ
ALB/Cre elevation.
Methods and results:
We examined urinary concentrations of
Cre and microalbumin, serum levels of Cre and cystatin C, arte-
rial oxygen saturation (SaO
2
) and haemodynamic variables in 150
patients with CHD (90 male, median age 5.5) who underwent cardiac
catheterisation between 2011 and 2012 in our hospital. Among these
patients 32% showed abnormal levels of
µ
ALB/Cre (
>
30). There
was no significant correlation between
µ
ALB/Cre and Cre or cystatin
C. Multivariate analysis with age, sex, systemic cardiac output, blood
pressure, pulmonary artery pressure, central venous pressure, and
SaO
2
including independent variables demonstrated that only SaO
2
significantly correlated with
µ
ALB/Cre (
p
=
0.019). In a separate
group of cyanotic CHD, there was also a statistically significant
correlation between
µ
ALB/Cre and SaO
2
(
r
=
0.70
p
<
0.05), inde-
pendent of the levels of Cre and systatin C.
Conclusions:
Low SaO
2
is an important determinant of renal impair-
ment even in children.
µ
ALB/Cre appears to be more useful to detect
the early phase of cyanotic nephropathy than serum Cre or cystatin C.
1518: SUCCESSFUL PERINATAL OUTCOME IN A PATIENT
WITH SINGLE VENTRICLE PHYSIOLOGY WITH EISEN-
MENGER SYNDROME
Amitabha Chattopadhyay, Navdeep Singh, Mahua Roy, Debasree
Gangopadhyay, Hemant Nayak, Prashant Thakur, Biswajit
Bandyopadhyay, Emmanuel Rupert, Ashis Ghosh
Department of Pediatric Cardiology, Cardiac Anesthesia ,
Gynaecology & Obstetrics, Rabindranath Tagore International
Institute of Cardiac Sciences, Kolkata, India
Background:
Pregnancy in patients with Eisenmenger’s syndrome
(ES) is associated with high maternal and foetal mortality as pulmo-
nary hypertension (PAH) is aggravated, leading to poor outcomes.
Here we report a rare case of successful outcome of pregnancy in
a patient with double inlet left ventricle (DILV) with ES. Although
pregnancy is discouraged in such patients, a coordinated multidis-
ciplinary team effort for a patient presenting in late gestation is
imperative.
Materials and method:
A 26-year-old primipara with short stature
and torticollis presented at 32 weeks’ gestation; ultrasound showed
a single live fetus. She was haemodynamically stable, in NYHA
class II and saturating at 85% in room air. A loud second heart
sound along with an ejection systolic murmur could be appreciated.
Echocardiography diagnosed DILV with a large inlet ventricular
septal defect (VSD) amounting to a single ventricle, unrestricted
pulmonary blood flow and severe PAH. Foetal echocardiography
revealed no major cardiac abnormalities. Chest X-ray alluded to
established ES and she had a sinus rhythm on electrocardiograph
(ECG). Inputs from the obstetrician, anaesthesiologist and neona-
tologist were taken. The patient was admitted for monitoring and
oxygen inhalation. Heparin infusion was started and diuretics were
minimised to prevent volume depletion. Intravenous betamethasone
was administered for foetal lung maturity. A caesarean section was
undertaken at 35 weeks’ gestation along with tubal ligation. Spinal
anaesthesia had to be converted to general anaesthesia for adequate
analgesia. A healthy, appropriate-for- gestational-age, baby girl was
delivered. The postpartum period was uneventful. The newborn’s
echocardiogram was normal. The mother was prescribed oral sildena-
fil and bosentan in the postpartum period along with advice to refrain
from excessive physical exertion.
Conclusion:
A multidisciplinary approach, judicious use of medica-
tions and anaesthesia and delivery at a centre with expertise in grown
up congenital heart diseases is mandatory for favourable outcome in
an otherwise extremely high-risk pregnancy in cases of ES.
1566: FONTAN OPERATION IN ADULTS: IS IT NECESSARY
TO STAGE THE PROCEDURE?
Ravi Agarwal, Saileela, Krishna Manohar, KM Cherian
Frontier Lifeline Hospital, Chennai, India
Background
: Data on immediate postoperative results of Fontan
operation in adult patients are limited. We present a single institution’s
experience with single-stage and staged Fontan procedures in adults.
Materials and methods
: Case records of adults (
>
18 years of age)
who underwent Fontan operation from February 2004 to July 2012
were reviewed.
Results
: Among 28 patients, 15 underwent single-stage Fontan
whereas 13 patients underwent completion of staged Fontan. Mean
age at surgery was 21.96
±
1.37 years. The ventricular morphology
was left in 16, right in 6 and biventricular in 6 patients. Mean pulmo-
nary artery (PA) pressure was 13.14
±
1.13 mmHg and mean ventric-
ular end diastolic pressure was 11.7
±
1.15 mmHg. Extracardiac
Fontan was done in 14 and lateral tunnel was done in 14 patients.
All of them had fenestration. Atrioventricular (AV) valve repair was
performed in 4 patients. Two patients had pacemaker implantation
during the procedure for pre-existing complete heart block. The
mean cardiopulmonary bypass time was 185
±
26.26 min and cross
clamp time 56
±
12.34 min. Among survivors, the mean duration
of mechanical ventilation was 17
±
4.39 hours and that of inotropic
support was 51
±
9.4 hours. Average intensive care unit (ICU) stay
was 3.25
±
0.42 days and chest drain duration was 7.16
±
1.7 days.
There was no statistical significance (unpaired t test) between those
who had single-stage Fontan and staged Fontan completion in terms
of survival and abovementioned outcome measures. Four patients
(14%) died in the postoperative period; 2 patients died due to post-
operative arrhythmias, 1 due to failing Fontan and 1 due to severe
anaphylaxis.
Conclusion
: Single-stage Fontan operation can be performed safely
in the adult age group, if PA pressure is normal. There seems to be
no significant difference in the early postoperative results between
single-stage and staged Fontan in adults.
1582: ROLE OF ROUTINE USE OF CONTINUOUS POSITIVE
AIRWAY PRESSURE THERAPY (CPAP) IN FAST TRACK-
ING AFTER OPEN HEART SURGERY IN ADULTS WITH
CONGENITAL HEART DISEASES
Varuna Varma, Nirmal Gupta
Department of CVTS, Sanjay Gandhi Postgraduate Institute of
Medical Sciences, Lucknow, India
Introduction
: Prolonged elective ventilation after open-heart surgery
in adult congenital heart disease patients for respiratory complica-
