CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
146
AFRICA
Centre for Women, Children and Reproduction, Copenhagen
University Hospital, Denmark
2
Institute of Sports Medicine, Department of Orthopedic Surgery M,
Institute of Sports Medicine Copenhagen, Bispebjerg Hospital and
Centre for Healthy Aging, Faculty of Health Sciences, University of
Copenhagen, Copenhagen, Denmark
3
Institute of Clinical Medicine, University of Bergen, Norway
4
Copenhagen Trial Unit, Centre for Clinical Intervention Research,
Copenhagen University, Denmark
5
The Heart Centre, Copenhagen University Hospital, Rigshospitalet,
Denmark
6
National Research Centre for theWorking Environment, Copenhagen,
Denmark
Background
: Intensive exercise may be an important part of reha-
bilitation in patients with congenital heart disease (CHD). However,
performing regular physical exercise is challenging for many adoles-
cent patients. Consequently, effective exercise encouragement may
be needed. Little is known on the effect of e-Health encouragements
on physical fitness, physical activity and health-related quality of
life (HRQoL) in adolescents. This trial is a nationwide interactive
e-Health rehabilitation study lasting one year, centred on interactive
use of mobile phone and Internet technology.
Hypothesis
: We hypothesised that e-Health encouragements and
interactive monitoring of intensive exercise over one year could
improve physical fitness, physical activity and HRQoL.
Methods
: Two hundred and sixteen adolescents (13–16 years)
with surgically corrected complex CHD, but without significant
haemodynamic residual defects and no restrictions to participate in
physical activity are in the process of being enrolled by invitation
after informed consent. Physical fitness is measured as the maximal
oxygen uptake (VO
2
peak) at baseline and after 12 months by an
assessor blinded to the randomisation group. After baseline testing,
the patients are 1:1 randomised to an intervention group or a control
group. Individually fully automated tailored e-Health encourage-
ments: SMS, Internet and mobile applications aimed at increasing
physical activity are delivered to the participants in the intervention
group once a week. Bandura’s social cognitive theory inspires the
behavioural theoretical background.
Results
: The e-Health intervention and the Godfrey cycle ergometer
protocol has been feasibility tested and seems applicable to adoles-
cents with CHD. The trial is expected to contribute to new knowledge
regarding how physical activity in adolescents with CHD can be
increased and possibly co-morbidity reduced.
182: PULMONARY ATRESIA WITH INTACT VENTRICU-
LAR SEPTUM: SINGLE INSTITUTION EXPERIENCE
Olena Boiko
1
, Andrii Maksymenko
2
, Arkadii Dovgaliuk
2
, Yuliia
Kuzmenko
2
, Iliya Yemets
3
1
Paediatric Cardiology, Ukrainian Children’s Cardiac Centre, Ukraine
2
Paediatric Interventional Cardiology, Ukrainian Children’s Cardiac
Centre, Ukraine
3
Paediatric Cardiac Surgery, Ukrainian Children’s Cardiac Centre,
Ukraine
Objective:
This study analyses outcomes and predictive factors in
cases of percutaneous and surgical treatment of pulmonary atresia
with intact ventricular septum (PA-IVS).
Methods and Results:
Between September 2003 and March 2012,
53 consecutive newborns with PA and IVS were reviewed. Ten
patients had a concomitant pathology, Ebstein’s anomaly (
n
=
6),
severe dysplasia of TV and RV (
n
=
4) including Uhl’s syndrome (
n
=
2). All patients were divided into three groups: no to mild RH hypo-
plasia (
n
=
35), moderate hypoplasia (
n
=
10), and severe in eight
patients. Thirty-two neonates with PA-IVS underwent attempts with
percutaneous balloon pulmonary valvoplasty as primary procedure,
which was successful in 28 patients. Mortality rate was 10.7%, there
was no procedure-related death or major complications. Freedom
from re-intervention was 32%. Nineteen patients required 23 addi-
tional surgical procedures after BPVP, 10 of them in the 10 days
after BPVP. Primary surgical procedure was performed in 21 patients
(including three patients after unsuccessful BPVP). There were 11
one-stage repair with mortality rate 55% (
n
=
6) and BTSh in 10 with
mortality rate 20% (
n
=
2). Mortality rate after surgical procedures
was associated with presence of Ebstein’s anomaly (four of six),
severe dysplasia of TV (two of two) (
p
<
0.001). Five patient was
refused treatment because of RVDCC (
n
=
3) and severe dysplasia of
the right ventricle (
n
=
2). Of 44 patients who survived, 23 already
had biventricular circulation and four are planned for biventricular
repair, four are planned for 1.5-ventricle circulation, and eight are
awaiting staged univentricular correction.
Conclusions:
Percutaneous balloon valvotomy is an effective treat-
ment strategy for cases of PA-IVS with well-formed right ventricle
and absence of right ventricular dependent coronary circulation.
Severe dysplasia of RH structures and Ebstein’s anomaly were asso-
ciated with high mortality.
188: QUANTIFICATION OF QUALITY IN CONGENITAL
HEART SURGERY
Nicodeme Sinzobahamvya, Claudia Arenz, Sojiro Sata, Christoph
Haun, Ehrenfried Schindler, Peter Zartner, Viktor HraskaI, Boulos
Asfour
German Paediatric Heart Centre, Sankt Augustin, Germany
Background:
Estimation of quality of congenital heart surgery
should reflect procedural complexity, achieved survival and observed
postoperative unfavourable events. It should be quantified to facili-
tate bench-marking.
Methods:
Procedural complexity was determined by Aristotle’s
basic complexity score. Hospital and 30-days survival was applied.
Surgical performance was estimated as the product of complexity
score and achieved survival. Observed morbidity was calculated as
score according to the methodology of Sata and co-authors. The
following formula was used: Quality in congenital heart surgery
=
surgical performance – morbidity score. Means are given with
±
standard deviation.Year 2011 results were analysed.
Results:
Primary procedures (542), including 46 (8.5%) without
cardiopulmonary bypass, were evaluated. Total cavopulmonary
connection with external fenestrated conduit constituted the most
frequent operation (
n
=
34). Mean Aristotle basic score amounted
to 7.78
±
2.65 points. Survival reached 98.15% (532/542). Surgical
basic performance attained was 7.64
±
2.60 points. No adverse event
occurred following 183 (33.8%) procedures. Calculated morbidity
score averaged 2.26
±
1.80 points for the whole cohort. Consequently,
quality of congenital heart surgery for year 2011 was quantified at
7.64 – 2.26
=
5.38 points.
Conclusions:
Such quality quantification adequately reflects
complexity of performed procedures and related observed mortality
and morbidity. Once accepted, it could serve as a reliable tool for
monitoring and comparing the achievement of various programmes
of congenital heart surgery.
200: FACTORS AFFECTING GROWTH FROM BIRTH TO
NORWOOD DISCHARGE: RESULTS FROM THE SINGLE
VENTRICLE RECONSTRUCTION TRIAL
LuAnn Minich, for the Paediatric Heart Network Investigators
University of Utah, USA
Background
: Growth failure after the Norwood procedure is a poten-
tially modifiable risk factor for medical morbidity and neurodevel-
opmental outcome. We sought to characterise growth patterns and to
determine risk factors for poor growth between birth and Norwood
discharge.
Methods:
We performed a secondary analysis of growth using the
Single Ventricle Reconstruction Trial (SVR) database, in which
subjects undergoing a Norwood procedure were randomised to modi-
fied Blalock-Taussig vs right ventricular-to-pulmonary artery shunt.
