CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
14
AFRICA
have emphasised the critical importance of the early mother–infant
relationship for the general development and future well-being of
the child.
Methods
A prospective, longitudinal, staged study was designed to
explore the psychological well-being of mothers and babies and the
nature of the developing mother–infant relationship following the
infant’s heart surgery. Complementary qualitative and quantitative
research methods were used. Data were collected when the infant
was two and nine months old. Mothers’ perceptions, standardised
measures of maternal distress, and observations of infant interaction
with the researcher were compiled at each stage. Maternal distress
was evaluated using the Edinburgh Post-Natal Depression Scale,
State-Trait Anxiety Scale and Parenting Stress Index Short Form.
Infants’ well-being was tapped using a measure of social withdrawal
(ADBB). In-depth interviews with the mother explored experi-
ences of the diagnosis, infant’s hospitalisation and treatment, and her
perceptions of her developing relationship with her infant. The result-
ing narratives were subjected to thematic content analysis.
Results
: The cardiac diagnoses varied from an isolated VSD to
HLHS. Very high levels of maternal distress were found and almost
half of the infants were socially withdrawn Maternal distress was
associated with infant social withdrawal. Thematic analysis of the
maternal interviews revealed shock and acute stress as central to
mothers’ experience. Also, mothers’ perception of infant responsive-
ness appeared to affirm life, and recognition of these qualities in the
infant may help to facilitate mothers’ recovery.
Conclusion
: Important issues need to be addressed to provide
services for facilitating the well-being of both mother and infant over
and above improving surgical outcomes. The research was funded by
the NHMRC and carried out with the support of Monash University,
MCRI, Monash Medical Centre and The Royal Children’s Hospital.
218: ROLE OF FENESTRATION IN THE FONTAN CIRCU-
LATION: HAEMODYNAMIC RESPONSES TO CARDIAC
OUTPUT CHANGE
Hirofumi Saiki, Hirotaka Ishido, Satoshi Masutani, Hideaki Senzaki
Saitama Medical University, Saitama, Japan
Background:
Although the fenestrated Fontan procedure was devel-
oped to assure haemodynamic stability during the acute postoperative
phase, controversy exists whether fenestration for the chronic phase
is beneficial and how fenestration works in response to homonymic
changes. In this study, we investigated the haemodynamic behavior
of the fenestrated Fontan circulation in response to increased and
decreased cardiac output.
Methods:
We studied 15 Fontan patients with fenestration. During
cardiac catheterisation, haemodynamic changes in response to dobu-
tamine infusion and atrial pacing were examined both before and
after temporal occlusion of fenestration.
Results:
The trends of changes in cardiac output (CO) and arterial
oxygen saturation (SaO
2
) by atrial pacing varied among patients.
With the increase in cardiac output, fenestration predominantly
provided an increased amount of CO. Because of increased CO,
oxygen saturation was preserved during the dobutamine infusion.
As for atrial pacing, ventricular relaxation could determine the
CO response to increased heart rate (HR), irrespective of baseline
pulmonary-to-systemic flow ratios (Qp/Qs) and pulmonary arterial
resistance. Conversely, SaO
2
was determined by the change in Qp/
Qs and change in central venous oxygen saturation. Interestingly, we
observed a linear relationship between stroke volume (SV) and Qp/
Qs, indicating that SV could determine Qp/Qs during HR variations
in fenestrated Fontan. Furthermore, we found that patient age was an
independent determinant of individual SV–Qp/Qs relationships by
multiple regression analysis (
p
=
0.013).
Conclusions:
The Qp/Qs can change with HR variations on the
basis of the patient’s specific SV–Qp/Qs relationship. Because this
relationship varies with the patient’s growth, and because oxygen
saturation is strongly influenced by central venous oxygen satura-
tion, fenestration showed beneficial and ideal activity, especially in
younger patients. Fenestration would be active in preserving both
oxygen saturation and preload corresponding to cardiac output varia-
tions, both in increasing and decreasing cardiac output.
228: PAEDIATRIC ECMO AT SMALL PAEDIATRIC CARDI-
AC CENTRES IN THE NORDIC COUNTRIES
Mette Veien
1
, Lars Lindberg
2
, Valeria Perez de SÃ
2
, Kari Wagner
3
,
Paula Tynkkynen
4
, Ola Ingemansson
5
, Hanne Ravn
1
1
University Hospital of Aarhus, Denmark
2
University Hospital of Lund, Sweden
3
University Hospital of Oslo, Norway
4
University Hospital of Helsinki, Finland
5
University Hospital of Sahlgrenska, Gothenburg, Sweden
Background:
Paediatric ECMO is a highly specialised treatment and
experienced teams are necessary for an acceptable outcome. The five
Nordic countries all have a confined background population, result-
ing in a restricted number of paediatric ECMO runs in each centre. In
order to compare the performance of the Nordic centres with the rest
of the world we compared data from a 10-year period with the ELSO
register and with selected high-volume centres.
Methods:
A MEDLINE and PUBMED search (2005–2012) was
done to find results from larger single-centre studies. Data will be
collected retrospectively and will comprise children
<
19 years of
age from the six Nordic centres Cumulative data from all the Nordic
centres will comprise sufficient data to perform relevant statistics and
evaluate the overall performance of minor ECMO centres.
Results:
Mortality and secondary outcome as well as data on demo-
graphics, indications and complications will be presented from the
Nordic centres. A comparison of indications, outcome and complica-
tions associated with ECMO will be performed between data from
the Nordic centres and the ELSO register as well as selected single
large-centre studies.
Conclusion:
The analysis will provide insight into the performance
of minor centres, and if specific ECMO runs or indications should
be improved or referred for larger centres. Furthermore, the analysis
will address whether there are certain risk factors associated with a
poor outcome. As data analysis is still pending, no conclusions can
be made at this point.
244: EARLY AND MID-TERM OUTCOMES OF A SUTURE-
LESS TECHNIQUE FOR POSTOPERATIVE PULMONARY
VENOUS STENOSIS
Kizuku Yamashita, Koji Kagisaki, Takaya Hoashi, Isao Shiraishi,
Hajime Ichikawa
National Cerebral and Cardiovascular Centre, Japan
Background
: Sutureless
in
situ
pericardium repair for the relief of
pulmonary venous stenosis (PVS) after the repair of TAPVC was
firstly reported by F Lacour-Gayet in 1996. This technique has been
popular because of its potential to avoid recurrent stenosis. However,
detailed clinical advantages remain unclear. We retrospectively
reviewed our surgical experience and compared the outcome with
that of conventional procedures.
Methods
: For the relief of postoperative PVS after TAPVC repair,
five patients underwent a conventional procedure such as orifice
cutback or resection of a proliferated intima from 1999 to 2004
(group C, four males, median 93 days old, 3.6 kg). Thereafter seven
patients with PVS were repaired with the sutureless technique from
2005 to 2011 (group S, five males, 119 days old, 3.4 kg). Patients
with a single ventricle were excluded. There were no significant
differences regarding patient characteristics. Follow-up examinations
were completed in all patients.
Results
: The cumulative survival rates at five years in groups C and
S were 60 and 85.7%, respectively. Freedom from re-intervention
for the pulmonary veins at five years in groups C and S were 60 and
85.7%, respectively. The rate of re-stenosis after relief of PVS were
100% (10/10) in group C and 31.6% (6/19) in group S (
p
=
0.0088).
