CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
163
outcome of EA/TEF. Our aim was to evaluate the impact of CHD on
timing of surgical repair and outcome of children with EA/TEF in
the current era.
Methods:
A retrospective review of patients with EA/TEF treated
at two academic institutions from 1995 to 2011 was performed. The
presence of cardiac defects, other anomalies, surgical intervention
and outcome were recorded.
Results:
Among 231 babies with EA, 117 (51%) had CHD. Neonates
with EA/TEF and CHD had lower gestational age (
p
=
0.04), birth
weight (
p
=
0.001), and were more likely to be syndromic (
p
=
0.0002) than patients without CHD. VSD and ASD were most
common, followed by anomalies of the systemic/pulmonary veins,
tetralogy of Fallot, aortic arch anomalies, atrio-ventricular valve
abnormalities, and double-outlet right ventricle. There was no differ-
ence between EA/TEF alone and EA/TEF with CHD in the age of
oesophageal surgery, surgical approach, days of mechanical ventila-
tion, and the length of hospital stay, although CHD neonates had a
higher incidence of pre-operative mechanical ventilation (
p
=
0.006).
Overall mortality was 9%, 6/114(5%) in EA/TEF without CHD,
16/117(14%) in EA/TEF with CHD (
p
=
0.04). However, only 5/22
deaths were the direct result of CHD; the remainder were due to other
anomalies or respiratory disease.
Conclusions:
CHD did not influence surgical strategy or morbidity
in this series, although mortality was higher in the presence of CHD.
Our data indicate that CHD was not directly responsible for death,
and mortality may therefore have been multifactorial. Newborns
with EA/TEF should be evaluated for CHD, but with improvements
in surgical and neonatal care the co-occurrence of EA/TEF and CHD
does not preclude a good outcome in the majority of patients.
403: SILVER DRESSINGS FOR STERNOTOMY INCISION
CARE IN PAEDIATRIC CARDIAC PATIENTSTO DECREASE
SURGICAL SITE INFECTIONS
Sandra Staveski, Claire Abrajano, May Casazza, Ellen Bair, Emily
Dong, Amy Petty, Katie Felix, Hanson Quan, Stephen Roth
Lucile Packard Children’s Hospital, Stanford, California, USA
Background:
The consequences of surgical site infections (SSIs)
can be significant and range from discharge delays to mediastinitis.
Meticulous wound care is important to reduce SSIs. Our study team
hypothesised that the use of silver-impregnated dressings on post-
operative paediatric cardiac surgery patients could reduce SSIs.
Methods:
Institutional review board approval was obtained to
examine the infection preveniton qualities of silver-impregnated
dressings on children post-sternotomy for congenital heart defects.
Our population included infants to adolescents
<
19 years of age and
cardiac diagnoses ranging from RACHS-1 score 1 to 6. The final
sample was 122 children (silver
=
62; standard
=
60). The sample size
was chosen for a clinically important effect size of 0.5 in the detec-
tion of differences in SSI rates with
>
75% power at a level of 0.05.
Appropriate dressings were applied in the operating room, and chil-
dren were followed for five days post-operatively or until discharge.
The ASEPSIS wound score is a validated wound assessment tool; it
was utilised to assess wound infections. The study team supervised
all dressing changes during the study period. Thirty-day follow up for
SSIs was performed. This randomised controlled trial evaluated silver-
impregnated dressings versus our standard dressings on SSI rates.
Results:
There were no SSIs in either study group. We found that
there was no difference in type of dressing utilised, on SSI rates.
Conclusions:
Our study does not support the use of silver-impreg-
nated dressings in children after congenital heart surgery as a SSI
prevention method.
404: MYOCARDITIS IN CHILDREN “CLINICAL PROFILE
AND OUTCOME
Shakuntala Prabhu, Sumitra Venkatesh, Anand Ranagol, Snehal
Kulkarni
Department of Paediatrics, Division of Paediatric Cardiology, India
Aim:
To study the demographic profile, clinical presentation and
outcome of children diagnosed with acute myocarditis.
Methods
: Records of 38 children diagnosed with acute myocarditis
were analysed.
Results:
There were 44.7% of patients below one year of age with
male:female ratio being 1.4:1. Congestive heart failure, breathlessness,
viral prodrome and fever were the common presenting symptoms. The
initial clinical diagnosis was congenital heart disease, CCF, unex-
plained tachycardia and pneumonia in 78%. The duration of symp-
toms before diagnosis was more than five days in 85%. Tachycardia,
gallop, bradycardia, hypotension, hyperdynamic precordium and
cardiogenic shock were the presenting signs. Fulminant myocarditis
was diagnosed in five patients (13.1%). Anaemia, hypocalcaemia,
and altered liver enzymes were the biochemical abnormalities noted.
Anaemia correlated with a poorer outcome on follow up (
p
<
0.05).
High CPK:CPK-MB was seen in 31 (81.5%); 34 (84.7%) had an
abnormal X-ray and 26 (68%) had abnormal ECGs. Two-dimensional
echocardiogram revealed moderate to severe left ventricular dysfunc-
tion (LV) in 19/38 (50%). Furosemide and/or captopril were initial
medications used with 11 (28.9%) needing an inotrope and eight
(21%) requiring immune modulators. Hospitalisation ranged from
<
five days in 7.8% to
>
15 days in 2%. CCF was difficult to treat in five
patients (13.1%). Two patients died during the acute phase and four
in the sub-acute phase of illness. At the three-month follow up, those
with fulminant myocarditis had earlier normalisation of LV function
than those with acute myocarditis (
p
=
0.048);. 26 children (68.4%)
had complete recovery with six (15.7%) having a partial recovery.
Conclusion
: Acute myocarditis often presents with non-cardiac
symptoms, thus delaying clinical diagnosis. Fulminant myocarditis
has better long-term outcomes than acute myocarditis.
405: RHEUMATIC FEVER AND RHEUMATIC HEART
DISEASE: AN URBAN STUDY
Sumitra Venkatesh, Pankaj Bagesar, Shakuntala Prabhu, Snehal
Kulkarni
Department of of Paediatrics, Division of Paediatric Cardiology, BJ
Wadia Hospital for Children, Mumbai, India
Aims:
To study the demographic
,
clinical and echocardiographic
profile at presentation and a two-year follow up of children diagnosed
with rheumatic heart disease (RHD)/acute rheumatic fever (ARF).
Methods:
Records of 69 patients diagnosed with ARF/RHD were
analysed. Psycho-social evaluation and compliance were assessed
with a separate questionnaire
Results:
Male:female ratio was 2.1:1. Mean age was 9.5 years with
2/69, being less than three years. Over-crowding was noted in 62.3
and 80% of patients belonged to the lower socio-economic class.
Carditis (78.2%), polyarthritis (56.5%), chorea (7.2%), fever (68%)
and arthralgia in 62.3% were the presenting symptoms. ASLO titre
was positive in 82.6%, while leucocytosis, elevated ESR and posi-
tive CRP was seen in 49, 60.8 and 78%, respectively. Compliance
with penicillin prophylaxis was noted in 86.5%. Non-availability of
injection (24.6%), self-omission (13%) and switching to alternative
medicine (11.6%) were the reasons cited by the defaulters. Initial 2D
echocardiogram/Doppler revealed mitral affection in 92.7%, aortic
valve in 1.4%, dual valve involvement in 8.6% and silent carditis
in 8.6%. On follow-up echocardiogram, 36.2% showed improve-
ment, 20.3% worsened, 43.5% remained unchanged with six patients
requiring valve surgery. Compliance with penicillin prophylaxis was
90.3% in the improved group and 71.2% in those who worsened (
p
<
0.05). Parents were concerned about poor scholastic performance
(32%), sub-optimal health and activity (78%), financial burden
of therapy (33.3%), future marital and reproductive life concerns
(100%), with 6% of young adults reporting employment issues.
Conclusion:
Carditis and arthritis were the commonest presentation.
Intermittent non- availability of drugs was the commonest reason
for poor compliance. The disease and treatment hampers scholastic
performance, increases economic burden and lowers the self-esteem
of the child.
