CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
204
AFRICA
especially in patients admitted to neonatal and paediatric intensive
care units (NICU/ PICU). Fungal endocarditis is an IFI with high risk
of complications and death. Several risk factors such as prolonged
hospital stay, use of central venous catheters and broad-spectrum
antibiotics, and the particular vulnerability of the immunological
immaturity of the infants, especially preterm newborns, have been
identified. In these cases, even non-pathogenic strains might be iden-
tified with related risk factors.
Methods:
We reviewed paediatric case report with unusual fungal
mitral valve endocarditis treated medically in Colombia.
Results:
We present a two-month-old male infant with a history
of complications associated with 28 weeks’ prematurity, prolonged
hospitalisation in the NICU/PICU, episodes of early and late neona-
tal sepsis, necrotising enterocolitis complicated with short-bowel
syndrome transiently treated with probiotics. He was managed with
broad-spectrum antibiotics, and had a central venous catheter. He
developed mitral valve endocarditis caused by
Saccharomyces
sp,
which was isolated from several blood cultures. He was treated
initially with fluconazole and changed to deoxicolato of amphotericin
B based on laboratory susceptibility, with complete clinical and
microbiological recovery. Surgical management was not performed
and differed due to the patient’s condition.
Conclusions:
Isolation of this non-pathogenic yeast, widely used as
probiotic, as a cause of endocarditis in a patient with multiple risk
factors such as our patient’s case has been infrequently reported.
Nevertheless, it suggests that there are certain circumstances in
which these probiotics should be used with caution.
989: LONG-TERM SURVIVAL AFTER SURGERY IN
PATIENTS WITH CONGENITAL HEART DEFECTS AND
DOWN SYNDROME
Eva Stramvall Larsson, Haykan Berggren, Jan Sunnegayrdh
The Queen Silvia Children’s Hospital, Sahlgrenska University
Hospital, Sweden
Background:
To collect reliable and complete data for evaluation of
long-term survival after paediatric cardiac surgery in patients with
Down syndrome.
Methods
:
All 288 patients (131 girls, 157 boys) operated due to
congenital heart defects in our institution before the age of 18 years,
from 1 January 1994 to 1 January 2009 were included. During the
study period, nearly 50% of all paediatric cardiac surgery in Sweden
was performed at our institution. Patient files were cross-checked as
of 1 Janury 2012 against the National Population Registry in Sweden,
allowing for reliable and complete data on long-term survival. Two
patients emigrated and were lost to follow up.
Results:
Median age at first surgery was 0.44 years (0.01–15.69
years); 142 (49%) had surgery for atrioventricular septal defects
(AVSD), 72 (25%) for ventricular septal defects (VSD), 13 (5%) for
isolated tetralogy of Fallot and seven for AVSD and tetralogy. Six
patients had univentricular heart palliations. Eleven of the patients
with AVSD/VSD had a pulmonary artery banding as the first opera-
tion. Median age of survivors at follow up was 10.6 years (3.3–32.6
years); 18 deaths (6.3%) occurred with a median age at death of 1.6
years (0.06–21.36 years). The cause of death was pulmonary hyper-
tension in four, and septicaemia in five. One patient operated for a
VSD at the age of four months also had biliar atresia and had a liver
transplant. He died at the age of three years. One patient died in an
accident. There were seven cardiac deaths. Fifteen patients developed
complete AV-block postoperatively, needing a pacemaker. Eleven
patients developed significant mitral valve regurgitation and had a
mechanical valve prosthesis inserted.
Conclusions:
With 93.7% of the patients alive at follow up, long-
term survival was favourable. The majority of deaths (78%) occurred
after 30 days postoperatively, reflecting the need for long-term follow
up.
990: THE AMAZING RIGHT BUNDLE BRANCH BLOCK: A
VANISHING ACTWITNESSED IN MOTION
Gurur Biliciler-Denktas, Henry Burkholder, Mohammed Numan
University of Texas at Houston, USA
We report a three-year-old male with VSD and aortic insufficiency
who acquired a RBBB after surgical repair and we have captured
its real-time resolution on surface ECG during a follow-up clinical
visit. The initial postoperative visit 12-lead ECG showed a complete
RBBB with a QRS duration of 160 ms. A 12-lead ECG at a subse-
quent follow-up visit showed normal sinus rhythm with rSR’ pattern
noted in V1, slurred S in lead I, V1 QRS duration of 160 ms, and
T wave that was deflected opposite the terminal deflection of the
QRS complex defining the patient’s right bundle branch block.
Interestingly, the RBBB changed morphology during the electro-
cardiogram on the V1 rhythm strip to an incomplete RBBB pattern
(QRS duration
=
80 ms).
This ECG captures the resolution of a RBBB after VSD surgical
repair in real time. Subsequent ECGs confirmed the resolution of the
RBBB. The mechanism behind a RBBB secondary to surgical VSD
repair is usually due to operative injury to the proximal right bundle,
Purkinje fibre network, or distal branch or branches of the right
bundle from where the patch is introduced. This type of damage is
unlikely to resolve. Transient RBBB in postoperative VSD patients is
most likely due to a different mechanism such as local inflammation
or oedema. This case demonstrates the need to closely follow ECGs
after surgical VSD repair and that damage to the conduction system
may not be permanent.
Since RBBB may eventually cause diastolic dysfunction in this
group of patients, resolution of the block is not trivial in nature. The
resolution of this conduction delay shows that inflammation and
oedema may play a role in RBBB, even months after surgery.
1000: MIDTERM FUNCTIONAL OUTCOMEAFTER REPAIR
OF ANOMALOUS ORIGIN OF THE LEFT CORONARY
ARTERY FROM THE PULMONARY ARTERY (ALCAPA)
Lennart Duebener, Claudia Arenz, Peter Murin, Ehrenfried Schindler,
Martin Schneider, Peter Zartner, Nicole Toussaint-Gåtz, Nicodeme
Sinzobahamvya, Boulos Asfour, Victor Hraska
German Paediatric Heart Centre, Sankt Augustin, Germany
Background
: Treatment options for ALCAPA repair include direct
implantation of the origin of the left coronary artery into the aorta,
and the Takeuchi procedure, which involves creation of an aortopul-
monary window and a tunnel that directs blood from the aorta to
the anomalous left coronary artery. The patient outcome and the
incidence of residual and new lesions after the two types of ALCAPA
repair were analysed.
Patients
: From 1995–2012 a total of 21 patients (76.2% female)
underwent ALCAPA repair at our institution. Four (19%) had a
Takeuchi procedure and 17 (81%) direct implantation of the LCA.
Concomitant procedures included mitral valve repair (
n
=
2) and
ASD closure (
n
=
1). The mean patient age at time of surgery was
8.3 months (range: first day of life – 41.4 months).
Results
: Surgical and late mortality rate was zero. The mean length
of follow up after surgery was 6.2 years (range: 0.4–10.9 years).
Mean postoperative LV fractional shortening at last follow up was
38.3
±
5.6% and mean LVEDD was within normal limits. Reasons
for re-operations included residual mitral regurgitation (MR) (
n
=
1)
and baffle leaks (
n
=
2). The freedom from re-operation was 81% at
five years. Mild main pulmonary artery stenosis was documented in
three patients after Takeuchi repair. Three patients had a moderate
degree of residual mitral regurgitation; the remaining patients were
free of MR or had only a mild degree.
Conclusions
: ALCAPA repair can be performed with low surgi-
cal mortality. In the majority of patients after ALCAPA correction,
both ventricular function and mitral valve regurgitation normalise
over time. Therefore concomitant mitral reconstruction may not
be required upon initial repair. Coronary transfer is our preferred
