CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
210
AFRICA
Background
: The prognosis for hypoplastic left heart syndrome
(HLHS) has greatly improved over the past years, but there is still a
significant risk of inter-stage mortality, particularly between stages
1 and 2 of surgical palliation. Tricuspid regurgitation (TR) is known
to be a risk factor for postoperative and inter-stage mortality. We
hypothesised that a smaller BT shunt would lead to a reduction in
ventricular volume loading and also a reduction in TR. This study
aimed to evaluate the effect of BT shunt size on the severity of TR.
Methods:
A retrospective review of all patients with HLHS who had
a Norwood procedure in our institution between January 2006 and
December 2011 was performed. Patient demographic, echocardio-
grams, MRI, operative and postoperative data were reviewed. The
impact of BT shunt size on severity of TR at the time of BCPS was
analysed.
Results:
In this time period, 64 neonates with HLHS underwent a
Norwood procedure with a modified BT shunt at our institution.
Thirty-two (32/64) had a 3.5-mm BT shunt (group 1) and 32/64 had
a 3.0-mm BT shunt (group 2). Survival to BCPS was 53/64 (83%)
overall, with 25/32 (78%) in group 1 and 28/32 (87%) in group 2.
The prevalence of significant TR (
≥
moderate) on pre-operative
assessment in preparation for BCPS was 9/25(36%) in group 1 and
2/28(7%) in group 2 (
p
=
0.01
). Tricuspid valve repair was performed
on 7/25(28%) in group 1 and 4/28(14%) in group 2 (
p
=
0.21
). The
rate of non-fatal serious adverse events was similar in the two groups.
Conclusion:
A smaller-sized modified BT shunt at the initial
Norwood procedure reduces the prevalence of significant tricus-
pid regurgitation. Further investigation and long-term follow up is
required to determine other potential complications of this surgical
strategy.
1065: EFFECT OF BERAPROST ON PULMONARY ARTERY
PRESSURE IN PULMONARY HYPERTENSION DUE TO
LEFT-TO-RIGHT SHUNT CONGENITAL HEART DISEASE
Mahrus Rahman
1
, Teddy Ontoseno
1
, Alit Utamayasa
1
, Ery Oliviato
1
,
Windhu Purnomo
2
1
Department of Child Health, Medical School, Airlangga University,
Soetomo Hospital, Surabaya, Indonesia
2
Faculty of Public Heath, Airlangga University, Surabaya, Indonesia
Background:
The late diagnosis and surgical management of left-to-
right shunt congenital heart disease (L-R shunt CHD)
causes
pulmo-
nary hypertension. To date there is no effective drug to decrease
pulmonary artery systolic pressure. Beraprost, an oral prostacyclin
analogue that works as a pulmonary artery vasodilator, was expected
to decrease PASPS in children with L-R shunt CHD.
Methods:
A pretest–postest study was conducted on 17 subjects
aged two months to 16 years old, with VSD, ASD, PDA or a combi-
nation, who developed pulmonary hypertension. Patients with other
structural cardiac defects or with pulmonary infection were excluded.
Echocardiography examinations were performed before and after
administration of beraprost 1 µg/kgBB/day for three months.V
max
TR
, V
max
L-R, and PASP were measured and M-mode measurements of
the pulmonary valve, including a wave, EF slope and mid-systolic
notch were examined. Adverse reactions were noted, and monitoring
was performed every two weeks.
Results: A
V
max
TR decrease [0.7
±
0.79 m/s (
p
=
0.004)], Vmax L-R
increase [0.6
±
0.64 m/s (
p
=
0,018)] and PASP decrease [18.3
±
21.90 mmHg (
p
=
0.003)] were observed. There were no significant
changes in wave, EF slope and mid-systolic notch.
Conclusions:
There was a decrease in pulmonary artery systolic
pressure after administration of beraprost in children with L-R shunt
CHD who develop pulmonary hypertension.
1067: DELAYED UPTAKE AND WASHOUT OF CONTRAST
IN INFARCTED MYOCARDIUM SHOWN WITH 4D CT IN
PIGS
Sebastian Udholm
1
, Sofie Laugesen
1
, Peter Agger
1
, Jesper Honge
1
,
Morten Smerup
1
, Morten Bättcher
2
, Jens Michael Hasenkam
1
1
Department of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Skejby, Denmark
2
Cardiac Imaging Centre, Aarhus University Hospital, Skejby,
Denmark
Background:
Assessment of ischaemic and potentially viable
myocardium plays an important role in the planning of revascu-
larisation of patients with critical coronary atherosclerosis. Cardiac
computed tomography (CT) is being used increasingly in the func-
tional and morphological analysis of cardiovascular diseases and
specifically in the screening and evaluation of atherosclerotic lesions
in coronary artery disease. The aim of the present study was to
investigate the pattern of contrast distribution over time in pigs with
experimentally induced anterior myocardial infarctions, to evaluate
the feasibility of using simple CT enhancement as a viability marker.
Methods:
This study was conducted as an experimental animal
follow-up study. Twelve female pigs weighing 50 kg were subjected
to an ischaemic myocardial lesion induced by 60 minutes of balloon
occlusion of the left anterior descending artery immediately distal
to the first diagonal branch, followed by removal of the balloon and
reperfusion. After six weeks, CT was performed using intravascular
contrast agent. Measurements of radiodensity in Hounsfield units in
the infarct zone and the non-ischaemic lateral wall were performed
at 20 seconds, one, three, five, eight and 12 minutes after contrast
injection.
Results:
We found highly significant differences in radiodensity
between the two zones at all time points except
t
=
1 minute. The
healthy myocardium showed a more rapid uptake and washout of
contrast compared to the infarct zone. In particular, the ratio between
early and late uptake was a strong marker of viable myocardium.
Conclusion:
The delayed uptake and washout of contrast agent in
the infarct zone compared to the zone of healthy myocardium corre-
sponded well with existing knowledge from MRI and other methods
and most likely reflects the impairment of the vascular bed in the
infarcted myocardium. The present study shows promise for future
clinical application of CT in a combined assessment of coronary
anatomy and myocardial viability.
1069: THREE-DIMMENTIONAL ROTATIONAL ANGIOG-
RAPHY IN PATIENTS WITH SINGLE VENTRICLE AFTER
TOTAL CAVO-PULMONARY CONNECTION
Sebastian Goreczny
1
, Pawel Dryzek
1
, Tomasz Moszura
1
, Jacek J.
Moll
2
, Andrzej Sysa
1
, Jadwiga A. Moll
1
1
Department of Cardiology, Polish Mother’s Memorial Hospital,
Research Institute, Rzgowska Lodz, Poland
2
Department of Cardiac Surgery, Polish Mother’s Memorial Hospital,
Research Institute, Rzgowska Lodz, Poland
Background:
Three-dimensional rotational angiography (3DRA)
is an emerging technology that could be a beneficial adjunct to
fixed-plane angiography and could enhance diagnostic capabilities
in patients with single ventricle after various stages of palliation. We
report our total experience using 3DRA in patients after total cavo-
pulmonary connection (TCPC).
Methods:
A retrospective analysis of all patients after TCPC who
underwent 3DRA was performed. Philips Allura system was used
to acquire non-gated, breath-held images. During a 240-degree,
4.1-second isocentric rotation, 122 angiographic images were
acquired and automatically reconstructed in real time.
Results:
Between 09/2010 and 06/2012, we performed 41 3DRAs
in 21 patients after TCPC. All but one patient underwent total of
32 interventions. Twenty-four 3DRAs were performed prior to the
intervention, with 17 remaining to assess the results of percutanous
treatment. Median age and weight was 9.13 years (4.1–24.1) and 24.8
kg (13–56), respectively. Median contrast dose for 3DRA and for
total study was 1.45 ml/kg (0.9–2.4) and 4 ml/kg (1.5–9.8), respec-
tively. Median area dose for the whole study, time of fluoroscopy
and total time of study was 330.2 cGy/cm
2
(144.8–1325.2), 15.2 min
(9.3–54.4) and 70 min (55–165), respectively. Rotational angiogra-
