CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
253
assessed serially before and after TCPC (extracardiac conduit in all
patients), until discharge, for superior mesenteric flow velocities,
systemic micro-vascular function via laser Doppler (baseline and
reactive skin perfusion in response to acetylcholine (Ach) and sodi-
um nitroprusside), and for certain HRV indices (standard deviation of
the normal-to-normal RR intervals (SDNN), LF and HF; BioMedical
Inc, Taiwan).
Results:
The mesenteric diastolic flow VTI and the micro-vascular
perfusion and reactivity to Ach decreased postoperatively especially
on day 1 after surgery (
p
<
0.05). HRV LF and HF were reduced
postoperatively at all time points (
p
≤
0.05). The mesenteric diastolic
flow velocity on day 1 correlated with the preoperative transpulmo-
nary gradient (
p
=
0.02,
r
=
-0.7), and both with the duration of PE
(
p
<
0.05,
r
>
0.4). Lower preoperative values of SDDN were associ-
ated with higher preoperative transpulmonary gradients (
p
=
0.01,
r
=
-0.8), and to some extent with PE duration (
p
=
0.06,
r
=
-0.6).
Neither the demographic variables (age at surgery, time between
Glenn and TCPC, weight) nor the heart-lung machine duration were
associated with PE duration.
Conclusion:
TCPC is ensued by abnormalities in mesenteric flow,
systemic micro vascular function and cardiac autonomic function.
Although several of these variables show some association with PE
duration, given the small sample size, further studies are needed to
validate these findings and to interrogate the mechanisms.
1581: HOW IS THE PERI-PATCH MYOCARDIUM IN
VENTRICULAR SEPTAL DEFECT (VSD) PATCH REPAIR
Lucy Eun
1
, Han Ki Park
2
, Nam Kyun Kim
1
, Jae Young Choi
1
1
Pediatric Cardiology, Yonsei University Severance Cardiovascular
Hospital, Korea
2
Cardiovascular Surgery, Yonsei University Severance Cardiovascular
Hospital, Korea
Introduction:
Strain rate (SR) and strain (
ε
) in tissue Doppler imag-
ing provide new non-invasive measurements of myocardial function,
independent of heart motion. This study assesses the extent of peri-
patch regional myocardial function after patch repair of ventricular
septal defect (VSD).
Method and results:
Myocardial SR and
ε
were recorded from
the peri-patch myocardium and remote septum from patch area in
20 patients (1 month to 10 years of age, mean 2.6 years). Distance
between the patch and the point of returning to remote normal
ε
profile was measured. Compared to the remote myocardial region,
peri-patch myocardium had decreased peak longitudinal SR (-3.3
±
1.8 s
-1
vs -4.8
±
3.3 s
-1
,
p
<
0.05), delayed time to peak longitudinal SR
(151
±
81 ms vs 119
±
56 ms,
p
<
0.05), decreased peak
ε
(longitudi-
nal -20
±
8% vs -28
±
10%; radial 20
±
14 % vs 34
±
22%,
p
<
0.01),
and delayed time to peak
ε
(longitudinal 316
±
76 ms vs 241
±
67 ms;
radial 341
±
94 ms vs 269
±
81 ms,
p
<
0.0001). The mean distance
from the patch to the remote patch
ε
curve was 2.65
±
0.77 mm.
Conclusion:
Peri-patch myocardium after repair of VSD has delayed
and diminished contraction as compared to more remote normal
myocardium.
1595: GEOMETRIC CHARACTERISATION OF 100 PATIENT-
SPECIFICTOTAL CAVOPULMONARY CONNECTIONSAND
THEIR RELATION TO HAEMODYNAMIC OUTCOMES
Elaine Tang
1
, Maria Restrepo
2
, Chris Haggerty
2
, Lucia Mirabella
2
,
James Bethel
3
, Kevin Whitehead
4
, Mark Fogel
4
, Ajit Yoganathan
2
1
School of Chemical and Biomolecular Engineering, Georgia Tech,
Atlanta, Georgia, USA
2
Department of Biomedical Engineering, Georgia Tech and Emory
University, Atlanta, Georgia, USA
3
Westat, Inc. Rockville, Maryland, USA
4
Division of Cardiology, Children’s Hospital of Philadelphia, USA
Background:
The total cavopulmonary connection (TCPC) anato-
mies are complex and have great patient-to-patient variability. The
geometric characteristics can impact the haemodynamic outcomes,
namely: (1) TCPC energy dissipation which can affect ventricu-
lar function; and (2) unbalanced hepatic flow distribution (HFD)
which increases the risk of pulmonary arteriovenous malformations
(PAVM). In this study, we present a large-scale cohort geometric
characterisation of different TCPCs and explore how the anatomical
differences translate to the resulting haemodynamic outcomes.
Methods:
A total of 100 patient-specific TCPC 3D anatomies were
reconstructed from magnetic resonance images (MRI). Diameter,
shape factor (SF), minimum/maximum diameter and tortuosity
(vessel length/shortest distance between the two ends of a vessel)
were quantified at each vessel. Angles between connecting vessels
and caval offset (distance between the superior vena cava (SVC)
and the Fontan pathway) were also quantified. Computational fluid
dynamics simulations were carried out using time-averaged flow
boundary conditions (obtained from phase contrast MRI) to quantify
the resulting TCPC energy dissipation index (TCPC-EDI) and HFD,
which were then correlated to the geometric parameters;
p
<
0.05 was
considered significant for all statistical correlations.
Results
: TCPC-EDI correlated negatively with normalised diameters
at all TCPC vessels, and also SFs of SVC, RPA (right pulmonary
artery) and the Fontan pathway. Cardiac index was found to have
positive significant correlations with Fontan pathway SF, and
normalised SVC and Fontan pathway diameters. HFD was found to
correlate with the pulmonary flow distribution, normalised PA diam-
eter, caval offset and angles across the connections. No significant
correlations were found between tortuosity and the haemodynamic
endpoints.
Conclusions:
Small vessel diameters and SFs are correlated with
higher TCPC-EDI and lower cardiac index. This highlights the
importance of dilating stenosis in any associated vessel of the
connection. Also, PA diameter, caval offset and connection angles
together can impact HFD.
1599: MANAGEMENT OF DEXTROCARDIA, SITUS INVER-
SUS TOTALIS, MIXED TYPE TAPVC, COMPLETE AV
CANAL DEFECT, COMMON ATRIUM, BILATERAL SVC,
PDA, SEVERE PAH’
Sivasubramanian Muthukumar, Jebaraj, Ranjith Karthekayan,
Dheeraj Reddy, Periyasamy Thangavelu
Sri Ramachandra University, Chennai, India
Objective:
To present the management of dextrocardia, situs inversus
totalis, TAPVC – mixed, complete atrioventricular (AV) canal defect,
common atrium, bilateral SVC, patent ductus arteriosus (PDA),
severe pulmonary arterial hypertension (PAH).
Diagnosis:
This 9-month-old girl baby girl was admitted with failure
to thrive and respiratory distress. Echo evaluation revealed the above-
mentioned diagnosis. After preoperative evaluation, surgery was
performed. Operative finding included mixed type TAPVC – right
superior and middle pulmonary veins and left inferior pulmonary
vein were draining into common venous chamber. A vertical vein
from the common chamber was joining RSVC, and a left supe-
rior vein to LSVC. The right upper lobe vein joined the RSVC.
Morphologic right atrium (RA) was on right side receiving RSVC
and hepatic vein. Morphologic left atrium (LA) was on the left side
receiving LSVC and IVC. Other findings were: unroofed coronary
sinus; complete AV canal defect – Rastelli Type A with large inlet
ventricular septal defect (VSD); severe mitral regurgitation (MR) –
anterior mitral leaflet (AML) cleft; common atrium.
Results:
The procedure included TAPVC repair & AV canal repair.
Rerouting of pulmonary veins was done with wide anastomosis
between the common venous chamber and mLA. Vertical vessel
was ligated .Since innominate vein was present, LSVC was inter-
rupted, hence diverting left superior vein to mLA. Regarding AV
canal repair, a double patch technique was used. VSD closure, MV
repair with AML cleft repair, tricuspid valve repair, atrial septal
defect (ASD) closure with Pericardia patch created an atrial baffle,
diverting IVC, RSVC and hepatic vein to mRA. Core cooling was
