CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
266
AFRICA
1781: COMPARISON OF EXERCISE CAPACITY IN YOUNG
PATIENTS AFTER CORRECTION OF TETRALOGY OF
FALLOT AND AFTER ATRIAL SWITCH (SENNING OPERA-
TION) OF TRANSPOSITION OF GREAT ARTERIES IN
LONG TERM FOLLOW-UP
Beata J Pietrucha
1
, Artur Z Pietrucha
2
, Andrzej Rudziski
1
1
Children’s Cardiology Department, Children’s University Hospital,
Jagiellonian University, Krakow, Poland
2
Coronary Disease Department, Jagiellonian University Medical
College, Krakow, Poland
Methods:
We observed 49 patients (pts) who were divided into two
groups. Group I consisted of 35 patients after correction of tetralogy
of Fallot (TOF) (6 females, 29 males), age range from 8.7 to 21.7
yrs (mean 14.6 yrs). Group II consisted of 14 pts after operation of
transposition of great arteries (TGA) by Senning method (6 girls, 8
boys) age range from 7.3 to 17.8 yrs (mean 13.1 yrs). In all pts 24-hour
Holter ECG monitoring was performed with assessment of heart
rhythm and presence of arrhythmias. Treadmill exercise testing (TT)
was done in all pts and modified Bruce protocol was used. We estimat-
ed total metabolic equivalent (MET), total exercise time, presence of
arrhythmias and changes in ST segment. In 9 pts (25.6%) from group
I ventricular arrhythmias were noticed, but in 3 subjects only was
complex arrhythmia present. In group II dysfunction of sinus node
was observed in 5 pts (35.7%). Significant changes of ST segment
and dysfunction of right ventricle during TT was present in 5 patients
after TOF (14.3%); such changes with additional chest pain could be
seen in 6 patients (42.9%) after Senning operation. During TT mean
MET parameters achieved by pts after TOF were significantly higher
than in pts after Senning operation (14.12 vs 12.76) and TT duration
was significantly longer in pts after TOF operation (13:12 vs 10:39).
In 3 pts (8.6%) after TOF, reoperation and/or ICD implantation was
considered, while another 3 pts (21.4%) needed reintervention.
Conclusions:
Patients after correction of TOF have much better long-
term prognosis in comparison to patients after Senning operation for
transposition of great arteries. Systemic right ventricle dysfunction is
frequently observed in patients after Senninng operation of transpo-
sition of great arteries. TT could be very useful in determination of
high-risk patients after complex congenital heart defect correction.
1787: THE EVIDENCE-BASED ‘DECISION ANALYSIS’
AND PATIENT/FAMILY SHARED DECISION MAKING IN
MANAGEMENT OF CHD
Mahmoud Elbarbary
King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia
Decisions in a critical care setting can frequently be difficult and
involve several trade-offs and multiple risk-benefit ratios. In the face
of this dilemma, the currently most commonly used methods to make
a decision in these circumstances depend on the doctor’s personal
knowledge or experience, nihilism, deferring to other experts, defer-
ring to patients, dogmatism or just blindly following a policy. These
methods are not scientifically sound. They not only lack objectivity
but more importantly lack evidence supporting the decision, and
even sometimes minimise adequate and appropriate involvement of
the patient/family. This situation is frequently encountered in making
decisions of management of congenital heart diseases.
In the recent era of evidence-based medicine, full arrays of deci-
sion support aids have been developed, among which an important
method, which is unfortunately infrequently used in PCICU, is the
evidence-based Decision Analysis (DA). In this presentation, we will
explain this important tool for aiding decision and how it can help
in making difficult decisions by utilising the best available scientific
evidence together with incorporating the patient/family’s own prefer-
ences and values with a scientifically based methodology that is not
only objective but also is expressed in numerical values of disutility
and probability. The presentation will also explain the various tools
that can be utilised to achieve proper patient/family shared medical
decision making.
1790: CHANCES OF NEWBORNS AND INFANTS TO
SURVIVE TO HEART TRANSPLANT IN A LOW DENSITY
POPULATIONAREA: IMPACT OF MECHANICAL SUPPORT
AND ABO INCOMPATIBLE TRANSPLANT
Desiree Machado
1
, Chloe Joynt
2
, Ernest Phillipos
2
, Ivan Rebeyka
3
,
Kristin Simard
4
, Lori West
5
, Simon Urschel
5
1
Department of Pediatrics, Division of Neonatology and Pediatric
Intensive Care, University of Alberta, Edmonton, Alberta, Canada
2
Department of Pediatrics, Division of Neonatology, University of
Alberta, Edmonton, Alberta, Canada
3
Department of Pediatrics, Division of Cardiac Surgery, University of
Alberta, Edmonton, Alberta, Canada
4
Transplant Services, University of Alberta, Edmonton, Alberta,
Canada
5
Department of Pediatrics, Division of Pediatric Cardiology,
University of Alberta, Edmonton, Alberta, Canada
Background:
Prolonged time on a waitlist affects survival pre and
post heart transplantation (HTx). We analysed outcomes of patients
listed for HTx aged below 3 months in the low population density
region of western Canada.
Materials and methods:
We reviewed patients listed below age of
90 days from 2006 to 2011, to determine waitlist mortality, outcomes
after HTx and factors that could impact outcomes.
Results
: Twenty-seven patients were listed during the study period.
Congenital heart disease was the predominant diagnosis in 20 patients
(74%), and cardiomyopathy, myocarditis and others in the remaining
7. Twelve patients (44%) died or were delisted as a result of clinical
deterioration after a median of 32 days (from 7 to 127 days); one was
removed after 112 days because of clinical improvement. HTx was
performed in 14 (52%) patients after a median waitlist of 51 days
(from 2 to 215 days). Mortality in 14 patients who required extra-
corporeal life support (ECLS) pre-Tx (9 bridged to transplant, 5 died
on waitlist) was not different from patients without ECLS (
p
=
0.61)
but time to death on the waitlist trended shorter (
p
=
0.09). In the
transplanted group, 7 patients (50%) received an ABO-compatible
(ABOc) heart, with 3 post-Tx deaths. The remaining 7 cases received
an ABO-incompatible (ABOi) graft and are alive. ABOc patients
waited a median of 51 days compared to 49 days for ABOi Tx (
p
=
0.53). Patient death was not associated with prematurity (
p
=
0.61)
or birth weight below 2.5 kg (
p
=
0.71). Cumulative survival post-
listing was 44%.
Conclusion:
HTx outcomes in early childhood are promising;
however high waitlist mortality has a negative impact on overall
results. Despite having strategies such as ABOi HTx, waitlist mortal-
ity in western Canada exceeds rates reported from higher population
density areas and is higher than other reported age groups. Further
strategies to improve organ availability/allocation are required.
1796: VENTRICULAR SEPTAL DEFECT – AN UNUSUAL
SEQUEL OF BLUNT CHEST TRAUMA IN A 7-YEAR-OLD
BOY
Ogunkunle Oluwatoyin, C O Duru, B E Adebayo, S I Omokhodion
University College Hospital, Ibadan, Nigeria
Background/hypothesis:
Ventricular septal defect (VSD) is the
commonest congenital cardiac lesion encountered worldwide. Only
very rarely is it acquired, and causation through blunt injury is even
rarer.
Materials and methods:
A 7-year-old boy suffered blunt trauma to
his chest while at play with his peers at school. He had been quite
well before then, with no symptoms related to the cardiovascular
system and with no growth or developmental delay. He presented
2 days later at our centre with features of acute congestive cardiac
failure. Two-dimensional and Doppler echocardiographic examina-
tion revealed a rent in the peri-membranous portion of the outlet
ventricular septum with the avulsed flap still attached to the septum.
Results:
Cardiac failure was refractory to anti-failure therapy and
other stabilisation measures. His clinical condition took a rapid turn
