CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
25
time in intensive care unit was 5.39 days. Twenty-four patients had
complications (31%); 15 required some type of re-intervention and
five died before hospital discharge (6.3%). The main cause of death
was infection. The length of hospital stay before surgery was a risk
factor for infection and death.
Conclusions:
In our country refererral for congenital heart surgery
is delayed. Children often arrive with associated infections or acquire
an infection in hospital awaiting corrective surgery. It is imperative
to educate primary care physicians for an earlier referral and to
improve our referral system to avoid long periods of hospitalisation
before surgery.
587: THE PROCESS AND EXECUTION OF MULTI-INSTI-
TUTIONAL CROSS-SECTIONAL FOLLOW-UP STUDIES:
THE CONGENITAL HEART SURGEONS’ SOCIETY DATA
CENTRE EXPERIENCE
Veena Sivarajan
1,2
, Susan McIntyre
1,2
, Sally Cai
1,2
, Annette Flynn
1,2
,
Christina Faber
1,2
, Maulik Baxi
1,2
, Brian W McCrindle
1,2,3
, Jeffrey
Poynter
1,2
, Christopher Caldarone
1,2,3
, William G. Williams
1,2,3
1
The Hospital for Sick Children, Toronto, Canada
2
The Congenital Heart Surgeons’ Society Data Center, Toronto,
Canada
3
University of Toronto, Toronto, Canada
Background:
The Congenital Heart Surgeons’ Society (CHSS) data
center (DC) serves as the coordinating centre for multi-institutional,
cross-sectional follow-up studies of children with complex and rare
congenital heart defects (CHD). The success of our studies relies on
our ability to follow patients long term. Recent trends show a decline
in follow up. The DC has developed new strategies to improve long-
term follow up.
Methods:
Our annual cross-sectional follow-up process extends over
a three-month period, which entails questionnaire mail-out, reminder
calls and dedicated time to locate patients with wrong addresses. A
variety of options exist for patients to complete follow-up forms includ-
ing mail, e-mail or telephone. Locating patients with wrong addresses
continues to be challenging despite the use of death registries, internet
searches, Facebook and Twitter. New strategies to address these issues
include creation of a one-page form sent to participating institutions
verifying patient information as well as decreasing follow up to two
months, and utilising the third month to solely address these issues.
The DC team continuously explores additional ways of completing and
submitting annual follow up including a secure website patients can log
into that would adhere to current privacy laws.
Results:
The implementation of the patient update form has been
somewhat effective in obtaining current patient information essential
to follow up. The use of social media has not been as successful as we
had anticipated. The DC staff and members of the Research Institute
at the Hospital for Sick Children continue to collaborate on develop-
ing a secure website for patients to complete online annual follow up.
Conclusions:
Although these strategies have been somewhat effective
in improving our follow up, we are continuously exploring other strat-
egies to improve the success of our long-term follow up. To ensure
the success of multi-institutional, cross-sectional follow-up studies,
continuous evaluation and implementation of new strategies is critical.
590: EFFECTIVENESS OF CONTRAST-ENHANCED
COMPUTEDTOMOGRAPHYASA SUPPORTIVE MEASURE
FOR TREATMENT OF MEDIASTINITIS AFTER PAEDIAT-
RIC CARDIAC SURGERY
Akio Ikai, Junichi Koizumi, Kazuyoshi Kanno, Tomoyuki Iwase,
Satoshi Nakano, Wataru Soda, Shin Takahashi, Kotaro Oyama,
Hitoshi Okabayashi
Iwate Medical University, Japan
Objectives
: Mediastinitis after cardiac surgery is a serious compli-
cation; however, there is no consensus on the treatment strategy of
mediastinitis in paediatric cardiac surgery.
Methods
: Paediatric patients who showed postoperative infectious
signs (e.g. fever, wound swelling, redness, pain, draining pus and
abnormal laboratory data) were evaluated using 320 multi-detector
row contrast-enhanced computed tomography (CECT) for diagnosing
mediastinits. We defined that a typical CECT image of mediastinitis
showed fluid collection with ring enhancement behind and between the
sternum. Aggressive debridement followed by primary sternal closure
was performed when typical findings of CECT were confirmed.
Results
: From January 2007, 533 paediatric patients underwent
median sternotomy. Thirteen cases (2.4%) had CECT performed for
evaluating mediastinitis. The typical findings were obtained in 12 of
the 13 cases. In one case without typical findings, pus flowed out
from infectious site before CECT. Aggressive debridement followed
by primary sternal closure was performed in all cases. There were
no operative and hospital deaths. Re-exploration was required in
one case due to the placement of a polytetrafuoloethylene membrane
after the initial debridement. In 14 debridements for the 13 cases, the
median mechanical ventilation time was 16.0 hours (range 0–116.6),
and length of intensive care unit stay after primary sternal closure
was four days (range 1–21 days). The median postoperative hospital
stay from primary sternal closure was 23 days (range 15–53 days).
Conclusion
: Primary sternal closure is feasible surgical treatment for
mediastinitis in paediatric patients. The CECT image is helpful for
aggressive debridement due to precise detection of the inflammatory
area of mediastinitis. CECT should be a useful supportive measure
for improving the outcome of primary sternal closure.
603: CARDIOPULMONARY EXERCISE TESTING IN
PATIENTSWITH PRIMARY PULMONARY HYPERTENSION
Hironori Ebishima, Hideo Ohuchi, Tohru Iwasa, Shin Ono, Osamu
Yamada
Division of Paediatric Cardiology, National Cerebral and
Cardiovascular Centre, Japan
Background:
Cardiopulmonary exercise testing (CPX) has been
widely used for assessing heart failure severity in children and
adolescents with cardiac disease. However, little CPX-derived data
on those with primary pulmonary hypertension (PPH) are available.
Aim:
Our purpose was to clarify relationships between CPX-derived
variables and haemodynamics obtained by cardiac catheterisation in
children and adolescents with PPH.
Methods
and
Results:
From 1995 to 2011, 18 PPH patients (age:
18.1
±
6.2 years) underwent 48 CPXs and the results were compared
with the haemodynamics. Ventilatory equivalent for carbon oxide
production at peak exercise (peak VE/VCO
2
) closely correlated with
the pulmonary-to-systemic artery pressure and resistance ratios (
r
=
0.5,
p
<
0.001, and
r
=
0.6,
p
<
0.001, respectively). When patients
were divided into two groups according to the peak VE/VCO
2
, i.e.
high VE/VCO
2
vs low VE/VCO
2
, the high-VE/VCO
2
group showed
significantly higher pulmonary arterial pressure and resistance, lower
cardiac index, smaller left ventricular size, and shorter distance of
six-minute walk (
p
<
0.05). In contrast, the other CPX-derived vari-
ables, including peak oxygen uptake or heart rate, did not correlate
with the haemodynamics.
Conclusions:
Peak VE/VCO
2
was the best CPX-derived variables for
predicting haemodynamic severity in children and adolescents with
PPH, indicating the importance of exercise ventilatory abnormality
in PPH pathophysilogy.
605: HEART RATE VARIABILITY IN CHILDREN WITH
VASOVAGAL SYNCOPE DURINGASYMPTOMATIC PERIODS
Hong Tian, Mingyu Fu, Ling Tao, Yuyang Liu, Guoying Huang,
Yonghao Gui
Children’s Hospital, Fudan University, Shanghai, China
Objective:
To retrospectively analyse the heart rate variability
parameters in children with vasovagal syncope (VVS) during asymp-
tomatic periods.
