CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
31
period (2005–2011) at a tertiary cardiac surgical centre with a refer-
ral base of 14 million people.
Results:
Ninety-eight patients underwent systemic-to-pulmonary
arterial shunting over a seven-year period, of which only 23 ultimate-
ly underwent correction of their primary cardiac lesion. A significant
number of patients were lost to follow up or died due to diarrhoea
and respiratory disease.
Conclusions:
In a resource-scarce environment, the primary pallia-
tion of cyanosed neonates with systemic-to-pulmonary arterial
shunts has a sub-optimal long-term result. Resources should be put
into the development of centres specialising in early neonatal correc-
tive surgery.
696: A RETROSPECTIVE REVIEW OF HIV-INFECT-
ED PATIENTS UNDERGOING CONGENITAL CARDIAC
SURGERY IN KWAZULU-NATAL, SOUTH AFRICA
Darshan Reddy, Julian Buckels
Inkosi Albert Luthuli Central Hospital, Durban, South Africa
Background:
South Africa has one of the highest prevalences of
HIV infection in the world (30%), with the perinatal HIV infection
rate in KwaZulu-Natal over 40%. HIV-exposed neonates and infants
undergoing congenital cardiac surgery (either palliative of correc-
tive) in sub-Saharan Africa remain an unstudied population. We have
formulated institutional guidelines based on clinical experience in
order to manage these patients.
Methods:
We reviewed the case records of all HIV-exposed patients
who underwent congenital cardiac surgery over a seven-year period
(2005–2011) at a tertiary cardiac surgical centre with a referral base
of 14 million people.
Results:
No significant difference in in-hospital morbidity or mortal-
ity rate was noted in HIV-exposed patients undergoing congenital
cardiac surgery, compared to non-exposed patients with similar risk
stratification. However, the late mortality and long-term outcome
following surgery remains unclear.
Conclusions:
While HIV-exposed patients undergoing congenital
cardiac surgery have an acceptable in-hospital morbidity and mortal-
ity rate, late mortality (particularly related to opportunistic infections)
requires further evaluation. In addition, patient access to and compli-
ance with highly active antiretroviral therapy (HAART) is variable.
In undertaking congenital cardiac surgery in HIV-positive patients, a
sound knowledge of drug interactions, immunology, risks of mother-
to-child transmission (MTCT) and the manifestations of opportunistic
infections is required in order to formulate institutional guidelines.
743: SUSTAINEDBIVENTRICULARPACINGMAY IMPROVE
CARDIAC INDEX, BLOOD PRESSURE AND CEREBRAL
BLOOD FLOW IN INFANTS WITH ELECTRICAL DYSSYN-
CHRONY AFTER SURGERY FOR CONGENITAL HEART
DISEASE
Mark Friedberg, Steven Schwartz, Hargen Zhang, Cedric Manlhiot,
Maria Ilina, Neil Seller, Brian McCrindle, Glen Van Arsdell,
Elizabeth Stephenson
Hospital for Sick Children, Toronto, Ontario, Canada
Background:
Cardiac index (CI) decreases in the initial postopera-
tive period after congenital heart disease (CHD) surgery, exposing
infants to adverse haemodynamics. Electrical dyssynchrony, mani-
fested by prolonged QRS duration (QRSd), may be an important
factor. We hypothesised that continuous, simultaneous left and right
ventricular pacing (BiVp) after CHD surgery improves cardiac index
and haemodynamics in the early postoperative period.
Methods:
We prospectively recruited infants with biventricular CHD
who were under four months of age and undergoing surgery on cardi-
opulmonary bypass. Infants were randomised, regardless of QRS
duration, to receive standard of care or standard of care + BiVp for 48
postoperative hours or until extubation, if sooner. Infants randomised
to BiVp received atrial, right ventricular and left ventricular leads.
Continuous BiVp (atrial tracking) was initiated upon return to ICU.
Haemodynamics were assessed at least every three hours for the
first 24 hours and at least every six hours thereafter for up to 48
hours. CI was measured by Fick using mass spectroscopy for oxygen
consumption. Near-infrared spectroscopy was used to measure
cerebral saturation. Primary outcome was change in CI over the first
48 postoperative hours.
Results:
Forty-two infants (21 controls, 21 Bivp; 3.8
±
0.9 kg, 50%
transposition of the great arteries) were randomised. Infants with
prolonged baseline QRS (
>
98th percentile) experienced decreased
CI, which was prevented by BiVp. Controls with normal QRS
durations for age had consistent improvement in CI in the first 48
hours, while those with prolonged QRS durations showed delayed CI
recovery. BiVp tended to improve CI recovery [+0.118 (0.374) ml/
min/m
2
,
p
=
NS], blood pressure [BIVP +8 (3) mmHg,
p
=
0.01] and
cerebral blood flow in infants with wide QRS, but did not improve
CI in infants with narrow QRS.
Discussion:
Continuous BiVp may be useful to improve CI, blood
pressure and cerebral flow in infants with electrical dyssynchrony
after CHD surgery.
756: COMPLICATIONSAND OUTCOMES OF CHYLOTHOR-
AX FOLLOWING CARDIAC SURGERY
Johnny Millar
1
, Roberto Chiletti
1
, Bodine Belderbos
2
1
Intensive Care Unit, Royal Children’s Hospital, Melbourne, Australia
2
Erasmus University Medical Centre, Rotterdam, the Netherlands
Background:
To review the experience of post-cardiac surgery
chylothorax at our institution over a six-year period, with emphasis
on complications and mortality.
Methods:
Episodes of postoperative chylothorax from 1 June 2005
to 31 May 2011 were identified from intensive care and cardiac
surgical databases. Demographic, operative, haemodynamic, labora-
tory and outcome data were collected from the medical record and
electronic databases. A multivariate model was constructed to define
predictors of death.
Results:
One hundred and sixteen episodes of chylothorax were
confirmed, yielding an incidence of 2.2% in postoperative patients.
The median age of patients was 57 days (range one day – 16 years).
One-third of episodes occurred following one of the three stages of
single-ventricle palliation. The highest specific incidence occurred
following neonatal repair of anomalous pulmonary venous drain-
age (17.4% of such operations). Maximum daily chyle drainage
(median 46 ml/kg/day, 2–617) was negatively correlated with age and
positively with duration of chylothorax. Initial feeding was paren-
teral in 49.5%, and enteral in 50.5%. Patients treated with parenteral
nutrition at any time had higher mean daily drainage (
p
<
0.001).
Laboratory consequences of protein loss were common: lympho-
paenia 92.2%; hypoalbuminaemia 87.1%; hypoproteinaemia 85.3%;
hypogammaglobulinaemia 67.2%. Thirty-one per cent developed
sepsis; these patients were younger and had lower immunoglobulin
levels than those who did not develop sepsis. Median ICU stay was
10 days with a median hospital stay of 116 days. The mortality rate
was 15.6%, with a median time to death from the day of surgery of
68 days (9–296). The lowest blood lymphocyte count and the lowest
serum albumin were independent predictors of death.
Conclusions:
Chylothorax is an infrequent complication of cardi-
ac surgery but is associated with high morbidity and mortality.
Minimum blood lymphocyte count and serum albumin are independ-
ent predictors of death in patients with this complication.
758: PERIODONTAL DISEASE IN CHILDREN WITH
CONGENITAL HEART DISEASE AND ITS CORRELATION
WITH LEVELS OF LDL CHOLESTEROL
Adriana Bresolin, Carlos Nassar, Patricia Nassar, Edson Silva, Alex
Sandro Jorge, Giselle De Mello, Carolina Talini, Larissa Pasqualotto,
Mariana Pronsati, Camille Pompeu
State University of West Paraná, Brazil
