CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
35
3
University of California, Irvine, USA
4
Brigham and Womens Hospital, Harvard Medical School, Boston,
USA
Background:
The fluid dynamics (shear stress and vorticity) of the
blood in the transposed great arteries in TGA patients after arterial-
switch operations (ASO) with spiral course or anterior branching
of the pulmonary arteries (Lecompte) is unknown. The aim of this
study was a comprehensive assessment of blood flow profiles in the
great arteries utilising advanced MRI techniques two decades after
the ASO.
Methods:
Twenty-four TGA patients (Lecompte:
n
=
12, 19.2
±
3.9 years post ASO; non-Lecompte, spiral:
n
=
12, 24.1
±
4.3
years post ASO) were studies with high-field MRI at 3 Tesla. All
patients underwent a comprehensive cardiovascular MRI, including
anatomical and functional cardiovascular evaluation. Additionally,
13 patients and five healthy volunteers received time-resolved
3D flow measurements (4D flow) using novel phase-contrast MR
techniques (FOV 250–337 mm
2
, venc 150 cm/s in three orthogonal
directions, true spatial resolution: 2.5 mm
3
isotropic, temp. resol
35 ms, TR/TE 4.6/3.2;
α
5–10°). Dedicated software was used for
colour-coded 4D visualisation of blood flow profiles and streamlines
(GT-Flow™, Gyrotools Inc, Zurich). Fluid dynamics were calculated
with in-house customised software.
Results:
In patients with a spiral course (non-Lecompte) of the
great arteries, vorticity index and shear stress were more favourable
compared to the Lecompte group (aorta: 234.51
±
35 vs 289.36
±
24 m
2
/s, pulmonary artery: 72.54
±
15 vs 93.53
±
13 m
2
/s;
p
<
0.01,
respectively; aorta: 0.35
±
0.14 vs 0.54
±
0.21 N/m
2
, pulmonary
artery: 0.31
±
0.09 vs 0.42
±
0.17 N/m
2
;
p
<
0,01). In both groups
we found one patient with an occluded left coronary artery. A sinus
valsalva aneurysm was present in the non-Lecompte group.
Conclusions:
On long-term follow up, a spiral course of the great
arteries in TGA patients post ASO showed more physiological blood
flow dynamics compared to anterior branching of the pulmonary
arteries (Lecompte). Therefore, in elegible patients, a spiral course
should be considered.
899: EXTRACELLULAR MATRIX GRAFT FOR CARDIAC
ANDVASCULAR RECONSTRUCTIVE SURGERY: PRELIMI-
NARY CLINICAL RESULTS
O Milanesi, M Padalino, G Torin, VL Vida, R Biffanti, A Cerutti, B
Castaldi, N Maschietto, E Reffo, G Stellin
University of Padova, Italy
Background:
Porcine extracellular matrix graft (Cormatrix
®
ECM)
has been widely used in clinical setting to repair the pericardium but
no reports exist to date showing its use and efficacy in vascular and
cardiac repair.
Aim:
To evaluate Cormatrix
®
ECM material as a possible patch for
clinical use in reconstructive cardiac surgery.
Methods:
We reviewed the report of the last clinical and echocardio-
graphic evaluation of 23 patients affected by Tof, PV stenosis isolated
or in association with other CHD, AS, PAPVD, other CHD, operated
on at our Institution since December 2009, in whom Cormatrix
®
ECM patch was used during reconstructive surgery. We included in
our evaluation only patients in whom Cormatrix
®
ECM patch was
employed for RVOTor PV/PAs reconstruction, with at least one echo
examination after discharge home.
Results:
Fourteen patients met the enrolment criteria: affected by
ToF, 10 cases; DORV sub-pulmonary VSD + subAoS + AoCo,
complete A-V septal defect, PS and RV hyoplasia, asplenia syndrome
+ single RV + PS, one case each. Median age at operation was 4.8
months (1–66). Cormatrix
®
ECM patch was used for RVOT recon-
struction in ToF patients, PV reconstruction in two cases, PAs patch
augmentation in two. At a mean follow-up of 15.3 months (2–24)
severe RVOT stenosis requiring treatment was present in two ToF
patients, one in association with signs of persistent inflammation
and pulmonary haemorrhage requiring pneumonectomy. Absent or
trivial pulmonary regurgitation was recorded in two ToF, mild in two,
moderate in four, in one associated with moderate stenosis, the last
four with RV dilatation. One patient each in the group of PV recon-
struction and PAs augmentation presented severe recurrent stenosis,
requiring haemodynamic manoeuvres.
Conclusion:
On short-term follow up, the performance of the
Cormatrix
®
ECM patch seemed suboptimal. Further clinical experi-
ence and longer follow up are needed to judge the adequacy of this
material.
911: TREATMENT OF PULMONARY ARTERIAL HYPER-
TENSION IN PATIENTS WITH CONGENITAL HEART
DISEASE
Katja Prokselj
1
, Tomaz Podnar
2
, Samo Vesel
2
1
University Medical Centre, Department of Cardiology, Ljubljana,
Slovenia
2
University Children’s Hospital, Cardiology Unit, Ljubljana, Slovenia
Background:
Pulmonary arterial hypertension with Eisenmenger
syndrome as its most advanced form is an important complication
of congenital heart disease. In recent years advanced therapy for
pulmonary arterial hypertension has been introduced. Efficacy and
safety of the advanced therapy in our patients with pulmonary arterial
hypertension associated with congenital heart disease was analysed.
Methods:
We analysed results of advanced therapy in patients
treated between November 2007 and December 2011. Clinical status,
systemic oxygen saturation measured by systemic pulse oximetry,
six-minute walk distance and laboratory parameters were assessed.
Results at three, six, 12 and 24 months on the treatment were
compared to baseline parameters.
Results:
In the observed period, 23 patients were treated with
PAH-specific therapy. As a first-line drug, bosentan was used in 19
and sildenafil in four patients. Due to clinical worsening a second-
and a third-line drug had to be added on during a study period in
four and one patient, respectively. Eighteen patients (78.3%) reported
improvement in functional capacity. Two patients (8.6%) died. The
mean six-minute walking distance significantly increased over time
from 334.7
±
87.7 m at baseline to 348.5
±
89.1 m at three months (
p
=
0.002), 373.2
±
74.4 m at six months (
p
=
0.005), 383.2
±
62.3 m at
12 months (
p
=
0.017) and 396.3
±
92.8 m at 24 months of treatment.
No significant adverse events were reported.
Conclusions:
Advanced therapy for pulmonary arterial hypertension
was beneficial in patients with congenital heart disease. Significant
improvement in exercise capacity was observed. The therapy is safe
and no significant adverse effects were reported.
935: ADJUSTABLE BILATERAL PULMONARY ARTERY
BANDING AIMING AT STAGED BIVENTRICULAR REPAIR
FOR INFANTS WITH UNBALANCED VENTRICLES AND
COARCTATION OF THE AORTA
Shigeaki Kaga
1
, Shoji Suzuki
1
, Yoshihiro Honda
1
, Hiroaki Kise
2
,
Minako Hoshiai
2
, Masahiko Matsumoto
1
1
University of Yamanashi Hospital, Department of Surgery, Japan
2
University of Yamanashi Hospital, Department of Paediatrics, Japan
Background:
Bilateral pulmonary artery banding (bPAB) is a surgi-
cal option for infants with unbalanced ventricles and coarctation
of the aorta (CoA), who are borderline candidates for biventricular
repair. However, it is not easy to know the optimal length of the bands
in early infancy, because we have to consider their growth and chang-
es in pulmonary vascular resistance during follow up. We applied a
unique treatment strategy which consisted of adjustable bPAB using
pliable ePTFE bands combined with staged percutaneous balloon
dilation on the banding sites for three critical infants. We report one
of the cases who had been successfully treated based on this strategy.
Case
report:
A newborn girl was diagnosed as having unbalanced
complete atrio-ventricular defect (cAVSD), CoA and hypoplastic
aortic arch, associated with 21-trisomy. The small LV volume and
