CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
36
AFRICA
the higher pulmonary vascular resistance related to chromosomal
anomaly were difficult issues, to be discussed in the initial treatment.
Subsequently, we performed bPAB using handmade banding tapes,
made of double-layered ePTFE membrane, 0.1 mm in thickness, on
the 10th day of life. The bands were tightly fixed using 7-0 poly-
propylene sutures. The lengths of the bands were 9.0 and 9.0 mm,
respectively. As she gained weight under medical treatment with
continuous lipo-prostaglandin E1 infusion, her saturation had gradu-
ally declined to 70%. Percutaneous balloon dilation was performed
to increase pulmonary blood flow using 3.5- and 4.0-mm balloon
catheters at 80 and 133 days old. At 169 days old, CoA repair was
carried out via a left thoracotomy. She had repeatedly undergone
balloon dilation until she reached a definitive operation. Catheter
study at one year after bPAB showed the adequately increased LV
volume. Thereafter she underwent biventricular repair with a success-
ful outcome. No peripheral pulmonary arterial patch angioplasty was
required.
Conclusion:
Our adjustable bPAB strategy provides great benefits
for treatment of borderline infants for biventricular repair.
939: SINGLE-PORT SUBXIPHOID APPROACH WITHOUT
FEMORAL CANNULATION FOR ASD CLOSURE
Sivasubramanian Muthukumar, Ranjith Karthekeyan, Harish Babu,
Thangavelu Periyasamy
Sri Ramachandra University, Chennai, India
Aim:
To present the technique and results of the single-port subxi-
phoid approach without femoral cannulation for ASD closure in
children.
Methods:
ASD closure can be performed through a mini-sternotomy
or subxiphoid approach with a small skin incision. Femoral arterial
cannulation is generally used to minimise the length of the incision.
We present our experience with a small-incision (average 2 cm)
subxiphoid approach for ASD closure without femoral cannulation.
We established CPB with an aortic cannula and venous cannulation
with RA and IVC cannulas. We used a reinforced arterial cannula, a
right-angled reinforced venous cannula for IVC, and straight rein-
forced cannula for RA. Core cooling was done to 32°C. ASD closure
was done under fibrillatory arrest. We used an autologous pericardial
patch for ASD closure in the majority of patients. After de-airing the
LA, the fibrillator was removed. An internal defibrillator was used if
the heart did not pick up sinus rhythm spontaneously. After rewarm-
ing, the patient was weaned off CPB.
Results:
We perfomed single-port subxiphoid ASD closure in 137
patients over three years from May 2009 to April 2012. In that time,
73 patients were female and 64 were males. The mean CPB time
was 41 min. The mean fibrillatory arrest time was 10 min. In three
patients, it was converted to full sternotomy. The mean length of the
skin incision was 2 cm. The mean ventilation time was 83 min. All
patients had a very short ICU and hospital stay.
Conclusion:
The single-port subxiphoid ASD closure without femo-
ral cannulation can be performed in all patients efficiently and safely
and the technique is reproducible.
942: RECURRENT RESPIRATORY PAPILLOMATOSIS
COMPLICATED BY INTRACARDIAC EXTENSION
Firoza Motara, Krubin Naidoo, Sue Klugman, Debbie White, Togara
Pamacheche, Y Perner, Deliwe Ngwezi
CM Johannesburg Academic Hospital and the University of the
Witwatersrand, Johannesburg, South Africa
Intoduction:
Intracardiac masses are rare in children. Normal struc-
tures and variants may mimic a cardiac mass. Abnormal cardiac
masses commonly include tumours, thrombi and vegetations.
Case
report:
We present an unusual case of recurrent respiratory
papillomatosis with malignant progression and intracardiac exten-
sion. An eight-year-old male presented with a chronic history of
recurrent respiratory papillomatosis involving the larynx initially
but which later spread distally to involve the trachea and bronchi.
He subsequently developed bronchiectasis. He has had regular ENT
consultations and required laser treatment for the papillomas; in addi-
tion he had a tracheostomy at a young age. His acute presentation was
a threatened right upper limb due to right axillary artery and brachial
artery occlusion. Echocardiography demonstrated a mass within
the left atrium. Despite anticoagulation, antibiotics and antifungal
treatment, this mass progressively enlarged and further proceeded to
embolise to the distal aorta, resulting in an acutely threatened lower
limb. Surgical resection of the intracardiac mass was undertaken after
the second embolic event and at surgery the mass was noted to arise
from a pulmonary vein. The final diagnosis of the intracardiac mass
was made on histology, which showed a well-differentiated squamous
cell carcinoma which had arisen in the context of the antecedent
history of human papilloma virus-induced laryngeal and bronchopul-
monary papillomatosis.
Conclusion:
The above confirms that intracardiac tumours in
the paediatric population are more likely to be metastatic. Even
though echocardiography permits dynamic evaluation of intracardiac
masses, allowing delineation of the anatomical extent and the physi-
ological consequences of the mass, histology provides the definitive
diagnosis.
949: CONGENITAL CARDIAC ANAESTHESIA DATABASE
RESULTS 2010–2011
David Vener
Baylor College of Medicine/Texas Children’s Hospital, Houston,
TX, USA
The Congenital Cardiac Anesthesia Society (CCAS) has partnered
with the Society of Thoracic Surgeons (STS) to include fields
relevant to our speciality as part of the STS Congenital Surgery
database. This cooperative effort started in January 2010. Since
that time, participation has grown to include data from over 30 sites
in the United States. The locations include representation from a
wide range both geographically and in programme size. The Spring
2012 harvest, encompassing 1 January 2010 to 31 December 2011,
includes data from 20 226 discrete anaesthetics; 13 796 of these
cases were cardiac surgical (CPB, no CPB, support devices), 3
354 were from the Cardiac Catheter Lababoratory and 3 076 were
thoracic procedures, minor procedures or non-CV/non-thoracic on
CV patients requiring CV anaesthesia (such as G-tube placement
or Ladd’s procedure). Data are being harvested on a wide variety
of anaesthesia topics such as airway and medication management,
monitoring modalities and anaesthesia-related adverse events. The
overall adverse event rate was 2.1% and ranged from relatively minor
(line placement requiring more than one hour) to severe (cardiac
arrest unrelated to surgical events). The overall adverse events are
detailed in the presentation.
950: SURGICAL REPAIR OF TOTALANOMALOUS PULMO-
NARY VENOUS CONNECTION IN EMERGING ECONO-
MIES: ARE GOOD OUTCOMES POSSIBLE
SANS
INHALED
NITRIC OXIDE AND ECLS?
Parvathi Iyer, Anurag Kaw, Neeraj Awasthi, Sanjay Khatri, Ajmer
Singh, Sumeer Girotra, Sitaraman Radhakrishnan Savitri Shrivastava,
Krishna Iyer
Fortis Escorts Heart Institute, India
Background
: Peri-operative management of sick infants with total
anomalous pulmonary venous connections (TAPVC) remains a chal-
lenge, especially in emerging economies where many patients present
with unstable haemodynamics. Post-operative pulmonary hyperten-
sion (PH) and secondary low-cardiac output state (LCOS) may be
refractory, needing expensive therapeutic modalities such as inhaled
nitric oxide (iNO) and or mechanical support.
Objective
: To evaluate the early outcome of TAPVC repair without
recourse to mechanical support or inhaled nitric oxide.
