CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
44
AFRICA
inhaled iloprost 2.5 mcg q2h. Over the next week SB was weaned
off iNO and his ventilator support was decreased by 50%. Cardiac
catheterisation revealed mPAP 40 mmHg and PVRi 6.58 units/m²
with normal RV function. He was transitioned to inhaled treprostinil
three breaths q6h in an effort to provide an acceptable regimen for
a step-down unit. SB tolerated the transition without systemic side
effects or bronchospasm. Echocardiogram at 10 months reveals mild
elevation of PAP and normal RV function.
NH was a two-month-old with partial monosomy 10q26, partial
trisomy 10p12.2, PDA and PPHN, who developed suprasystemic
PAP and RV dysfunction on sildenafil and iNO. At one month he
was started on iloprost 2.5 mcg q2h after severe hypotension with
milrinone, and subsequently transitioned to inhaled treprostinil three
breaths q6h. At two months he underwent cardiac catheterisation with
mPAP of 49 mmHg and PVRi 5.6 units/m² with normal RV function.
NH’s PDA was uneventfully closed. He continues to tolerate inhaled
treprostinil without side effects.
Conculsions:
Inhaled treprostinil may be safely and effectively
administered to ventilator-dependent infants.
1219: COMPARISON OF RESULTS OF AUTOLOGOUS
VERSUS HOMOLOGOUS BLOODTRANSFUSION IN OPEN-
HEART SURGERY
Bilgehan Oz, Gokhan Arslan, Erkan Kaya, Celalettin Gunay, Mehmet
Arslan
Gulhane Military Medical Academy, Ankara, Turkey
Background:
In this randomised, controlled study we investigated
the effects of autologous and allogenic blood transfusion in adult
on-pump cardiac surgery.
Methods:
Three hundred and four patients who underwent surgery
between January 2009 and April 2012 were randomised into
two groups. The A group (
n
=
164) consisted of patients who
received autologous blood transfusions, and the B group (
n
=
160)
patients received allogenic blood transfusions. All patients underwent
on-pump cardiac surgery via a sternotomy. The time to extubation,
chest tube drainage volume, postoperative red blood cell counts,
amount of blood transfused, postoperative temperature, and postop-
erative haematocrit level were recorded in the intensive care unit on
the 14th postoperative day.
Results:
Intra-operative bleeding and fluid resuscitation were similar
in the two groups, however, there were significant decreases in post-
operative blood loss, extubation period, postoperative red cell counts,
and fever in group A compared with group B. Drainage volume in
group A was 397
±
77.6 ml with a mean haematocrit value of 29.3
±
3.5%. There were no deaths. No patients needed re-exploration for
bleeding. There were no postoperative complications; 64 patients
(40%) did not receive any blood or blood products and 24 patients
(7%) needed only one unit of homologous red cell transfusion in the
retransfusion group, whereas 40 patients (26%) needed one unit, and
three patients received two units of homologous red cell transfusion
in control group B (
p
=
0.008). At discharge, the mean haematocrit
value was statistically higher in group A compared with group B.
Conclusion:
The use of autologous blood in patients having under-
gone open-heart surgery not only attenuated side effects and compli-
cations of transfusion but also positively affected the postoperative
recovery process. Therefore, it can be considered to be an easy,
effective and cheap technique.
1227: ROUTINE CLOSURE OF VENTRICULAR SEPTAL
DEFECT THROUGH LEFT VENTRICLE OUTFLOWTRACT
DURINGARTERIAL-SWITCH OPERATION FOR D-TRANS-
POSITION OF THE GREAT ARTERIES/VENTRICULAR
SEPTAL DEFECT
Laszlo Kiraly
Sheikh Khalifa Medical City, United Arab Emirates
Background:
Arterial-switch operation (ASO) and VSD closure for
d-TGA-VSD is performed worldwide with excellent surgical results.
Traditionally, VSD closure has been proposed via a trans-tricuspid
or trans-ventricular (in Taussig–Bing anomaly) approach. We present
our experience with VSD closure through the left ventricular outflow
tract (LVOT) as an easy and reproducible technique.
Objective:
To study safety and feasibility of VSD closure via LVOT
during ASO.
Methods:
Operations were performed with continuous, moderately
hypothermic CPB cardioplegia. Having the great arteries divided, the
VSD was closed through the LVOT with a PTFE patch and running
suture. The ASO then continued in the usual manner. A double-clam-
shell device was applied to close additional apical VSDs. Results
were evaluated with intra-operative TEE.
Results:
Neonates (9 SD, 4.8 days) undergoing ASO (
n
=
102) had
their VSDs closed (38) via LVOT. Aortic/pulmonary diameter ratio
was 0.64. Morphological malalignment: VSD with (21 patients)
and without (five) sutures anchored superficially on remnants of
the peri-membranous septum and postero-inferior muscular rim;
Taussig–Bing anomaly (nine patients); three additional apical VSDs
were repaired. Coexisting LVOTO (eight), neo-aortic valvotomy/
plasty (four), and aberrant MV chords (three) were addressed from
the same approach. TEE showed no significant residual shunt. All
patients had normal AV conduction postoperatively. No surgical
morbidity/mortality occurred.
Conclusions:
Larger neo-aortic/LVOT diameter in d-TGA-VSD
offers a safe and reproducible technique for VSD closure during
ASO. This approach obviates restricted trans-tricuspid visibility and/
or the need of ventriculotomy (Taussig–Bing anomaly). Associated
LVOT anomalies can be simultaneously addressed. Concerns of
injuring the AV conduction can readily be avoided by appreciating
the morphology and anchoring superficial sutures on the fibrous
remnants of the perimembranous septum and/or applying a suture-
less flap extension of the patch in the area of the penetrating bundle.
1235: PREVALENCE AND CORRELATES OF LEFT
VENTRICULAR HYPERTROPHY IN THE PAEDIATRIC
HYPERTENSIVE POPULATION
Diana Drogalis, Anna Tsirka, Jennifer Friderici
Baystate Medical Center, Springfield, MA, USA
Background:
Hypertension (HTN) is common in childhood, yet the
diagnosis is frequently delayed. Prior literature shows that up to 35%
of children diagnosed with HTN have left ventricular hypertrophy
(LVH) at presentation. Therefore an echocardiogram (echo) is recom-
mended at the initial evaluation. In recent years, however, awareness
of paediatric HTN has improved. We hypothesised that the current
prevalence of LVH in paediatric hypertensive patients is lower than
previously reported.
Methods:
A single-site retrospective chart review was performed
from 1 July 2009 to 20 February 2012. Charts with ICD-9 code of
hypertension were identified in the echo server and appointment
database. Patients were considered at risk for LVH if ECG voltages
(S in V1, R in V6) were
≥
98%, or if LVMI was
>
95 g/m
2
(females)
or 115 g/m
2
(males) as per American Society of Echocardiography
(ASE) guidelines.
Results:
Children (140, age 3–17 years) with untreated HTN were
identified; 33 were excluded due to incomplete data. Mean age was
13.6 (SD 3.2) years; 78.5% of the cohort were male; 51.4% were
obese, 33.6% had stage 1 HTN and 47.7% had stage 2 HTN. Mean
LVMI was 79.6 (SD 20.7) g/m
2
, and 4.7% (95% CI: 0.6%, 8.7%) met
ASE LVH criteria. LVMI correlated positively with age (
r
=
0.43,
p
<
0.001), SBP (
r
=
0.29,
p
=
0.001), black vs white race (
r
=
0.24,
p
=
0.009), male gender (
r
=
0.30,
p
<
0.001); 18.7% (95% CI: 11.2%,
26.2%) of patients demonstrated ECG LVH evidence. ECG LVH
indicators did not correlate with LVMI (
r
=
0.1,
p
=
0.32) or any
other variables (all
r
<
|0.10|). ECG voltages and LVMI showed poor
agreement (kappa
=
2.1,
p
=
0.93).
Conclusion:
In our single-institution cohort of 140 patients, LVH
incidence was
<
5% in untreated hypertensive children, which was
