CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
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AFRICA
procedure in young infants.
Conclusions:
Preliminary findings suggest that NCV abnormalities
are undetectable in the early period after CPB. Further studies are
required to investigate early features of CIPN in ill children in the
intensive care unit.
1275: SCIMITAR SYNDROME: A 20-YEAR SINGLE-INSTI-
TUTION EXPERIENCE
Zohair Al Halees, Bahaaldin Al Soufi, Ziad Bulbul, Abid Awan,
Mansour Al Joufan, Ahmed AlOmrani, Mamdouh Al Ahmadi
Heart Centre, King Faisal Specialist Hospital and Research Centre,
Jeddah, Saudi Arabia
Objectives:
To review our experience in the management of scimitar
syndrome over the last 20 years.
Methods:
Clinical records, echocardiographic images, catheterisa-
tion data, operative reports and follow-up information were recorded
and reviewed. The patients were divided into infant (
<
1 year) and
adult (
>
1 year) forms. Those who had complete repair of the anoma-
lous vein were subdivided into baffling or re-implantation of the
anomalous scimitar pulmonary vein to the back of the left atrium.
Results:
Between 1986 and 2006, 36 patients presented with scimi-
tar syndrome. There were 20 females and 16 males (mean age 29
months), with 22 patients in the infant group. Higher proportions of
infants had right lung hypoplasia and four had primary right pneu-
monectomy as sole therapy with good outcome. Thirty patients had
systemic collateral supply to the right lung; 20 had coil embolisation.
Coil embolisation was the only intervention in five patients. Surgical
repair of the scimitar vein was accomplished in 21 patients with 10%
mortality. No major differences were encountered in the incidence
of pulmonary hypertension, early mortality and late survival of the
two age groups. Also no differences in early mortality, late outcome
and rates of obstruction between different methods of surgical repair
were seen.
Conclusion:
Good, comparable results were achievable in infants
and older children with scimitar syndrome with an aggressive
approach comprising liberal coil embolisation of collateral vessels
and early surgical repair of the anomalous pulmonary vein. Primary
pneumonectomy may be an option in selected patients. Both baffling
and re-implantation techniques provided similar outcomes.
1281: BEATING-HEART AORTIC ARCH REPAIR WITH
MILD HYPOTHERMIA: OUR EXPERIENCE WITH THREE
CASES
Yogesh Sathe, Muthukumarvel, Prabhu, Prashant Shah
Lifeline Hospitals, Chennai, India
Introduction:
Aortic arch repair surgery can be performed by vari-
ous techniques. Selective antegrade cerebral perfusion with continu-
ous coronary perfusion at mild hypothermia is discussed here.
Methods:
From March 2009 to date, three patients have been oper-
ated on with this technique.
Case 1:
A nine-year-old child with supravalcular aortic stenosis of
diffuse variety involving aortic arch and arch vessels. Case 2: An
eight-year-old male child with Shone’s complex, hypoplastic aortic
arch, and severe coarctation of the aorta. Case 3: An eleven-year-old
male child with hypoplastic arch, severe coarctation of the aorta,
single ventricle PDA, and severe PAH.
Result:
All three patients had innominate artery cannulation for ante-
grade cerebral perfusion and ascending aortic cannulation for coro-
nary perfusion. Total mean CPB time was 85 min. Arch isolation time
was 40 min and mean temperature was 28°C. All patients recovered
well without any neurological complications and hospital stay was
eight days. At the two-year follow up, all patients were doing well.
Conclusion:
Aortic arch repair can be done safely with a selective
antegrade cerebral perfusion technique.
1282: BROM’S TECHNIQUE FOR SUPRAVALVULAR
AORTIC STENOSIS: OUR EXPERIENCE
Mahalakshmi, Yogesh Sathe, Prabhu, Prashanth Shah
Lifeline Hospitals, Chennai, India
Introduction
: Supravalvular aortic stenosis is a rare form of
left ventricular outflow obstruction, commonly seen in William’s
syndrome with a diffuse variety of localised narrowing at the sino-
tubular junction. This was a study of the management of supravalvu-
lar aortic stenosis with Brom’s three-patch enlargement technique.
Methods
: We operated on a total of four patients with supravalvular
aortic stenosis, two with a localised variety and one with a diffuse
variety involving the ascending aorta and aortic arch vessel origin.
Mean age of patients was 8.4 years. Three patient had William’s
syndrome while one had Shone’s complex component (parachute
mitral valve with non-significant gradient). All four patients with
supravalvular aortic stenosis were repaired with Brom’s technique
(individual patch augmentation of each sinus). In patients with the
diffuse variety along with Brom’s technique, the ascending aorta
and origin of the aortic arch vessels were enlarged with a pericardial
patch. Mean CPB time was 190 minutes, aortic cross-clamp time
was 116 min. There was no hospital mortality. Mean ICU stay was
2.5 days, hospital stay was 7.6 days. Discharge echo on the seventh
postoperative day suggested no gradient at the sino-tubular junction.
Three patients had their three-year follow up without any complica-
tions.
Conclusion
: Brom’s technique is a good, simple and safe technique
for supravalvular aortic stenosis, with a good surgical outcome.
1283: CASE REPORT: EXTENSIVE ARCH REPAIR WITH PA
BANDING FOR DORV, LARGE VSD, SINGLE VENTRICLE
Yogesh Sathe, Prabhu, Muthukumarvel, Prashant Shah
Lifeline Hospitals, Chennai, India
Case
report:
A six-year-old boy presented with frequent lower
respiratory tract infections since early infancy, needing frequent
hospitalisations. Clinically, the child had cyanosis, clubbing, precor-
dial bulge, Harrison’s sulcus indicating a high pulmonary blood flow
situation with a loud P2, soft pansystolic murmur and a mid-diastolic
flow murmur at the apex. Clinically he appeared operable. Echo
examination revealed DORV, large inlet VSD, subaortic extension,
apical Swiss cheese defects, straddling tricuspid valve, normally
related great arteries with hugely dilated, confluent branch pulmo-
nary arteries, a hypoplastic aortic arch with interruption, and PDA
supplying the descending aorta. CT angiogram revealed a hypoplastic
transverse arch with post subclavian, preductal coarctation of the
aorta. The child underwent extensive arch repair with coarctoplasty
and PA banding. Postoperatively, the child was extubated within 24
hours. He was discharged within 10 days. At the one-year follow up,
the PA band gradient was 70 mmHg with room air saturation at 84%.
1285: CASE REPORT 2: MODIFIED GLENN ANASTOMOSIS
IN A CASE OF PAPVC TO SVC AND SINGLE VENTRICLE
Yogesh Sathe, Prabhu, Muthukumarvel, Prashant Shah
Lifeline Hospitals, Chennai, India
Introduction:
Many procedures have been reported for the repair
of partial anomalous pulmonary venous connection (PAPVC) with
return to the high superior vena cava (SVC). Total cavo-pulmonary
connection (TCPC) has been a common procedure but anatomical
complexity of the pulmonary veins and systemic venous return in an
asplenic heart makes the definitive repair more difficult. The PAPVC
repair concomitant with Glenn anastomosis and the shift of the infe-
rior vena cava (IVC) orifice has seldom been reported. We present
a novel technique, in which the pulmonary artery (PA) translocation
was performed to avoid obstruction of the pulmonary veins when
Glenn anastomosis was established.
Discussion:
A four-year-old cyanotic boy diagnosed with unbalanced
