CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
47
AV septal defect, transposed great arteries, and severe pulmonary
stenosis underwent modified superior cavopulmonary anastomosis
after wide mobilisation of the branch pulmonary arteries up to the
hilar level, using the translocated main pulmonary artery. The proxi-
mal SVC stump receiving the three pulmonary veins was left behind,
draining into the atrium. The postoperative course was uneventful
and the postoperative echo revealed unobstructed flow in the modi-
fied BDG anastomosis, and well flowing unobstructed pulmonary
veins. The child recovered well and was discharged in seven days.
This case report highlights the rarely described technique using the
MPA stump to complete the Glenn anastomosis, while the lower
stump of the SVC was left connected to the heart, which received the
pulmonary veins. A more generous dissection and mobilisation of
the branch pulmonary arteries up to hilar level is needed to avoid the
kinking of the left pulmonary artery after translocation of the main
pulmonary artery.
1286: ROLE OF TISSUE GLUE IN PAEDIATRIC CARDIAC
SURGERY: OUR EXPERIENCE
Prashantkumar Dineshchandra Shah
Lifeline Hospitals, Chennai, India
Introduction:
Complex congenital cardiac surgery involving multi-
ple suture lines at the arterial level increase morbidity due to bleeding
and transfusion-related complications. Appropriate use of tissue glue
in a suitable site and a convenient method is discussed in this article.
Methods:
The study period was between March 2011 and the
present. In 11 patients we used tissue glue, in five patients, tissel, in
four, coseal and in two, flow seal. We used the rapid method for tissel
and coseal in neonates and infant aortic surgery. We used tissel just
before aortic cross-clamp removal, and coseal mainly in redo aortic
surgery and coarctation of the aorta. For post-clamp removal bleeding
we used flow seal along with surgical packing.
Results:
Tissel worked in four patients but in the frst patient, due to
inappropriate application, it was not effective. Coseal worked well in
the drop technique but in one patient where we used the spray tech-
nique, it was not satisfactory due to low volume. There was no suture
hole bleeding in 10 patients, which has reduced OT time, ventilation
time, blood and blood products, and suture usage. This has helped
fora speedy postoperstive recovery and prevented blood product-
related complications.
Conclusion:
The appropriate type of glue application in indicated
patients with the correct amount and technique improves patient
outcomes by reducing morbidity related to bleeding and it is also
cost effective.
1292: CARDIAC ARREST AS A CONSEQUENCE OF CARDI-
AC FIBROMA INA PREVIOUSLY HEALTHY INFANT: CASE
REPORT
Maria Suely Bezerra Diógenes, Helena Catarina Moreira Modotte,
Erasmo Assumpção Neto, Nilton Ferraro Oliveira, Renato Lopes
Souza, Célia Maria Camelo Silva, Euclides Saqueti Filho, João
Chaker Saba, Luciana Da Fonseca, Mercia Marcelino Souza Ishigai
Federal University of São Paulo, Brazil
Background:
Cardiac tumours are very rare and mostly benign.
Cardiac fibroma ranks second in frequency and clinical manifesta-
tions depend on the degree of ventricular filling and obstruction of
the left ventricular outflow tract.
Case
report:
MMC, a previously healthy 14-month-old male
infant, was admitted to the emergency room of a nearby hospital in
cardiac arrest and was promptly ressuscitaded after cardiopulmonary
manoeuvres. The patient developed heart failure and low cardiac
output in the following days. The chest X-ray revealed cardiomegaly
and pulmonary congestion. The ecocardiogram with Doppler showed
an image suggestive of cardiac tumour with regular margins occu-
pying the middle part of the interventricular septum and extension
to the apex and anterior wall of the left ventricle, measuring 4.9
× 4.8 cm and displaying signs of dynamic obstruction of the left
ventricular outflow tract. Computerised tomography and magnetic
resonance imaging of the chest also showed an image suggestive
of a large cardiac tumour. Cardiac surgery was undertaken via the
transaortic approach and the presence of a tumour affecting most of
the left ventricular cavity, compromising the left coronary bed was
visualised, thereby restricting its total resection. So we opted for
partial resection of the left ventricular outflow tract. Pathology of
the material revealed a cardiac fibroma. The child had progressive
clinical improvement in the postoperatory period and was discharged
from hospital within three weeks with no signs of left ventricular
obstruction or heart failure and is doing well as an out-patient with
low-dosage beta-blocker.
Conclusions:
Cardiac tumours can lead to cardiac arrest and heart
failure, and must be included in the diagnostic hypothesis.
1297: BIVENTRICULAR OUTFLOWTRACT RECONSTRUC-
TION: THE AORTIC TRANSLOCATION (NIKAIDOH)
PROCEDURE VS THE RASTELLI PROCEDURE
Claudia Natalia Villalba, Julieta Irman, Mariela Mouratian, Maria
Victoria Lafuente, Pablo Garcia Delucis, Jose Luis Pibernus, Horacio
Capelli
Hospital JP Garrahan, Argentina
Objective
: To compare the Rastelli (R) and the Nikaidoh (N) proce-
dures in terms of early and mid-term results.
Methods
: Betweeen January 2000 and January 2012, 23 patients
underwent a biventricular outflow tract reconstruction at our institu-
tion, with a mean age of 3.8 years old (SD
±
2.7) and a mean weight
of 14 kg (SD
±
4.6). The anatomical variants were transposition of
the great arteries (TGA) and double-outlet right ventricle (DORV)
with non-committed ventricular septal defect (VSD) and pulmonary
stenosis (PS). Patients were divided into group I
=
Nikaidoh (10) and
group II
=
Rastelli (13).
Results
: The mean CPB perfusion time was 227 min (SD
±
64)
and aortic cross-clamping was 150 min (SD
±
46), which was more
prolonged in group I (
p
=
0.006). The mean mechanical ventilation,
inotropic requirement and hospital stay was five days (QI 25–75%
=
2–19), six days (QI 25–75%
=
3–28) and 10 days (QI 25–75%
=
7.7–30). During the immediate postoperative period: nine patients
experienced ventricular dysfunction and nine arrythmias, without
significant differences between both groups. There was no mortal-
ity in group I, whereas four patients died in group II (
p
=
0.05). The
mean follow up was 4.6 years (QI 25–75%
=
2–7). Arrhythmias (
p
=
0.04) and right ventricular outflow tract obstruction (RVOTO) (
p
=
0.03) were more frequent in group II. All of the Nikaidoh group were
free of LVOTO, whereas three patients in the other group developed
subaortic stenosis. None developed aortic insufficiency larger than
mild. In group II: five interventional procedures (
p
=
0.01) and nine
re-operations (
p
=
0.004) were needed.
Conclusions
: In the Nikaidoh procedure, even though cross-clamp-
ing time was prolonged, patients remained free of major events
and mortality. In the Rastelli procedure with non-committed VSD
group: mortality, arrhythmias, RVOTO, interventional procedures
and re-operations were more frequent. Aortic translocation tech-
niques such as the Nikaidoh procedure seem promising, especially
in the presence of inadequate anatomy for a Rastelli repair. Further
studies are needed to confirm this in the long term and with a larger
number of patients.
1298: SOUTHAMPTON PRELIMINARY EXPERIENCE IN
THE USE OF AN EXTRACELLULAR MATRIX TO REPAIR
CONGENITAL AND ACQUIRED HEART DEFECTS
Michael J Lavrsen, Nicola Viola, Joseph Vettukattil, Markku Kaarne
University of Southampton, Southampton, UK
Background:
Surgical correction of congenital heart defects are
performed early in life. An ideal material for these corrections would
