CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
49
Objective:
To examine whether closure of isolated atrial septal
defects (ASDs) (secundum and sinus venosus type) in adults with
severe pulmonary hypertension improved their long-term clinical
outcome.
Methods:
In a retrospective study, there were 1 423 adult patients
with ASD. We examined the major cardiovascular events and overall
mortality of 68 adult patients with isolated ASDs and severe pulmo-
nary hypertension without Eisenmenger change. Sixty-two of them
underwent interventional closure either by means of percutaneous
transcatheter occluder or by open surgical repair. The remaining six
were on medical treatment. We compared the major cardiovascular
events, including death, stroke or paradoxical embolism, new-onset
atrial fibrillation or atrial flutter, infective endocarditis, progressed
pulmonary hypertension, pneumonia requiring hospitalisation, and
functional class deterioration in these two groups. Severe pulmonary
hypertension was defined as right ventricular systolic pressure
≥
60 mmHg, measured by transthorasic echocardiography. Follow-up
period was between one and 214 months.
Results:
The survival analysis did not reveal significant differences
in overall mortality (
p
=
0.805) and major cardiovascular events (
p
=
0.308) between the interventional-closure group and the medi-
cal treatment group. In the interventional-closure group, the risk
of having major cardiovascular events was significantly higher in
patients aged between 18 and 30 years (
p
=
0.019) and over 40 years
(
p
=
0.022) compared with those aged between 30 and 40 years,
although there was no significant difference in overall mortality
between these age groups (
p
=
0.108).
Conclusion:
Interventional closure may not be superior to medi-
cal treatment in improving major cardiovascular events and overall
mortality in adults with isolated ASD and severe pulmonary hyper-
tension. In the interventional group, age was an important predictor
of later cardiovascular events. This may have been due to the early
development of pulmonary hypertension in the younger group (age
18–30 years old) and chronic change of pulmonary vascular hyper-
tension in the older group (over 40 years old).
1317: REPAIR OF CONGENITAL MITRALVALVE MALFOR-
MATION IN INFANTS
Ming-Hsien Lin
1,2
, Chung-I Chang
1
, Shu-Chien Huang
1
, Yih-Sharng
Chen
1
, Ing-Sh Chiu
1
, Ming-Tai Lin
1
, Jou-Ko Wang
1
, Chi-Hsiang
Huang
1
1
National Taiwan University Hospital, Taipei, Taiwan
2
National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu,
Taiwan
Objectives:
Due to the wide spectra of morphological abnormalities,
associated cardiac anomalies and body size, surgical treatment of
congenital mitral valve malformations in paediatric patients remains
a therapeutic challenge. We reviewed our experiences with mitral
valve repair in infants.
Methods:
All consecutive patients with congenital mitral valve
disease who underwent surgery between 1998 and 2010 were studied
retrospectively. Patients with atrio-ventricular septal defects, atrio-
ventricular discordance, and functional single-ventricle anomalies
were excluded.
Results:
Between 1998 and 2010, 12 children (seven boys and five
girls) with a median age of 5.2 months (interquartile range 2.1–8.1
months) underwent surgery. The median follow-up time was 3.9
years (interquartile range, 1.2–8.9 years). Twelve patients (52.2%)
were under one year old. Ten patients (83.3%) were diagnosed with
mitral valve incompetence, while two (16.7%) were diagnosed with
stenosis. We attempted to repair the mitral valve in all patients,
except one with Shone’s complex and hammock valve. Associated
cardiac lesions were presented in eight patients (66.7%). Five patients
(41.7%) required re-operation, including three during the initial
hospitalisation and two during the follow-up period. All patients
who required re-operation needed mitral valve replacement with a
mechanical prosthesis, and the mitral valves appeared extremely
malformed in these patients during the first operation (hammock
valve in two patients and parachute mitral valve in one). Overall,
the success rate of mitral valve repair was 58.3% (seven patients).
There were no early or late deaths, and all survivors were categorised
according to the NewYork Heart Association classification system as
class I or II, with mild or less mitral dysfunction.
Conclusion:
Although mitral valve repair in infants with congenital
mitral valve disease is a challenging procedure, low surgical mortal-
ity can be achieved. Despite the severity of mitral valve dyspla-
sia, mitral valve repair should always be attempted. Patients with
extremely malformed mitral valves have a significantly higher risk
of requiring re-operation (
p
=
0.03, odds ratio
=
9.33). Initial mitral
valve repair can provide time for future mitral valve redo operations.
1318: HAND-MADE GORE-TEX VALVED CONDUIT FOR
RIGHT VENTRICULAR OUTFLOW TRACT RECON-
STRUCTION FOR PATIENTS WITH SEVERE PULMO-
NARY REGURGITATION AFTER TOTAL CORRECTION OF
TETRALOGY OF FALLOT
Kang-Hong Hsu
1
, Chung-I Chang
2
1
National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu,
Taiwan
2
National Taiwan University Hospital, Taipei, Taiwan
Background:
Surgical management of tetralogy of Fallot (TOF)
results in anatomical and functional abnormalities in the majority of
patients. Although right ventricular (RV) volume load due to severe
pulmonary regurgitation (PR) can be tolerated for years, there is now
evidence that the compensatory mechanisms of the right ventricular
myocardium ultimately fail and that if the volume load is not elimi-
nated or reduced, the dysfunction may be irreversible.
Methods:
This was a retrospective chart review study. From 2008 to
2012, there were 32 patients receiving pulmonary valve replacement
surgery due to severe pulmonary valve regurgitation and RV failure
decades after total correction for TOF. Among them, 15 patients
received hand-made valved Gore-Tex conduit reconstruction.
Results:
Thirteen patients received our handmade tri-leaflet conduit
reconstruction with tissue valves and two received monocuspid
valved conduit reconstruction with the outflow tract diameter around
20–24 mm. Three patients received intra-operative radiofrequency
ablation for pre-operative arrhythmia. There was no surgical morbid-
ity or mortality in our series. During follow up, they all remained in
NewYork Heart Association functional class I. The echocardiography
revealed mild residual pulmonary regurgitation.
Conclusion:
Pulmonary valve replacement with handmade valved
tricuspid Gore-Tex conduits provides similar short-term outcomes
when compared with traditional bioprosthesis and may avoid early
graft calcification in growing adolescents. With this design, we can
also provide a better landing area for later transcutaneous pulmonary
valve implantation. However, we need further follow up to analyse
our long-term surgical results.
1319: TRENDS IN EARLY RESULTS AFTER FONTAN
SURGERY: THE ENTIRE AUSTRALIAN AND NEW
ZEALAND EXPERIENCE OF 1 030 PATIENTS
Ajay Iyengar
1,2
, David Winlaw
3
, John Galati
2
, David Celermajer
4
,
Gavin Wheaton
5
, Robert Justo
2
, Thomas Gentles
7
, Leeanne Grigg
8
,
Andrew Bullock
9
, Yves d’Udekem
1,
2
1
Royal Children’s Hospital, Melbourne, Australia
2
Murdoch Children’s Research Institute, Melbourne, Australia
3
Heart Centre for Children, The Children’s Hospital, Westmead,
Sydney, Australia
4
Royal Prince Alfred Hospital, Sydney, Australia
5
Women’s and Children’s Hospital, Adelaide, Australia
6
Mater Children’s Hospital, Brisbane, Australia
7
Starship Children’s Hospital, Auckland, New Zealand
8
The Royal Melbourne Hospital, Melbourne, Australia
9
Children’s Cardiac Centre, Princess Margaret Hospital, Perth,
Australia
