CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
51
25 years. Permanent pacemaker implantation was required in four
patients. Re-operations were performed in 22 patients (21.4%, 95 CI:
17–52%), mainly for pulmonary stenosis (seven), aortic valve insuf-
ficiency (four) and left ventricular outflow tract obstruction (three).
Freedom from re-operation at 10, 20 and 25 years was 90.2, 76.9 and
65.7%. At last follow up, all patients were asymptomatic with normal
left ventricular function. Aortic root diameters were collected in 52,
of whom 29 (55.8%) had an aortic root dilatation (
>
2 SD), which
occurred more frequently in those with initial aortic arch obstruction
compared to those without (respectively 86.7 vs 43.2% of patients,
p
=
0.0043).
Conclusion:
Close to 20 years after ASO for complex TGA, late
outcome was encouraging, with no deaths after the first year of life.
However, the aortic root may dilate with time, more likely in patients
with initial aortic arch obstruction, who justify close follow up.
1351: MODIFIED NIKAIDOH OPERATION FOR D-TRANS-
POSITION OF THE GREAT ARTERIES WITH A VENTRIC-
ULAR SEPTAL DEFECT AND PULMONARY STENOSIS
USING ‘OVERSIZED’ CONDUITS
Timofey Nevvazhay, Alexey Chernogrivov, Julia Kalinicheva, Oxana
Talysheva, Tatiana Rybakova
State Centre for Cardiovascular Surgery, Penza, Russia
Objective:
Our seven-minute film demonstrates the surgical tech-
nique of aortic root translocation with arterial-switch procedure and
coronary artery re-implantation (modified Nikaidoh operation) for
d-transposition of the great arteries with VSD and left ventricular
outflow tract obstruction in a four- month-old patient (5.5 kg) previ-
ously palliated with systemic-to-pulmonary shunt.
Methods:
The surgical approach consisted of harvesting the aortic
root from the right ventricle, and the coronary arteries were excised
as circular buttons. The pulmonary valve was excised and the
conal septum was divided completely. The VSD was closed with a
triangular-shaped patch. The aortic root autograft was then rotated
180° and was sewn to the LV outflow. Re-implantation of the coro-
naries and Lecompte manoeuvre were done, as in the arterial-switch
procedure. The right ventricular-to-pulmonary artery continuity was
re-established using a pulmonary homograft.
Results:
The bypass time was 227 minutes, the cross-clamp time was
147 minutes. The patient was extubated in the operating room and
had an uneventful postoperative period and excellent echo results.
Conclusion:
Aortic translocation results in a more normal anatomi-
cal repair compared with the Rastelli operation. It is always possible
to place an oversized conduit (homograft) with little risk of sternal
compression. Individual coronary artery transfer during translocation
may prevent coronary insufficiency.
1365: TRUNCUS ARTERIOSUS – EARLY VERSUS LATE
INITIAL INTERVENTION: SINGLE CENTRE EXPERIENCE,
OUTCOMES AND MANAGEMENT OVER MORE THAN 10
YEARS
A Khushnood, A Kalantre, I Peart, G Gladman, E Ladusans, A
Shauq, P Venugopal, R Dhannapuneni, JSL Lim
Alder Hey Children’s NHS Foundation Trust, UK
Background:
Truncus arteriosus (TA) continues to be associated
with significant morbidity and mortality. Neonatal primary complete
repair has progressively become the treatment of choice for TA with
encouraging survival rates. Our aim was to compare and contrast
initial and late outcomes following surgery during the neonatal
period (
<
30 days) and infancy (
>
30 days).
Methods:
At a tertiary cardiac centre between 2001 and 2012, 51
patients with TA were reviewed in terms of staged versus primary
complete repair, early versus late mortality and re-intervention rates.
Associated cardiac anomalies were severe truncal regurgitation (
n
=
4), non-confluent pulmonary arteries (
n
=
5), interrupted aortic arch
(
n
=
5), coarctation of the aorta (
n
=
1) and double aortic arch (
n
=
1).
Results:
Fifty-one patients presented with TA between 2001 and
2012. Median weight was 3.14 (1.7–4.4) kg and median age was 22
(7–265) days; 49/51 were operated with 2/51 pre-operative deaths
(seven, 13 days). Five patients had staged repair with subsequent
surgeries within six months and none required further re-interven-
tion. In the primary complete repair group, three patients had severe
residual truncal regurgitation, while two had blocked conduits with
infective endocarditis. Nine/33 (27%) required re-intervention: three
conduit replacements, two truncal re-repairs and four trans-catheter
pulmonary artery dilatation. The mean duration of PICU stay post-
operatively was 10 (2–152) days, 43% were discharged within seven
days and 32% within 15 days.
Conclusion:
There was no significant difference (
p
=
0.72) in early
or late mortality between the repair strategies. Alternative strategies
such as staged repair will need to be explored for possible improved
outcomes.
1383: SERUM CONCENTRATIONS OF PROCALCITONIN
AFTER TETRALOGY OF FALLOT CORRECTION
Rubiana Sukardi
Pelayanan Jantung Terpadu, RSCM, Jakarta, Indonesia
Background
: Cardiopulmonary bypass in paediatric cardiac surgery
may cause a systemic inflammatory response syndrome (SIRS).
Clinical and laboratory signs of SIRS may mimics sepsis. An
increase in procalcitonini (PCT) has been a known potential biomark-
er of postoperative infection, but may also increase in children after
cardiac surgery.
Aim
: To establish the baseline levels of PCT after open-heart surgery
in order to analyse a possible induction of the inflammatory response
that might interfere with the diagnosis of infection by PCT.
Methods
:
Serum samples were collected from nine out of a total of
32 tetralogy of Fallot patients who underwent total correction and
showed signs of SIRS 24 hours postoperatively. Blood, sputum and
urine specimens for culture were also studied. Patients were followed
for the development of postoperative complications.
Results
:
The mean PCT value was 89.55 ng/ml (range 1.69–371)
(reference value
<
0.1 ng/ml). Only two patients showed positive
culture from their sputum (patient with PCT 2.74 ng/ml showed
Acinetobacter
pneumoni
, and patient with PCT 7.05 ng/ml showed
Streptococcus
viridans
plus
Klebsiela
pneumoni
).
Conclusions
:
An increase in PCT levels was observed in the first
postoperative day after cardiac surgery in all patients with SIRS,
however only 22% had proven infection.
1388: THE DISSOCIATION OF CEREBRAL TISSUE AND
CENTRAL VENOUS OXYHAEMOGLOBIN SATURATION
IN LOW-FLOW STATES DURING ECMO: EVIDENCE FOR
CEREBRAL AUTOREGULATION
Andrew Baldock
1
, Andrew Durward
2
1
University Hospital Southampton, UK
2
Evelina Children’s Hospital, Guy’s and St Thomas’ Hospital, NHS
Foundation Trust,UK
Background:
We report the relationship between central venous
(S
v
O
2
) and cerebral tissue (S
c
O
2
) oxyhaemoglobin saturation during
a case of veno-arterial ECMO. Problems with the arterial cannula
resulted in periods of low systemic blood flow, conditions in which
this relationship has not previously been studied. Transcranial near
infra-red spectroscopy (NIRS) provides a non-invasive measurement
of S
c
O
2
, which correlates positively with S
v
O
2
and has been used in
lieu
to detect inadequate systemic oxygen delivery in neonates with
hypoplastic left heart syndrome. NIRS is non-invasive, continuous
and avoids the complications of indwelling catheters. However, its
relationship with S
v
O
2
is not well understood and may have wide
limits of agreement, especially at lower values (S
v
O
2
<
50%). This
observation may represent the influence of cerebral autoregulation.
Methods:
A 6-kg, 14-month-old child underwent repair of mitral
