CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
52
AFRICA
stenosis. At the end of surgery, it was not possible to wean her from
bypass due to severe pulmonary hypertension. Veno-arterial ECMO
was instituted, which was initially complicated by excessive bleed-
ing and cannula malposition. Data were collected retrospectively.
Cerebral oximetry was compared to continuous monitoring of the
ECMO venous drainage cannulae (S
v
O
2
) over the first 500 minutes.
Results:
There were 20 epochs (median duration 150 seconds) of
acute severe reduction in arterial ECMO flow (
>
10% from baseline).
The median drop was 58%. This was associated with a much more
pronounced fall in S
v
O
2
(median 55% from baseline) compared to
S
c
O
2
(median 14% from baseline).
Discussion:
There was dissociation of S
v
O
2
and S
c
O
2
during low-flow
states. This suggests oxygen delivery to the brain is preserved and
supports the concept of cerebral autoregulation. S
c
O
2
may be main-
tained when global oxygen delivery is critically low and should not
be used in place of S
v
O
2
.
1390: ANESTHETIC TECHNIQUE FOR TRANSOESOPHA-
GEAL ELECTROPHYSIOLOGICAL STUDIES IN PAEDI-
ATRIC PATIENTS WITH WOLFF-PARKINSON-WHITE
SYNDROME
Christopher Snyder
Rainbow Babies’ and Children’s Hospital, USA
Objective:
All patients with Wolff-Parkinson-White syndrome
require risk assesement to determine their potential for rapid conduc-
tion down the accessory pathway during atrial fibrillation resulting in
sudden cardiac death. Transoesophageal electrophysiological studies
(TEEPS) are an effective risk-stratification tool. The purpose of this
study was to describe the least invasive and most effective anaesthetic
technique for transoesophageal electrophysiological studies.
Methods:
A retrospective review was done of anaesthetic tech-
niques used during TEEPS. Inclusion criteria were: pre-excitation
on ECG; age
<
18 years; and no history of tachycardia, palpitations,
or syncope. Patients had TEEPS under anaesthesia either as IV
sedation, monitored anaesthesia care (MAC), or general anaesthesia
(GA). Anesthetic technique (MAC vs GA) and airway management
decisions were left to the anaesthesiologist. Midazolam, fentanyl and
propofol were used in various combinations. Sevoflurane was used
during the induction period in all GA cases and stopped 10 minutes
prior to initiation of TEEPS.
Results:
Inclusion criteria were met by 20 patients with an average
age of 11.9 years, average weight of 48.9 kg and average height of
149.2 cm. IV sedation was performed on 15%, MAC on 10%, and
GA on 75% of patients. Airway management techniques included
13.3% LMA, 20% endotrachael tube (ETT) and 66% mask. IV
sedation as initial anaesthetic was found to be cumbersome and
uncomfortable. Next was ETT and LMA but trouble pacing was
encountered due to positional change of the oesophagus relative to
the left atrium during positive-pressure ventilation. Mask induction
was then performed in the remaining 10 patients with a TEEPS probe
inserted through a nare while the anaesthesiologist continued mask
ventilation. All were successful without complications.
Conclusions:
Mask anaesthesia was the preferred method due to its
overall simplicity and minimal interference with the TEEPs proce-
dure.
1396: TRUNCUS ARTERIOSUS: REVIEW OF SURGICAL
REPAIR OF CASES DONE AT THE WITWATERSRAND
GROUP OF HOSPITALS FROM 1974–2012
Gcina Dumani
1
, Antoinette Cilliers
1
, Krubin Naidoo
2
, Kathy Van
derdonck
2
1
Chris Hani Baragwanath Academic Hospital, University of
Witwatersrand, Johannesburg, South Africa
2
Charlotte Maxeke Academic Hospital, University of Witwatersrand,
Johannesburg, South Africa
Background:
Truncus arteriosus is an uncommon cardiovascular
anomaly characterised by a single arterial trunk with a single semi-
lunar valve and supplying blood flow to the aorta, pulmonary arter-
ies and coronary arteries. Associated complex cardiac lesions and
pulmonary hypertension lead to high morbidity and mortality rates.
Methods:
This was a retrospective review of 53 patients who under-
went surgical repair of the truncus arteriosus between 1974 and 2012.
Data related to clinical features, diagnosis, operative procedures, pre-
operative and postoperative follow up were collected.
Results:
Fifty-three patients (23 males and 30 females) underwent
surgery to repair the truncus arteriosus. The most common presenting
features were dyspnoea, tachypnoea, cardiac murmurs, congestive
cardiac failure, shock and cyanosis. The median age at surgery was
eight months (range: 3 weeks – 7 years). Median weight at surgery
was 4.8 kg (range: 2.1–14.8 kg). Diagnosis was made with echocardi-
ography in all patients and confirmed on angiography in 31 patients.
Patients were classified according to Collert and Edwards as follows:
26 with type I; 24 with type II; two with type III, and one was
unclassified. Additional surgery undertaken during primary repair
included interrupted aortic arch repair in three patients and truncal
valve repair in two patients. Seven patients (13.2%) had moderate to
severe truncal valve regurgitation.The median cross-clamp time was
91 minutes and the median cardiopulmonary bypass time was 134
minutes. The right ventricular outflow tract was reconstituted using
a bioprosthesis in 32 (60.4%) and a homograft in 21 (39.6%). Eight
patients had subsequent surgery: seven required second pulmonary
outflow replacements and one patient truncal valve replacement.
Early mortality post primary repair was 24.5% including two patients
who required interrupted aortic arch repairs. The major cause of early
mortality was pulmonary hypertensive crisis.
Conclusion:
Truncus arteriosus is associated with a high operative
mortality if primary repair is delayed. A delay in the presenta-
tion associated with established pulmonary hypertension may be a
contributing factor.
1403: CARE OF A VAD PATIENT ON A WARD HDU: A
MULTIDISCIPLINARY PERSPECTIVE
Allison Chapman
1
, Lesley Hamilton
2
1
Freeman Hospital, UK
2
Newcastle Upon Tyne, NHS Trust, UK
Background:
Mechanical circulatory support is an important
adjunct to the treatment of children with advanced heart failure. We
are currently the second largest centre in the world for mechanical
support and have been implanting the Berlin heart (our institution’s
preferred support device) since 2005. The research undertaken looks
at the most suitable environment in which to nurse the stable paedi-
atric VAD patient, comparing PICU ward care and HDU ward care.
Methods:
A questionnaire was designed to look at four key issues:
child development, emotional and psychological wellbeing, staff-
ing/education, and cost implications. These questionnaires were
completed by children, parents and carers. Members of the MDT all
involved in the care of this patient group also completed question-
naires or underwent interviews.
Results:
This study is ongoing we are currently gathering data.
Conclusions:
As this study is ongoing, it is difficult to draw conclu-
sions. However, so far, the research shows the most suitable environ-
ment in which to nurse this patient group is on a ward HDU. The
availability and access to other service providers is better. The chil-
dren nursed in this area also have more access to play and education
facilities, therefore providing improved development. Emotionally
the children and their families can adapt to a more ‘normal’ routine,
parents become more involved in the care of their child, and the need
for night time sedation is less frequent. The data we are currently
gathering relates to funding and cost implications.
1418: POSTOPERATIVE FEEDING PRACTICE AND
WEIGHT GAIN IN NEONATES POST ARTERIAL-SWITCH
OPERATION
