CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
53
Bodil Larsen
1
, Meghan Pohl
1
, Mariska Simons
2
, Ernest Ernest
3
,
Andrew Mackie
3
, Lois Hawkins
3
1
Clinical Nutrition, Alberta Health Services, Canada
2
Faculty of Agricultural, Life and Environmental Sciences, University
of Alberta, Canada
3
Department of Paediatrics, University of Alberta and Stollery
Children’s Hospital, Canada
Background:
The progression of nutrition and its impact on feed
tolerance and weight gain in postoperative transposition of the great
arteries (TGA) babies is not widely studied.
Methods:
A retrospective chart review was conducted to observe
feeding practice in postoperative TGA infants between 2007 and
2012. A standardised feeding programme was not in place during the
study period. Sixty-five infants aged 39
±
2 (36–42) weeks’ gesta-
tion underwent an arterial-switch procedure at a median age of nine
(3–88) days. The progression of feeds in the postoperative period was
documented.
Results:
Total fluid intake (TFI) progressed to demand feeding
(breast and/or bottle) by ward day 2
±
2 (0–11), and by postoperative
day 12
±
11 (3–63). On transfer from intensive care to the ward, TFI
was 131
±
14 (100–150) ml/kg/day, of which 60% of infants were
naso-gastric (NG) fed, 28% naso-jejunally (NJ) fed and 12% either
parenteral or orally fed. There was no observed impact on incidence
of feeding intolerance in those NJ versus NG fed, or those receiving
hypercaloric feeds versus standard concentrations. Thirty-seven per
cent of infants received one or more feeding-related referrals. It took
11
±
6 (5–29) days until weight gain was achieved postoperatively.
Age-appropriate weight gain (15–30 g/day) was achieved in 47%
of infants by the time of discharge [11
±
6 (5–29) days]; however
58% of patients were discharged below birth weight. Infants were
discharged home on either oral (46%) or enterally supported (54%)
feeds. Feeds consisted of mother’s milk (49%), formula (14%),
hypercaloric mother’s milk (28%) or hypercaloric formula (6%).
Conclusions:
More than half of infants were transferred or discharged
home below birth weight. This suggests that more aggressive feeding
may improve weight gain outcomes post TGA surgery. Standardised
feeding progression to establish age-appropriate weight gain may be
beneficial.
1420: SURGICAL INTERVENTION IN PATENT DUCTUS
ARTERIOSUS IN NIGERIA
CKP Ofoegbu, PO Adeoye, JK Afolabi
University of Ilorin Teaching Hospital, Ilorin, Nigeria
Background:
Congenital cardiac diseases are not uncommon in the
Nigerian population and patent ductus arteriosus (PDA) accounts
for a significant proportion of this burden. The management is still
a challenge due to late presentation, financial constraints and avail-
ability of expertise and facilities. This surgically amenable anomaly
can be dealt with in Nigeria with currently available expertise and
facilities. This audit was done to review the division’s experience and
determine outcomes.
Methods:
A retrospective review was done of patients with PDA
operated on between July 2006 and June 2012. Data obtained
included demographics, echocardiographic features, and intra- and
postoperative data.
Results:
There were nine cases done during this period, three males
and six females. Median age at presentation and at surgery was
3.5 and nine months, respectively. Most (89%) had recurrent chest
infections and failure to thrive. Three patients (33.3%) had associ-
ated anomalies. The median pre-operative weight was 5.6 kg. All
the patients had left thoracotomy and PDA ligation under general
anaesthesia. The median PDA size intra-operatively was 5.5 mm and
66% (six patients) had short, stout PDA morphology. All had chest
tubes inserted intra-operatively. One patient had a lacerated PDA
intra-operatively with primary haemorrhage. Five patients (55.5%)
stayed in the intensive care unit (ICU). The median hospital stay was
nine days and all were discharged home alive and well.
Conclusion:
Patent ductus arteriosus can be safely managed with
currently available expertise and facilities. We have excellent
outcomes.
1423: LEFT THORACOSCOPIC SYMPATHECTOMY FOR
CARDIAC DENERVATION IN CHILDREN WITH LIFE-
THREATENING VENTRICULAR ARRHYTHMIAS
Sophie-Charlotte Hofferberth
1
, Frank Cecchin
2
, Dan Loberman
1
,
Francis Fynn-Thompson
1
1
Department of Cardiac Surgery, Children’s Hospital Boston, Harvard
Medical School, USA
2
Department of Cardiology, Children’s Hospital Boston, Harvard
Medical School, USA
Background:
The sympathetic nervous system plays a prominent
role in the development of many life-threatening ventricular arrhyth-
mias. In recent times, a small number of limited case series have
reported good long-term benefit using video-assisted thoracoscopic
surgery (VATS) for left cardiac sympathetic denervation (LCSD) in
patients with drug-refractory ventricular arrhythmias; predominantly
those with long-QT syndromes and catecholaminergic polymorphic
ventricular tachycardia (CPVT). It remains unclear how effective
this minimally invasive surgical treatment is and whether it might
be indicated in all paediatric patients with symptomatic ventricular
arrhythmias.
Methods:
We conducted a retrospective clinical review of all patients
who underwent left cardiac sympathetic denervation by means
of video-assisted thoracoscopic surgery at our institution. From
August 2000 to December 2011, 24 paediatric patients (13 long-QT
syndrome, nine catecholaminergic polymorphic ventricular tachycar-
dia, and two idiopathic ventricular tachycardia) were identified from
the cardiology database and surgical records.
Results:
There were no intra-operative complications, and blood loss
was minimal. Median post-operative length of stay was 2
±
6 days.
There were no major peri-operative complications. Longer-term
follow up was available in 22 of 24 patients at a median follow-up
time of 28 months (range 4–131 months). Sixteen (73%) of the 22
patients experienced a marked reduction in their arrhythmia burden,
while 12 (55%) became completely arrhythmia-free after sympathec-
tomy treatment.
Conclusions:
Video-assisted thoracoscopic left cardiac sympathetic
denervation can be safely and effectively performed in most children
with life-threatening ventricular arrhythmias. This minimally invasive
procedure is a promising adjunctive therapeutic option that achieves
a beneficial response in the majority of symptomatic patients.
1434: HYBRID STRATEGIES FOR HIGH-RISK NON-HLHS
PATIENTS: ROLE OF BILATERAL PULMONARY ARTERY
BANDINGWITH ANDWITHOUT STENTING OF THE PDA
Nicola Viola
1
, Kevin Roman
2
, James Gnanapragasam
2
, Marcus Haw
3
,
Joseph Vettukattil
2
.
1
Thoracic and Cardiovascular Surgery, University Hospital
Southampton, UK
2
Paediatric Cardiology, University Hospital Southampton, UK
3
Paediatric Cardiac Surgery, Helen DeVos Children’s Hospital, Gran
Rapids, MI, USA
Background:
Hybrid procedures involving bilateral pulmonary
artery banding (bPAB) and stenting of the PDA in HLHS are well
described, but their use in other diagnostic categories is rarely
reported.
Methods
: Three neonates with IAA + truncus arteriosus, IAA +
extreme prematurity and IAA + tricuspid atresia + DOLV, respec-
tively, underwent a staged repair with initial palliative procedure.
Results:
Patient 1 presented with a birth weight of 2.6 kg and diagno-
sis of persistent truncus arteriosus (Van Praagh type A4). Due to poor
response to prostaglandin it was decided to proceed on day 3 of life
with PDA stenting and bPAB, using sections of a 3-mm Gore-Tex™
