CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
54
AFRICA
tube. Five months later the patient underwent complete repair that
included re-implant of an occluded left subclavian artery. At three
months, normal biventricular function, mild AR and no pulmonary
artery stenosis were demonstrated.
Patient 2, a 28-week twin baby with birth weight 1.2 kg, presented
with IAA and underwent bPAB while on NICU using sections of a
3-mm Gore-Tex™ tube, to a mean systemic pressure of 30 mmHg
and oxygen saturations in the 70s. Four months later, having reached
the weight of 4.2 kg, the baby successfully underwent a full repair. At
two years the baby is well and thriving although has required balloon
dilatation of both pulmonary arteries.
Patient 3 presented with a background of DiGeorge syndrome,
IAA, HRHS, TGA and severe systemic AV valve regurgitation. On
day seven the baby underwent bPAB while on prostaglandin infu-
sion. Five weeks later the baby underwent complete repair. Despite
repeated attempts at correcting the persistent AV valve insufficiency
the child died, aged three months, due to low cardiac output.
Conclusions
: Manoeuvres aimed at limiting blood flow and main-
taining patency of the duct can be used successfully in neonates with
complex anomalies and prohibitive operative risks. A more accurate
patient selection might improve survival rates.
1436: SINGLE-STAGE TWO-INCISION TECHNIQUE FOR
THE MANAGEMENT OF COARCTATION WITH INTRA-
CARDIAC DEFECT
Kow Entsua-Mensah, Robin Kinsley
National Cardiothoracic Centre, Ghana
Background
: Management of coarctation and intracardiac defect
presents technical options that are not without complications. The
optimal surgical strategy for the management of the neonate and
infant with coarctation of the aorta and intracardiac defect is highly
debated. The risks of the various surgical options need to be consid-
ered in the choice of technique.
Methods
: A retrospective review was done of case notes, operation
reports and intensive care unit (ICU) charts of neonates and infants
admitted with the above diagnosis. A two-incision, single-procedure
strategy was used: first a left thoracotomy to repair the coarctation
and then, with the patient supine, a median sternotomy to correct
the intracardiac defect. This is preferred to concomitant pulmonary
artery banding or a median sternotomy with circulatory arrest.
Results
: Eight patients were enlisted into the study with a male:female
ratio of 1:0.6. Median age was 21.2 weeks (range 5.0–315.0) and
median weight was 5.5 kg (range 3.3–21.0). Median cardiopulmo-
nary bypass time was 51.0 minutes (range 44.0–77.0) and median
aortic cross-clamp time was 33.0 minutes (range 27.0–55.0). Median
length of stay in the ICU was 11 days (range 3.0–17.0). The intra-
cardiac defects were ventricular septal defects (VSD) in four patients
(50.0%), VSD, patent ductus arteriosus (PDA) and patent foramen
ovale (PFO) in two patients (25.0%), while one patient each (25%)
had VSD, PDA and double-outlet right ventricle (DORV), and VSD,
PDA and atrial septal defect (ASD), respectively. There were no early
or late deaths.
Conclusions
: Single-stage, two-incision technique for the repair of
coarctation and intracardiac defect achieves good results while avoid-
ing the risks of pulmonary artery banding and circulatory arrest.
1442: THE EFFECT OF ACUTE-ANGLE CORRECTION
ANGIOPLASTY (LEFT PULMONARY ARTERY BED
EXTENSION) FOR LEFT PULMONARYARTERY STENOSIS
IN PATIENTS WITH TETRALOGY OF FALLOT
WooSung Jang, Woong-Han Kim, Kwangho Choi, JinHae Nam,
Jeong Ryul Lee, Yong Jin Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National
University, China
Background:
Left pulmonary artery (LPA) stenosis with acute angu-
lation is the most common indication of re-operation following total
correction of tetralogy of Fallot (TOF). We investigated the surgical
outcome of acute-angle correction angioplasty in this study.
Methods:
Among 183 patients who received total correction of TOF
over the last 11 years, 53 patients underwent the surgical repair for
LPA stenosis as a concurrent procedure (M:F
=
28:25). The type of
LPA stenosis was classified into two groups: LPA os acute-angle
group (
n
=
29) (group I) [os focal (juxtaductal) (
n
=
20) and diffuse
stenosis (
n
=
9)] and os obtuse-angle group (
n
=
24) (group II) [os
focal (
n
=
14) and diffuse stenosis (
n
=
10)]. Acute-angle correction
angioplasty (LPA bed-extension technique to turn the acute angle of
the os into an obtuse angle) in group I and conventional patch angi-
ography in group II, was performed for stenosis relief.
Results
: There was no early or late mortality. Median follow-up dura-
tion was 1.8 years. There was no statistical difference [os focal steno-
sis (group I: 41.0%,
n
=
19), (group II: 41.2%,
n
=
11,
p
=
0.952),
diffuse stenosis (group I: 25.4%,
n
=
7), (group II: 36.8%,
n
=
7,
p
=
0.113)] in the latest left lung perfusion scan.
Z
-score improvement of
the os after surgery did not reach statistical significance between the
two groups [os focal stenosis (group I: 2.0, n
=
9), (group II: 2.9, n
=
7,
p
=
0.615), diffuse stenosis (group I: 2.5,
n
=
8), (group II: 3.1,
n
=
7,
p
=
0.694)]. There was no statistical difference in re-operation or
intervention [os focal stenosis (group I,
n
=
1, 5%), (group II,
n
=
1,
7.1%,
p
=
1.00), diffuse stenosis (group I,
n
=
4, 47.4%), (group II,
n
=
4, 40.0%,
p
=
1.000)].
Conclusions
: Acute-angle correction angioplasty carries prognostic
implications for surgical outcome in patients with TOF undergoing
surgical repair for LPA stenosis with acute angulation.
1448:
EXPERIENCE WITH NUNN’S POLYTETARFLUORO-
ETHYLENE (PTFE) BICUSPIDVALVES INRIGHTVENTRIC-
ULAR OUTFLOW RECONSTRUCTION FOR TETRALOGY
OF FALLOT AND RELATED ANOMALIES
Masaaki Kawada, Koichi Kataoka, Yoshinori Miyahara, Atsushi
Tateishi, Yoji Ohtsuka, Naoyuki Taga, Mamoru Takeuchi
Jichi Children’s Medical Centre, Tochigi, Japan
Background
: Much attention and many innovations have been
focused on minimising postoperative pulmonary regurgitation in the
repair of tertralogy of Fallot (TOF). Various valved outflow patches
have been developed with variable beneficial but limited effects.
Methods
: We employed a bicuspid polytetrafluoroethylene (PTFE)
valve developed by Nunn, published in
JTCS
in 2008, in 20 cases
with TOF or similar anomalies since 2007. Patients were aged eight
month to 14 years (median 18 months) and weighed 6.3–36.8 kg
(median 9.4). This valve, made intra-operatively on the operating
table, consists of seagull-shaped, wide bicuspid leaflets of 0.1-mm
thick PTFE with its middle free margin fixed to the posterior wall of
the main pulmonary artery (MPA). Valve competency was assessed
with ratio between velocity–time integrals of regurgitant and forward
flows at the pulmonary annulus level.
Results
: Reconstructed annulus size was 122% of expected normal
(91–186). Echocardiographic evaluation in the early and mid-term
results showed satisfactory valve function with regurgitant–forward
flow ratio of 24% (5–85), subgrouped as trivial in one, mild in 17 and
moderate in two patients. Median peak gradient across the valves was
20 mmHg (range 0–43). Cusp motion and trans-valvar flow charac-
teristics were well demonstrated on 2DE imaging.
Discussion
: Mid-term results so far are satisfactory in terms of valve
competency. This valve has the benefit of simple reproducibility, easy
handling, good function and is expected to offer better long-term
outcomes than the conventional monocuspid patch. When the valve
becomes stenotic from somatic overgrowth, the posterior fixation is
amenable to be ablated with a balloon catheter, although substantial
regurgitation could evolve.
Conclusion
: This novel Nunn’s bicuspid valve could be a good alter-
native, with at least satisfactory mid-term function, to other conven-
tional valves for TOF, with similar anomalies requiring a trans-annular
patch. Close observation and further evaluation are warranted.
