CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
59
in the past, there was little emphasis placed on the importance of
biomedical engineering support for humanitarian medical missions.
However, as technology for medical equipment has progressed at
a rapid pace, and the complexity of procedures has increased, it is
evident the role of biomedical engineering has expanded. An educa-
tion in this field is not enough. A discipline in computer engineering,
anatomy and physiology, and knowledge of equipment that is proce-
dure specific must be incorporated. In underdeveloped countries it is
quite common for these disciplines to simply not exist.
Methods:
Data were analysed from the ICHF’s (International
Children’s Heart Foundation) database over the past five years.
Results:
The analysis provides a common link between the various
types of equipment needed across all developing countries where
humanitarian medical programmes have been started. During this
five-year period, a total of 677 pieces of medical equipment were
sent to 23 locations in 16 different countries. Some specific types of
medical equipment included patient monitors, anaesthesia machines,
cardiopulmonary bypass machines, ventilators, defibrillators, elec-
tro-surgical units, syringe pumps, hypo/hyperthermia units, and
cardiac echo ultrasound units. ICHF biomedical engineering staff/
volunteers have made 49 trips to provide biomedical engineering
support and emergency repairs.
Conclusions:
ICHF has created a paradigm shift and raised the bar
of expectation on the level of education and expertise for biomedical
engineering support. This support is defined as installing, servicing,
repairing and providing staff training on biomedical equipment. The
end result has allowed ICHF medical programmes in developing
countries to grow at an accelerated pace, ensuring better patient
safety and improving surgical results.
1632: USE OF HOMOGRAFT TISSUE FOR PAEDIATRIC
ANDADULT CARDIAC SURGICAL DISEASE ON INTERNA-
TIONAL COMPASSIONATE MISSIONS
Aubyn Marath
1
, Janine Henson
5
, Le Ngoc Thanh
3
, Laura Schiff
6
,
Chrisanna Gustafson
7
, Wolfram Koehler
8
, John Connett
2
, Kyle
Rudser
2
, Lazaros Kochilas
1
, James St.Louis
1
1
Amplatz Children’s Hospital, University of Minnesota, MN, USA
2
Biostatistics and Informational Technology, University of Minnesota,
MN, USA
3
Hospital E Cardiac Specialist Centre, Hanoi, Vietnam
4
Oregon Health and Sciences University, OR, and CardioStart
International, USA
5
Fairview Hospital, University of Minnesota, MN, and CardioStart
International, USA
6
Enloe Medical Center, Chico, CA, and CardioStart International,
USA
7
California State University, Chico, CA, and CardioStart International,
USA
8
Erfurt, Germany
Background:
International visiting cardiology and cardiac surgery
teams that carry out paediatric and acquired cardiac surgery face
serious limitations in the scope of surgery possible and restricted
valve choices. These are complicated by late clinical presentations,
accelerated anatomical distortion from growth, and rheumatic valve
disease. The lack of effective primary care in many locations may
force surgeons to change from a conceptually good operative deci-
sion to a temporary and unsatisfactory short-term fix.
Methods:
In an attempt to address some of these issues and increase
the operative choices available, CardioStart International teams have
carried two homograft valves (donated by Cryolife Inc, Ga, USA)
on many two-week missions since 1996. In three countries receiv-
ing cardiothoracic surgical assistance, 18 patients between four and
56 years underwent conduit reconstructions to the aortic (five) or
pulmonary (13) position; two patients underwent the Ross procedure.
Six conduits were later implanted by the local surgical team based on
the intense learning experience they had gained during the mission.
Results:
Recent follow-up information is available in 15 patients
(indirectly, in a further three). One adult patient (Ross) died at 15
days from a chest infection. All remaining patients are known to be
alive, extending this small series follow-up experience to 16 years.
Six patients have now reached adulthood and are in gainful employ-
ment. None currently need revision/re-operation of their primary
operation. Ten patients are being tracked by a full international
database evaluation already in operation (UMN and OHSU, USA).
Conclusions:
Despite limitations of supply, homograft technology
can logistically be provided to the diverse patients groups seen; and
conduit implantation can readily be taught to local teams with excel-
lent initial outcome. In two of these countries, local surgical teams
have since developed local competence and limited availability, but
proper follow up remains a priority in assisting new programmes to
grow successfully.
1646: A TECHNIQUE TO CORRECT SEVERE STENOSIS
OF LEFT CORONARY ARTERY AS A LATE COMPLICA-
TION OF DIRECT RE-IMPLANTATION FOR TREATMENT
OF ANOMALOUS LEFT CORONARY ARTERY FROM THE
PULMONARY ARTERY
Andrey Monteiro
1
, Meier Milton
2
, Colafranceschi Alexandre
1
, Miana
Leonardo
1
, Alessandra Cosenza
1
, Bruno Marques, Ulises Alves,
Eliana Nadais, Hamiltom Torres, Maria Salgado
1
Instituto Nacional de Cardiologia, Predação, Brasil
A 11-year-old was admitted with unstable angina. At eight months
old the baby underwent a correction of ALCAPA using the technique
of re-implantation of the left coronary artery to the aorta with a button
of the pulmonary artery. The early and medium-term outcomes of the
operation were good. In the last six months the patient developed
angina and deterioration of the ejection fraction. Cardiac catheterisa-
tion revealed severe stenosis of the coronary artery from the anas-
tomosis with the ascending aorta to the bifurcation, and poor distal
opacification of both anterior descending and circumflex arteries.
At re-operation, the left coronary artery was stenotic with less than
1 mm diameter, and was solidly adhered to the posterior wall of the
pulmonary artery. The technique used to correct the stenotic coronary
artery was transection of the aorta distal to the origin of the left coro-
nary artery. A longitudinal incision of 3–4 mm was made in the aortic
wall, down to the anastomic orifice and the left coronary artery, all
the way to the bifurcation. Using a segment of the left subclavian
artery, opened longitudinally as a flap, the aortic wall, the new ostia
and the left coronary artery were enlarged. Both the ascending aorta
and the left subclavian artery were reconstructed, the first with end-
to-end anastomosis, and the second with a polyester graft. The patient
had an uneventful postoperative course. A cardiac catheterisation
performed one month after the re-operation revealed an adequate
flow through the left coronary artery and branches, and a better
segmental contractility of the left ventricle. The enlargement of the
stenotic coronary arteries with autologous arterial grafts is feasible
and shows good results. With the technique of direct implantation of
the left coronary artery to the aorta, excessive tension may occur with
the compression of the bovine pericardial graft. These were possible
causes of the coronary obstruction.
1652: STRICTLY POSTERIORTHORACOTOMY FORMODI-
FIED BLALOCK-TAUSSIG SHUNT
Frank Edwin, Baffoe Gyan, Innocent Adzamli, MarkTettey, Lawrence
Sereboe, Ernest Aniteye, Kow Entsua-Mensah
National Cardiothoracic Centrr, Korle Bu Teaching Hospital, Accra,
Ghana
Background:
In resource-poor settings, the modified Blalock-
Taussig shunt (MBTS) is often performed for symptomatic relief
in patients unable to afford the out-of-pocket expense for primary
complete correction. Posterolateral thoracotomy and sternotomy are
valid approaches for the creation of MBTS. However, in populations
predisposed to keloids and hypertrophic scars, the aesthetic insult
from either approach forms the basis of complaints from many
