CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
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AFRICA
patients. The strictly posterior thoracotomy (SPOT) may yield a
cosmetically superior result with a short posterior scar not evident
to the patient.
Methods:
From August 2011, we adopted the SPOT approach for
creation of the MBTS, which is preferably performed on the right
side. The patient is placed in a left lateral decubitus position with a
slight counter-clockwise chest rotation. The incision extends 6–8 cm
between the scapular spine and posterior axillary line, 2 cm parallel
to the vertebral border of the scapula. Limited division of the trape-
zius and lattisimus dorsi may be required beneath the skin incision to
facilitate exposure. The chest is entered through the bed of the fourth
rib. We used this approach in 23 patients.
Results:
There were 15 males and eight females with symptomatic
Fallot’s tetralogy. Ages ranged from 16 months to 17 years (median
four years). Shunt sizes used ranged from 4–6 mm. Mean postopera-
tive SPO
2
was 84%. No shunt failures were encountered. Hospital
stay was 7–10 days. There was one re-operation for clotted haemo-
thorax; this 17-year-old patient was the only mortality (4.3%) from
sudden cardiac death on the seventh postoperative day. The cosmetic
result has been very appealing.
Conclusion:
The SPOT approach is a safe alternative for creation of
the MBTS; it yields a cosmetically superior result to both posterolat-
eral thoracotomy and sternotomy.
1662: DOUBLE-SWITCH PROCEDURE FOR C-TGA: IS IT
WORTH DOING?
Sivasubramanian Muthukumar, Ramyashri Chandrasekaran,
Jebaraj Rathinasamy, Periyasamy Thangavel, Ranjith Karthekeyan,
Thanikachalam Sadagopan
Sri Ramachandra Medical College, Chennai, India
Aim:
To present our limited experience with the double-switch proce-
dure in SRMC over a period of 15 months (April 2010 – June 2012).
Methods:
This group includes five patients with a diagnosis of
corrected TGA undergoing the double-switch procedure. The surgi-
cal options for C-TGA are anatomical and physiological repair.
Anatomical repair includes the double-switch procedure in the form
of either ASO + Senning or Rastelli + Senning. All our patients
underwent Rastelli + Senning as they were not suitable candidates
anatomically for ASO.
Results
: Four patients performed well in the immediate postoperative
period and were discharged from hospital. One patient died on the
fourth postoperative day.
Conclusion:
We believe that although the double-switch procedure
is complex, the immediate postoperative results were satisfactory.
Long-term follow up is needed in these patients. Hence we conclude
that the double-switch procedure should be considered in patients
with C-TGA.
1698: CONTEMPORARY SURGICAL APPROACH TO SCIMI-
TAR SYNDROME USING DIRECT RIGHT PULMONARY
VEIN-TO-LEFTATRIALANASTOMOSISVIA STERNOTOMY
Hanna Jensen, Nagarajan Muthialu, Barbara Furci, Robert Yates,
Martin Kostolny, Tain-Yen Hsia, Marc de Leval, Victor Tsang
Great Ormond Street Hospital for Children, NHS Trust, London, UK
Background
: There is no consensus on the optimal surgical tech-
nique for the repair of scimitar syndrome, an anomalous right
pulmonary venous connection to the inferior vena cava. We report
our experience with an anatomical approach involving direct anasto-
mosis of the right pulmonary vein to the left atrium, performed under
conventional cardiopulmonary bypass without the need for circula-
tory arrest through a sternotomy.
Methods
: This was a retrospective review of nine patients operated
from 2009 to 2011 for anomalous pulmonary venous connections
from the right lung to the IVC. The age of patients at presenta-
tion varied between three months and 27 years (mean 16 months).
Through a median sternotomy, the anomalous right pulmonary vein
was mobilised and disconnected close to the diaphragm and the
caval end was secured. The pulmonary end of the vein was brought
superiorly through a generous pericardial opening behind the right
phrenic nerve without tension, and via a natural or surgically created
atrial septal defect, a wide opening was created on the right side
of the posterior left atrium, wherein the scimitar vein was directly
anastomosed.
Results
: Eight out of nine patients were primary venous repair and
one patient had a previous failed repair using an intra-atrial baffle.
There were no operative deaths. The median cardiopulmonary bypass
time was 109 min and median cross-clamp time was 47 min. The
median ventilator time was 16.8 hours and the median stay at the
intensive care unit was 2.4 days. There were no re-explorations in the
postoperative period. There were no instances of pulmonary venous
obstruction. There were no late deaths within follow up of one year.
Conclusions
: Anatomical repair of the scimitar vein based on
re-implantation onto the left atrium via sternotomy results in safe
and reliable repair in patients with a wide age spectrum, including
re-operation.
1701: HAEMODYNAMIC CHARACTERISTICS OF PORCINE
DECELLURISED HENOGRAFTS FOR AORTIC VALVE
REPLACEMENT IN CHILDREN
Tomasz Mroczek, Janusz Skalski, Zbigniew Kordon, Miroslawa
Dudynska, Wojciech Stycula
Jagiellonian University, Krakow, Poland
Objectives:
Aortic valve repair and the Ross procedure are not
always applicable in aortic valve disease in children. We wanted to
demonstrate an alternative in a preliminary study of the performance
of decellularised porcine xenografts in children implanted into the
systemic circulation.
Methods:
Between January 2010 and March 2012, a total of nine
aortic valve replacements with Matrix decellurised porcine xeno-
grafts was performed. Operative results and postoperative haemody-
namics were evaluated.
Results:
The mean patient age was 6.4 years (range 3–15 years). The
mean weight was 15.2 kg (range 11–45 kg). The underling diagnoses
were isolated aortic valve disease in six, common arterial trunk in
two and single-ventricle type CHD with obstructed systemic outflow
tract in one patient. Among the children, three underwent additional
procedures: lateral tunnel Fontan operation, Damus-Kaye-Stansel
procedure and pulmonary homograft replacement. All children with
isolated aortic valve disease underwent previous balloon valvuloplas-
ty or surgical valvulotomy. The diameter of aortic grafts was 1 mm
in two, 14 mm in two, 17 mm in three, and 19 mm in two children.
Postoperative echocardiography demonstrated mean transvalvular
gradient 19 mmHg (range 10–27 mmHg) that did not tend to increase
over time. No significant valve insufficiency was observed. Follow-
up time varied between three and 24 months.
Conclusion:
Our preliminary results suggest that porcine decel-
lurised tissue-engineered xenografts may be the alternative option
for children who require aortic valve implantation or replacement.
1709: MANAGEMENT OF POST-OPERATIVE CHYLOTHOR-
AX IN PAEDIATRIC PATIENTS WITH CONGENITAL
HEART DISEASE
Antigoni Deri
1
, Trinette Steenhuis
1
, Rachel Meskell
2
, Kathryn
Lightfoot
2
, Demetris Taliotis
3
, John Thomson
1
1
Yorkshire Heart Centre, Leeds, UK
2
Leeds Teaching Hospitals, NHS Trust, Leeds, UK
3
East Midlands Congenital Heart Centre, UK
Background:
Chylothorax is a well-known postoperative complica-
tion affecting patients with congenital heart disease (CHD). No clear
consensus has been reached regarding the management strategy to
date.
Methods:
Data were collected retrospectively regarding the diag-
