CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
62
AFRICA
1728: PAEDIATRIC CARDIAC TUMOURS: A 43-YEAR
REVIEW
Laura Linnemeier, GenevieveYedlicka, DavidYang, Mark Turrentine,
Mark Rodefeld, John Brown
Indiana University School of Medicine, USA
Background:
Cardiac tumours in children are rare. Of the 800 cases
reported in the literature, 97% were benign. The most common
paediatric cardiac tumour is rhabdomyoma; most are asymptomatic,
regress over time, and often are only observed. When benign tumours
become obstructive and produce symptoms, they should be resected.
We retrospectively reviewed our experience over the last 40 years
to evaluate presentation, management and outcomes in this patient
population.
Methods:
Since 1969, 67 children were diagnosed with paediatric
cardiac tumours. Thirty-three (49%) were surgically managed and
further analysed. Twelve (39%) presented with symptoms of CHF.
Mean age at the time of diagnosis and surgery was 8.9 years (range:
1 day – 27 years).
Results:
Rhabdomyoma was the most common tumour. Although
there were only eight (24%) malignant cardiac tumours, five of the
six deaths in our series were from malignant tumours. Two malig-
nancies, however, a teratocarcinoma and a rhabdomyosarcoma,
were successfully excised and treated with chemotherapy. These two
patients have survived tumour-free for 15 and 25 years, respectively.
At a mean follow up of 4.6 (range: 0–26) years, 21 (91%) survivors
of all tumours remained free of lasting postoperative cardiac symp-
toms. Four (12%) had minimal follow up.
Conclusions:
Cardiac tumours are rare in children. Surgical exci-
sion or de-bulking should be carried out for rhabdomyomas and
fibromas causing significant obstruction. Myxomas and teratomas
require complete excision because they can embolise or recur locally.
Malignant cardiac tumours should undergo radical excision, if possi-
ble, followed by adjuvant chemoradiation therapy. An aggressive
surgical approach can yield long-term survival in some patients.
1738: ULTRASONOGRAPHY FOR VOCAL CORD MOBIL-
ITY AFTER PAEDIATRIC CARDIAC SURGERY
Mahmoud Elbarbary, Ghassan Shaath, Hani Najm
King Abdulaziz Cardiac Centre, Saudi Arabia
Objectives:
Upper airway obstructions after paediatric cardiac
surgery are not uncommon and have many reasons. Vocal cord
paresis or paralysis is not an unusual cause of airway obstruction or
failure of extubation after cardiac surgery. In this study we aimed
to evaluate the feasibility and accuracy of ultrasonography (US)
assessment of vocal cord mobility and compare it to fibre-optic
laryngoscopy (FL).
Methods:
A prospective pilot study was conducted in the paediatric
cardiac ICU (PCICU) from 1 June 2009 to 31 July 2010. Patients
who had cardiac surgery and manifested with significant signs of
upper airway obstruction were subjected to US screening of their
vocal cord mobility, followed by FL assessment. All operators were
blinded to each other’s reports. Results of invasive (FL) and non-
invasive (US) investigations were compared.
Results:
Ten patients developed persistent significant upper airway
obstruction after cardiac surgery and were included in the study.
Their mean weight and age were (4.6
±
2.5 kg) (2.7–9.4) and (126.4
±
162.4 days) (8–480), respectively. All patients were referred to
bedside US screening for vocal cord mobility. The results of US were
subsequently compared with FL findings. Results were identical in
nine (90%) patients and partially different in one (10%). Six patients
showed abnormal glottal movement while the other four patients
demonstrated normal vocal cord mobility by FL. Sensitivity of US
was 100% and specificity was 75%.
Conclusion:
US assessment of vocal cords is a simple, non-invasive
and reliable tool to assess vocal cord mobility in the critical care
setting. This screening tool requires skills that can be easily obtained.
1742: DEFINING NEURODEVELOPMENTAL OUTCOMES
FOLLOWING MECHANICAL CIRCULATORY SUPPORT
USING STANDARDISED CARE ASSESSMENT AND
MANAGEMENT PLAN (SCAMP) METHODOLOGY
Aparna Hoskote
1
, Timothy Thiruchelvam
1
, Sara O’Curry
1
, Jo Wray
1
,
Laura Davis
1
, Clair Westrope
2
, Jane Cassidy
3
, Allan Goldman
1
, Kate
Brown
1
1
Great Ormond Street Hospital for Children, NHS Trust, UK
2
Glenfield Hospital, University Hospitals of Leicester, NHS Trust,
UK
3
Newcastle upon Tyne NHS Trust, UK
Background:
ECMO support for cardiorespiratory failure increas-
es survival but neurodevelopmental outcomes remain ill-defined.
Currently no national/international-level consensus on neurological
follow up exists.
Aims:
To (1) establish a collaborative standardised clinical assess-
ment and management pathway (SCAMP) for neurodevelopmental
outcome between ECMO centres in England, (2) identify surveil-
lance, screening and early interventions to improve the level of
functional neurodevelopment, quality of life and family satisfaction
in children post mechanical support.
Methods:
Published literature, international recommendations and
local guidelines were reviewed. Expertise from neurology, neurora-
diology and neuropsychology was sought. Consensus was evolved
through a series of local and national specialist group meetings. A
background position paper outlining prevalence, uncertainties in
follow up, and appraisal of available neuropsychological assess-
ment was developed. Evidence-based management algorithms were
agreed on, incorporating plausible hypotheses pertaining to ‘knowl-
edge gaps’. A framework for cyclical analysis allowing variability
in outcomes to emerge alongside refinements in care and resource
utilisation was defined.
Results:
The incidence of neurodevelopmental sequelae is 20–35%
in neonatal populations and up to 50% in children supported
post-cardiac surgery, with limited literature on paediatric respira-
tory ECMO patients. Risk factors for neurological injury have been
identified, however few are modifiable. Neuro-imaging can help
categorise risk but cannot predict degree of neurodisability. An
algorithm was developed after consensus meetings between ECMO
centres in England standardising baseline assessment, follow up,
neuro-imaging and sequential, age-appropriate, neuropsychological
testing. Multiple plausible outcomes for future evaluations based on
prospectively collected data were identified.
Conclusion:
There is a clear need for uniformity in early identifi-
cation, risk evaluation and structured follow up of these children.
Timely, relevant and nationally resourced tests may minimise
neurological morbidity and maximise potential by the introduction
of early interventions. Using SCAMP methodology, it is possible
to seek national consensus, formulate evidence-based practice and
achieve a national framework to provide the longitudinal screening
of neurological deficits.
1754: CRITICAL ULTRASOUND, THE NEW ESSENTIAL
SKILL IN PAEDIATRIC CARDIAC ICU (PCICU)
Mahmoud Elbarbary
King Abdulaziz Cardiac Centre, Saudi Arabia
With the recent introduction of high-quality, reasonably priced and
completely portable neonatal ultrasound machines, a new paradigm
shift has also emerged in the philosophy of ultrasound imaging in
PCICU, which is the philosophy of ‘critical ultrasound’. This is a
shift from being an organ-based, systematic, comprehensive exami-
nation done by radiologists to a new concept of problem-based, goal-
directed, focused multi-organ, time-dependant examination done by
the treating neonatologist. The new paradigm is not trying to describe
an organ pathology but rather involves ‘focused, simple yes/no’
examinations for the airway, lung, heart, abdomen or limbs that are
directed to answer specific clinical problems (hypoxia, hypotension,
