CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
7
Background:
Right ventricular (RV) bypass is a palliative procedure
with a high incidence of complications.
Objective:
To evaluate mid-term RV bypass events, analyse long-
term mortality and compare the classic surgical technique with the
extracardiac conduit Fontan procedure.
Methods:
A total of 191 patients between 1987 and 2010 were
analysed. They had either atrio-pulmonary (AP) or extracardiac
conduit (EC) surgery, with mid-term follow up of 6.5
±
5 years (1–20
years). They were subdivided according to the type of surgery into
two groups: group I: AP, 39 patients with a median follow up of 14
years and group II: EC, 152 patients with follow up of four years.
Results:
Fifty-seven per cent of patients (
n
=
116) suffered from
complications, including late events (
n
=
111), arrhythmias (
n
=
49),
atrial flutter (n
=
13), thrombus (n
=
31), cerebrovascular accidents (
n
=
4), protein-losing enteropathy (
n
=
9), subaortic stenosis (
n
=
7),
therapeutic catheterisation (
n
=
43), re-operations (
n
=
20), reconver-
sions (
n
=
6), mortality (
n
=
9), ventricular dysfunction (
n
=
21), and
plastic bronchitis (
n
=
1). The late global mortality was 4.6% (
n
=
9).
In the univariate analysis, mortality was associated with ventricular
dysfunction (
p
=
0.0000), protein-losing enteropathy (
p
=
0.0000),
atrial flutter (
p
=
0.0012), re-operations (
p
=
0.0006), subaortic steno-
sis (
p
=
0.0024), thrombus (
p
=
0.01) and AP surgical technique (
p
=
0.0004). Multivariable analysis revealed that mortality was related to
ventricular dysfunction [
p
=
0.0003, OR
=
27.7 (4.64–165.24)], AP
technique [
p
=
0.0036, OR
=
0.06 (0.01–0.40)] and protein-losing
enteropathy
[
p
=
0.01, OR
=
9.31 (1.53–56.66)].
Conclusion:
Patients with atrio-pulmonary surgery presented with a
higher incidence of arrhythmias, thrombi, re-operations and mortal-
ity in comparison to those with extracardiac conduit surgery. Late
mortality was associated with ventricular dysfunction, atrial flutter,
protein-losing enteropathy, subaortic stenosis, re-operations, thrombi
and atrio-pulmonary surgical technique. Mortality predictors were
ventricular dysfunction, protein-losing entheropathy and atriopulmo-
nar surgical technique.
66: A 100-CASE CLINICAL ANALYSIS OF RECONSTRUC-
TION OF THE PULMONARY VALVE WITH AUTOLOGOUS
PERICARDIAL PATCH ON TETRALOGY OF FALLOT
CHILDREN
Hong Zhou
1
, Jing Lei
1
, Hongfeng Gao
1
, Bo Li
1
, Liang Tao
2
, Xiaodong
Zhu
2
, Guibao Huo
1
1
Xinjiang Hospital of Asia Heart Hospital, Xinjiang, China
2
Wuhan Asia Heart Hospital, Wuhan, China
Objective:
In order to reduce postoperative pulmonary insufficiency
(PI), a transannular monocusp patch was implanted in 100 patients
with severe tetralogy of Fallot (TOF) or double-outlet of the right
ventricle (DORV), who had a hypoplastic pulmonary valve.
Methods:
We have developed a method to reconstruct a triple-cusp
pulmonary valve ring. The patient’s pulmonary valve ring was divid-
ed into two parts, and a transannular monocusp patch was implanted
as the third one. The results of follow up were obtained within one
year of the correction, and were compared with all patients who had
received a simple transannular pericardial patch. The mean maxi-
mal systolic pressure gradient between the right ventricle and the
pulmonary artery were compared pre- and postoperation (73.95
±
30.42 mmHg; 15.67
±
10.62 mmHg), and the degree of PI was not
significant. The available monocusp patches could prevent or reduce
postoperative pulmonary insufficiency in patients with severe tetral-
ogy of Fallot. There were no deaths and in half the patients, no low-
heart output syndrome was observed.
Conclusions:
Children with symptomatic hypoplastic pulmonary
valve rings should be repaired early and mid-term follow-up results
are good. Improved operative techniques and emphasis on pericardial
pulmonary valves play an important role in increasing the outcome
of surgical treatment.
79: 15-MINUTE REINFORCEMENT TEST RESTORES
MURMUR-RECOGNITIONSKILLS INMEDICAL STUDENTS
John Finley
1
, Rachel Caissie
1
, Pam Nicol
2
, Brian Hoyt
1
1
Dalhousie University, Canada
2
University Western Australia
Background:
Accurate recognition of murmurs is an important skill
but is poorly performed by students and practitioners. Current teach-
ing methods are ineffective. We have previously shown that murmur
recognition can be rapidly taught to 90% accuracy with auditory
training but it declines within two months without reinforcement.
This study examined late reinforcement to restore skills.
Methods:
Thirty-six Canadian second-year medical students (17
controls and 19 study group) were enrolled in the study. Students
performed an online randomised test of 20 recordings, identify-
ing murmurs as innocent or pathological, followed by a one-hour
auditory training programme. The programme presents murmurs
in groups of four, each to be identified as normal or abnormal.
Difficulty increases through seven levels. Performance was scored
with a 20-item test immediately, and after two months. Twenty-two
students had re-testing one year later on 20 recordings and a mastery-
style reinforcement programme: any student scoring less than 90%
took another 20-item test, and if that test score was less than 90%, the
student took a final 20-item test.
Results:
With initial auditory training, the study group improved
from 79.7 (45–100%) to 92.1% (70–100%) (
p
=
0.005) but after two
months declined to 84.2% (65–100%) (
p
=
0.015), a non-significant
increase over pre-test scores. Controls had no change over two
months. The one-year follow-up test mean was 81% (55–100%), a
significant decline from the two-month post-test. Only six students
achieved the 90% level at this test, but after first and second rein-
forcement tests, an additional six and two students, respectively
reached 90%. The mean final score achieved by all students was
90% (70–100%).
Conclusion:
Murmur recognition is rapidly learned using auditory
training but the skill declines within two months. Most students
restored their skills with a brief reinforcement test one year later. The
optimal timing is unknown.
82: SURGICAL RECONSTRUCTION OF PULMONARY
STENOSIS WITH VENTRICULAR SEPTAL DEFECT AND
MAJOR AORTO-PULMONARY COLLATERALS
Richard Mainwaring, Mohan Reddy, Frank Hanley
Stanford University School of Medicine, USA
Background:
Pulmonary stenosis with ventricular septal defect
and major aorto-pulmonary collaterals (PS/VSD/MAPCAs) is an
extremely rare form of congenital heart defect. Although it has been
assumed that PS/VSD/MAPCAs would be similar to pulmonary atre-
sia (PA) with VSD/MAPCAs, there are currently no data to support
this conjecture. The purpose of this study was to review our surgical
experience with reconstruction of PS/VSD/MAPCAs.
Methods:
This was a retrospective review of 25 patients who were
born with PS/VSD/MAPCAs and underwent surgical reconstruction.
All patients had pre-operative pulmonary angiography to define the
central branch pulmonary arteries and MAPCAs. There were 14
females and 11 males and the median age at first surgery was four
months.
Results:
There was one operative mortality (4%) and no late
mortalities in this cohort of 25 patients; 96% of the survivors have
achieved complete repair. There were two distinct sub-groups: 11
patients demonstrated cyanosis and underwent an initial procedure to
augment pulmonary blood flow (+ PBF). The remaining 14 patients
formed the second group (– PBF).
Conclusions:
Outcomes for PS/VSD/MAPCAs were excellent with
low surgical mortality and high rates of complete repair. There were
two identifiable sub-groups with distinctive differences. These results
provide a prognostic outlook for patients with PS/VSD/MAPCAs,
which can be compared and contrasted with PA/VSD/MAPCAs.
