CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
172
AFRICA
Minako Hayakawa, Takeshi Hiramatsu, Gouki Matsumura, Takeshi
Konuma, Minori Tateishi, Yasuyuki Toyoda, Yuuki Nakayama,
Yukiko Yamada, Mitsugi Nagashima, Kenji Yamazaki
Tokyo Women’s Medical University, Japan
Object
: Bilateral pulmonary artery banding (BPAB) is effective
for high-risk hypoplastic left ventricle syndrome and its variants.
However, deformation or stenosis of the pulmonary artery is a serious
concern as a result. Recently we performed an adjustable BPAB with
ePTFE suture (CV-0) and absorbable sutures to prevent this problem
and examined its efficacy.
Method
: FromApril 2003 to January 2012, we retrospectively evalu-
ated 17 children who underwent BPAB and received the Norwood
procedure or definitive repair (nine in the adjustable BPAB group and
eight in the non-adjustable BPAB group). CV-0 was used as a band
in the adjustable BPAB. The band was fixed with absorbable sutures
(7-0 PDS) to the appropriate diameter according to the pulmonary
venous flow and/or O
2
saturation; along with non-absorbable sutures
(5-0 prolene) a few millimeters apart from the absorbable sutures.
In the non-adjustable BPAB, a 2-mm-wide Teflon tape and non-
absorbable sutures were used.
Results
: The average interval until the next operation was 101 days
in the adjustable BPAB group and 109 days in the non-adjustable
BPAB group. There was no stenosis of the pulmonary artery in the
adjustable group in the
next operation, whereas pulmonary artery
angioplasty was needed in four children in the non-adjustable group.
Conclusion
: Adjustable BPAB is effective in preventing stenosis of
the pulmonary artery and allows for pulmonary artery growth.
516: OUTCOME OF PRIMARY REPAIR OF ATRIOVEN-
TRICULAR SEPTAL DEFECTS IN CHILDREN: AN EXPERI-
ENCE FROMTHE RED CROSS CHILDREN’S HOSPITAL IN
SOUTH AFRICA
Proscovia Mugaba
1
, John Lawrenson
2,3
, George Comitis
2,3
, Andre
Brook
2,4
1
Makerere University College of Health, Kampala, Uganda
2
University of Cape Town/Red Cross Children’s Hospital, Cape
Town, South Africa
3
Tygerberg and Red Cross Children’s Hospital, Cape Town, South
Africa
4
Chris Barnard Division of Cardiothoracic Surgery, University of
Cape Town and Groote Schuur Hospital, Cape Town, South Africa
Background
: There is evidence to question the rationale for
performing pulmonary artery banding (PAB) prior to repair of a
complete atrio-ventricular septal defect (AVSD) in resource-limited
settings. However, data on primary repair of a complete AVSD in
these settings are scarce.
Objective
: We examined the outcome of primary repair of a complete
AVSD among children at the Red Cross Children’s Hospital (RCCH)
in South Africa, to determine whether this approach is justifiable as
the first line of management in a developing country.
Methods
: A retrospective review was performed on 31 children who
underwent primary repair of a complete AVSD at RCCH between
January 2009 and December 2010. We determined the surgical result,
mortality and current follow-up status. The minimum follow-up
period was one year.
Results
: Median age was 8 (3 to 26) months (nine aged
<
6 months,
10 aged 6–12 months and 12 aged
>
12 months. Mean weight was
6
±
2.4 kg. The majority (23/31) had Down syndrome (DS). Twelve
children required pre-surgical cardiac catheterisation. An accept-
able surgical result was achieved in 90% (28/31). There were three
re-operations; two right and one left atrioventricular valve annulo-
plasty. Early (30-day) mortality was 13% (4/31); three in-hospital
deaths attributable to infection and one ‘cot death’ at home. Overall
mortality was 29% (9/31); the majority (6/9) of deaths occurred after
initial hospital discharge. Out of 18 children followed up at RCCH,
13 are free of anti-failure treatment and there is no anticipated
re-operation.
Conclusion
: Primary repair of a complete AVSD was successfully
carried out with low incidence of re-operation and in-hospital mortal-
ity. Late surgery was common, translating to increased costs required
for cardiac catheterisation to assess operability. We conclude that
timely primary surgery should be advocated for, even in resource-
limited settings. Factors that reduce survival following successful
surgery and discharge from hospital should be addressed.
523: STUDY ON THE DIAGNOSIS AND TREATMENT OF
CHILDHOOD SUPRAVENTRICULAR TACHYCARDIA
WITH INTRACARDIACELECTROPHYSIOLOGY:REPORTS
OF 50 CASES
Chunhua Qi
1
, Lin Wu
1
, Ying Lu
2
, Lan He
1
1
Paediatric Cardiology, Fudan Children’s Hospital,
3
Technician, Fudan Children’s Hospital,
Background:
The aim of this study was to clarify the electrocar-
diographic characteristics of supraventricular tachycardia (SVT) in
children and improve the technique of intracardiac electrophysiology
(EPS) and radio-frequency catheter ablation (RFCA) in children.
Methods:
Fifty patients with SVT were enrolled in the study from
December 2007 to July 2012. The ECG data and the results of RFCA
(ablation success, complications and recurrence) were studied retro-
spectively.
Results:
Among the 50 patients, there were 29 cases (58%) with
atrial ventricular re-entrant tachycardia (AVRT), 10 cases (20%) with
atrial ventricular node re-entrant tachycardia (AVNRT), six cases
(12%) with atrial tachycardia (AT), two with AVRT accompanying
AVNRT, and one case with both AVRT and AT. The procedure was
abandoned in two patients because of the risk in one case (AVRT
and accessory pathway location near His bundle), and one case not
induced by EPS. No recurred tachycardia and complications were
found in all 50 cases up to the present.
Conclusions:
RFCA is a safe procedure for tachycardia management,
with high success rate and low rate of complications but the indica-
tions for RFCA should be carefully considered in young patients.
536: A CONCEPTUAL FRAMEWORK FOR COMPRE-
HENSIVE RHEUMATIC HEART DISEASE CONTROL
PROGRAMMES
Rosemary Wyber
Harvard School of Public Health, Harvard, USA
Background:
The World Health Organisation (WHO), World Heart
Federation (WHF) and other organisations recommend comprehen-
sive control programmes for rheumatic fever (RF) and rheumatic
heart disease (RHD). However, advice on components of control
programmes tend to be simple linear lists, with little guidance on
programme structure or priorities. In particular, there are limited
recommendations on ‘stepwise’ implementation with few guide-
lines on which programme components should take temporal
priority. An evidence-based framework for describing, prioritising
and implementing comprehensive RF/RHD control programmes is
needed. A unified framework approach would provide a structure for
international collaboration and comparison. Providing guidance on
programme priorities would be beneficial for emerging RHD control
programmes, particularly those spurred on by scale-up of echocardio-
graphic screening or delivery of tertiary interventions.
Methods:
A literature review of existing RF/RHD control programme
recommendations generated a list of programme components.
Descriptions and analysis of RF/RHD control programmes informed
temporal prioritising of component parts. Relevant programmat-
ic research from other vertical disease control programmes was
reviewed for generalisable implementation experiences.
Results:
Twenty-four individuals’ components of comprehensive
RF/RHD control programmes were identified. These fell into ‘base-
line’ programme requirements (including burden of disease data,
treatment guidelines and human resources), and requirements for
