CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
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AFRICA
patients (cognitive deficits in five; motor deficits in three). No
patients had evidence of renal dysfunction. At hospital discharge,
three patients had respiratory failure requiring tracheostomy and at
the latest follow up one remained dependent on mechanical ventila-
tion. Echocardiogram in 23 patients demonstrated normal systemic
ventricular (SV) function in 19 and mild–moderate SV dysfunction
in four. Unplanned cardiac re-interventions were required in 13/19
patients (68%): both percutaneous and operative in four (21%),
solely percutaneous in six (32%) and solely operative in three (16%).
Unplanned hospital re-admissions were documented in nine patients.
Conclusions:
Post-hospital discharge outcomes of CHS patients
requiring post-cardiotomy ECMO were encouraging with regard to
survival, respiratory and renal assessments. While SV function was
largely preserved in the mid-term, the rate of unplanned cardiac
re-interventions was high. Neurological impairment remained a
concern with evidence of both cognitive and motor deficits.
1405: REPAIR OFANOMALOUS LEFT CORONARYARTERY
FROM THE PULMONARY ARTERY: OUTCOMES AND
FOLLOW UP
Gladys Salgado
1
, Rodrigo Oribe
1
, Solana Villafañe Molina
1
, Marta
Lopez
1
, Jose Alonso
1
, Jose Suarez
2
, Horacio Capelli
1
1
Department of Cardiology, Hospital de Pediatria JP Garrahan,
Argentina
2
Deparment of Cardiovascular Surgery, Hospital de Pediatria JP
Garrahan, Argentina
Backround:
We reviewed early and late surgical results of children
with anomalous left coronary artery from the pulmonary artery
(ALCAPA).
Methods:
Between July 1994 and June 2012, 40 patients with
ALCAPA were repaired in our hospital. The median age was 4.5
months (range 1–156), mean weight 6 kg (range 3–63). Patients were
divided in two groups: (I) direct coronary transfer (
n
=
34) and (II)
coronary ligation (
n
=
6). Three simultaneous annuloplasties were
performed. The mean follow up was 4.12 years (range 0.25–16.1).
Results:
There were two hospital deaths: group I: 1/34 (2.9%), group
II: 1/6 (16.6%) and one late sudden death in each group. Both tech-
niques were equally effective regarding left ventricular shortening
fraction (LVSF) (long-term follow up: 38% vs pre-operative: 23%)
and mitral valve competence (mitral regurgitation (MR) was absent
or mild in 76% of patients in long-term follow up). One patient
required mitral valve replacement two months after coronary transfer.
Four patients underwent a redo: second mitral annuloplasty, coronary
artery bypass grafting, mitral valve re-replacement and pulmonary
supravalvular stenosis repair (one, 10, 11 and 13 years after surgery).
All survivors remain asymptomatic. Sixteen patients were catheter-
ised during follow up. In four patients, the left coronary artery was
occluded, all had normal LVSF and two had a normal excercise test.
This was performed in 15 patients: five were abnormal, two however
had normal coronary angiography.
Conclusions:
A dual coronary system could be stabilised safely in
children with ALCAPA. Early mortality was related to the sever-
ity of pre-operative left ventricular dysfunction. Late results were
satisfactory, with marked improvement of left ventricular LVSF and
mitral valve competence. Echocadiographic assesement and exercise
test are useful tools to evaluate potential myocardial injury, however
these two methods did not predict patency of the coronary arteries.
Therefore, a coronary angiography should be included in the follow-
up evaluation.
1410: CARDIAC RESYNCHRONISATION THERAPY (CRT)
IN PAEDIATRIC CARDIOLOGY: A NEW TENDENCY OR
THE EXCEPTION
WTetsuji Tamaki, Christiane Zambolin, Elizabeth Crevelari, Roberto
Costa, Silvana Nishioka, Martino Martinelli, Anisio Pedrosa, Fabio
Jatene
InCor, HCFMUSB, Brazil
Background:
Biventricular pacing was introduced in the middle
1990s as a new modality of treatment for patients with drug-refracto-
ry dilated heart failure (FE
<
0.3) and ECG evidence of dissynchro-
nous ventricular contraction. Initially the third lead was exclusively
placed by thoracotomy in the left ventricle wall (epimyocardial). In
2000 the first system was introduced to place left ventricular leads
through the coronary sinus. This study reports on our clinical experi-
ence with cardiac resynchronisation therapy per year since 1997, in
patients under 18 years of age.
Methods and Results:
We reviewed our case reports on CRT, from
the first surgical procedure in 1997 to 2012. Since 1997 we have
implanted 1 135 CRTs but only 16 patients were under 18 years old
(1.41%). In both groups there was a prevalence of males; 68% in
adults (group I) and 75% in the under-18s (group II). Five patients
were complete congenital heart block with pacemaker VVI who
developed dilated myocardial insufficiency from two months to eight
years and elected to CRT.
Discussion:
In children, CRT implantations are still limited by
generator size, and lead diameter incompatibility with vascular
dimensions. In adults epicardial leads are the exception, they are
more commonly used in children. CRT is indicated in very specific
cardiological conditions and even in those cases, the most optimistic
expectations show three-quarters respond to the therapy, but it has a
low impact on survival rates. Despite the growing indication for and
feasibility of CRT in infants and neonates, we lack evidence and a
consistent rationale for carrying out the procedure on them.
Conclusion:
Despite our experience with adults, and other trials on
CRT, in paediatric cardiology there is not enough evidence to know
when, how and why to do this operation on infants.
1411: LATERAL TUNNEL GROWTH: MAGNITUDE AND
IMPACT ON THE TOTAL CAVOPULMONARY RESISTANCE
Maria Restrepo
1
, Lucia Mirabella
1
, Elaine Tang
2
, Christopher M
Haggerty
1
, Malavika S Mundkur
1
, Mark A Fogel
3
, Anne Marie
Valente
4
, Doff B McElhinney
4
, Ajit P Yoganathan
1
1
Georgia Tech and Emory University, USA
2
Georgia Institute of Technology, USA
3
Children’s Hospital of Philadelphia, USA
4
Children’s Hospital Boston, USA
Background:
The total cavopulmonary connection (TCPC) is
usually performed with a lateral tunnel (LT) pathway or an extra-
cardiac (EC) conduit. Growth potential of the LT pathway has been
hypothesised as one of the main benefits of this strategy compared to
an EC conduit. However, the nature, magnitude and haemodynamic
implications of LT growth have not been characterised.
Methods:
LT (
n
=
7) and EC (
n
=
3) patient-specific TCPC anato-
mies and flows were reconstructed from retrospective serial cardiac
magnetic resonance images. Vessel centrelines were extracted using
the Vascular Modeling Toolkit for the Fontan pathway (FP), superior
vena cava (SVC), descending aorta (dAo) and pulmonary arteries
(PA). Parameters computed included: minimum, mean, and maxi-
mum diameters, FP volume, Nakata index and McGoon ratio. To
understand the impact of growth on TCPC resistance (R
TCPC
), compu-
tational fluid dynamic simulations were performed for the LT group
by simulating both serial changes (S1, S2) and absence of growth
(S3).
Results:
Absolute and normalised diameters increased in all vessels
in the LT patients; in the EC patients’ vessels, growth was less than
expected. Changes in the FP volume were one order of magnitude
larger in the LT than in the EC patients. Haemodynamically, aver-
age R
TCPC
was seen to increase serially by 20%, while in absence of
growth it increased 57%, indicating that TCPC growth helps limiting
the R
TCPC
increase while flow rate changes in time.
Conclusions:
Geometric changes over an average span of almost
five years showed cross-sectional and volumetric growth of the
LT pathway. Based on simulations, growth had a positive effect on
haemodynamic efficiency by reducing R
TCPC
even when some growth
was accounted for. These findings support the rationale of LT TCPC
