CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
242
AFRICA
to impact on long-term outcomes. In younger patients, an increase
in donor-to-recipient size ratio increases postoperative recovery.
However, the use of BSA is a more reliable tool for matching heart
sizes in all age groups.
1453: CLINICALAND SURGICAL EVOLUTION OF TRICUS-
PID ATRESIA AT A PAEDIATRIC HOSPITAL IN ARGEN-
TINA
Ana Maria Susana De Dios
1
, Fernanda Biancolini
1
, Julio Cesar
Biancolini
2
, Jesus Damsky Barbosa
3
, Miguel Granja
3
, Jose Vargas
4
1
Paediatric Cardiology, Pedro de Elizalde Children’s Hospital,
Argentina
2
Paediatics, Pedro de Elizalde Children’s Hospital, Argentina
3
Cath Lab, Argentina
4
Cardiovascular Surgery, Pedro de Elizalde Children’s Hospital,
Argentina
Aim
: The follow up of patients with tricuspid atresia (TA).
Methods
: A retrospective review was done of 45 clinical records of
patients with TA who were assessed at Pedro de Elizalde Children’s
Hospital from August 2005 to August 2012. They were grouped
according to Edwards and Burchel classification. Analysis was based
on clinical examination, radiology (Rx), electrocardiography (EKG),
echocardiography, catheterisation records and surgical treatment.
Statistical analysis: multivariable test
p
<
0.05.
Results
: There were 44 patients with TA, 44 patients with situs soli-
tus (SS), and one patient was indeterminate (Si). Type I: 43 patients
had ventricle–arterial concordance (95.5%). Type IA: three patients
had decreased pulmonary flow (PQ) (7%). Treatment: two systemic
pulmonary anastomosis (SPA), one Glenn shunt. Complications: one
patient with stenosis of the left pulmonary branch, one patient needed
occlusion of the inferior vena cava. Type IB
(58%): 24 patients had
normal PQ. Treatment: two patients had Park septectomy, 14 had
SPA, five had Glenn shunt, one had Glenn pulsatile, three had atrio-
pulmonary connection, and three had extracardiac cavopulmonary
connection. Complications: one patient needed mitral anuloplasty;
one had endocarditis; one AV dissociation, and required a pace-
maker; one had W-P-White syndrome. Type IC (32%): 12 patients
had increased PQ. Diagnosis: all in the first month: four patients
with pulmonary hypertension. Treatment: three patients had SPA;
later: two had Glenn, one Glenn pulsatile, and two atrio-pulmonary
connection. Complications: fibrillo-flutter four years later in one
patient and AV block in one.
Type II: ventricle–arterial discordance (5%). Type IIA: two
patients had decreased PQ, Si, RBVF, severe pulmonary stenosis and
mitral insufficiency. Treatment: one patient had SPA that needed a
stent in the pulmonary artery branch, Glenn dysfunction.
Type III: left-sided right ventricle (one loop) No patients. Follow up
only in 23 patients.
Conclusion
: Type I was the most frequent (95%) [IB (56%) and
IC (33%)]. Cyanosis was the most common clinical manifestation
(66%). EKG: superior axis was found in 19/45 patients, left ventri-
cle hypertrophy in 82.9% and left anterior hemiblock in 70% of the
patients. Regarding surgical procedure: 21 patients needed systemic
pulmonary anastomosis, 12 Glenn shunt (nine non-pulsatile, three
pulsatile), six atrio-pulmonary connection, and four extracardiac tube
connection.
1461: DETERIORATING PAEDIATRIC CARDIAC WARD
PATIENTS: A 12-MONTH REVIEW
Kim Trussler, Mary Wilson
Mater Children’s Hospital, Australia
Background
: To identify deteriorating patients and to describe char-
acteristics of the events and mortality.
Methods:
We retrospectively analysed data of all children from our
paediatric cardiac ward requiring secondary emergency response
team (SERT) attendance, and/or unplanned paediatric intensive care
unit (PICU) admission between January and December 2010. Data
were extracted from medical charts and the ward’s clinical informa-
tion system.
Results:
Thirty-six events were observed in 28 patients; 16 (44%)
were SERT calls, which included four (11%) episodes of CPR, and
20 (56%) separate PICU reviews. Overall 27 (75%) required transfer
to PICU. Most common reasons for triggering SERT calls or PICU
transfer were cyanotic episodes (28%), low-cardiac output state (23%),
bradycardia (11%), and arrhythmia (SVT/VT, 11%). There was a
statistical significance between cause of deterioration and whether
the child was categorised as either medical or surgical (
p
≤
0.05). Of
the children that deteriorated, 86% were aged less than 12 months.
Medical children were the most likely to deteriorate (57%) and it was
more likely to occur in the close observation unit within the ward
(69%) rather than in the general ward area. A slow deterioration as
opposed to an acute deterioration occurred in 64% of cases. Timing
of deterioration varied with 18% occurring within 24 hours of PICU
transfer and 36% within 72 hours. More events (72%) occurred outside
of office hours. Of the 28 patients there was a 24% mortality rate.
Conclusions:
Deteriorating cardiac patients on the paediatric cardiac
ward carry a high mortality rate long term. The implementation of
a clinical early warning tool, specifically designed for cardiac ward
patients, may be more efficient in detecting the deteriorating patient.
1468: LONGEVITYOF PALLIATION PROVIDED BY NEONA-
TAL DUCTAL STENTING BEFORE DEFINITIVE SURGI-
CAL CORRECTION FOR CONGENITAL HEART DISEASES
WITH DUCT-DEPENDENT PULMONARY CIRCULATION
Sivakumar Kothandam, Anilkumar Singhi, Sreeja Pavithran, Anpon
Bhagyavathy, Robert Coelho
MIOT Hospital, Chennai, India
Background
: Ductal stenting (DS) in duct-dependent pulmonary
circulation involves less morbid than neonatal Blalock–Taussig
shunt. We aimed to study whether DS provided adequately long
palliation.
Methods
: A prospective interventional clinical follow-up study of
consecutive infants followed after successful DS was done from two
tertiary referral centres. Patients were divided into three anatomical
groups. A: following pulmonary valvotomy for critical pulmonary
stenosis and atresia, for continuing duct dependency; B: tetralogy
of Fallot with pulmonary atresia where palliation is needed until
conduit replacement; and C: univentricular hearts where ductal stent
is needed until bidirectional Glenn shunt surgery. Interstage mortality
was studied.
Results
: Among a total of 24 infants, four patients in group A
followed for 26–54 months had adequate oxygen saturations and
no residual gradient. Tricuspid valve, pulmonary annulus and right
ventricle grew with age. After discontinuing antiplatelets, two stents
were patent after one year. In eight out of 11 group B patients,
corrective biventricular repair using conduits was done after 5–14
months (body weight 5–7.5 kg). One patient awaits conduit repair.
Bidirectional Glenn shunt and confluence repair was done in seven of
nine group C patients after 8–15 months (weight 6–8.5 kg). The hilar
pulmonary artery growths in B and C groups were adequate for surgi-
cal repair. No patient needed stent redilatations or additional shunts.
Four patients had sudden death at home and no autopsy was done.
Conclusions
: Duration of palliation by DS was sufficient to allow
adequate somatic growth before the next surgery. DS was acceptable
palliation after pulmonary valvotomy and univentricular hearts where
short-term patency is sufficient. In patients needing biventricular
repair with conduits, a longer term of palliation may be desirable and
ductal stent did not provide adequate pulmonary flows for a long time.
There was an interstage mortality of 16% of unknown causes after DS.
1472: CMRASA NON-INVASIVE DEFINITIVE DIAGNOSTIC
TOOL FOR COMPLEX CYANOTIC CONGENITAL HEART
DISEASE
