CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
27
620: SAFETYAND TOLERANCE OF ORAL ENOXIMONE IN
PAEDIATRIC MYOCARDIAL FAILURE
Anke Katharina Furck, Sian Bentley, Nitha Naqvi, Margarita
Bartsota, Michael Rigby, Rodney Franklin, Zdenek Slavik
Royal Brompton Hospital, Royal Brompton and Harefield NHS
Foundation Trust, Sydney, Australia
Background
: Continuous intravenous administration of phosphodi-
esterase 3 inhibitors have proven to be a valuable and successful ther-
apy in paediatric patients with acute or chronic myocardial dysfunc-
tion. Intravenous treatment is associated with risk of infection and
considerable patient discomfort. There is currently no specific oral
preparation available. Weaning from intravenous medication to oral
angiotensin converting enzyme (ACE) inhibitors and beta-blockers
can be challenging. We examined our experience using the intrave-
nous preparation of enoximone as an oral medication in this setting.
Methods
: We retrospectively reviewed hospital records of 33 patients
receiving oral enoximone in a single tertiary paediatric cardiac centre
between November 2005 and December 2011. Indications for oral
enoximone were inability to wean from intravenous milrinone infu-
sion and/or intolerance of ACE inhibitor therapy.
Results
: Patient age at the start of oral enoximone was 0.5–191
months (median 8.5 months). Seven patients (21%) had left ventricu-
lar dysfunction due to myocarditis/cardiomyopathy and 26 (79%) had
myocardial dysfunction complicating congenital heart disease, 25
(75%) following cardiac surgery. Of this latter group, 12 (48%) had
left ventricular, nine (36%) had right ventricular and four (16%) had
biventricular dysfunction. All patients received oral enoximone at 1
mg/kg three times a day. Enoximone was well tolerated at this dose
without adverse haemodynamic effect. Due to the alkaline nature
of this solution there were two (6%) patients with blood-stained
gastric content aspirates when enoximone was administered without
milk, which subsequently resolved when given with milk. No other
adverse effects were encountered and the families tolerated well the
inconvenience of using an intravenous preparation orally. Results of
outcome data analysis will be presented.
Conclusions
: Oral enoximone is a safe alternative to protracted intra-
venous treatment of severe myocardial failure in children. Based on
our experience it is a well-tolerated and promising alternative when
ACE inhibitors and beta-blockers are not tolerated.
622: THE NIKAIDOH SURGICAL PROCEDURE: INITIAL
EXPERIENCE AND MID-TERM RESULTS
Villalba Claudia Natalia, Irman Julieta, Lafuente Maria Victoria,
Mouratian Mariela, Barreta Jorge, Capelli Horacio
Hospital J P Garrahan, Argentina
The Nikaidoh procedure is a recent surgical approach to repair TGA
and DORV with VSD and PS.
Objective
: To review our experience using the Nikaidoh procedure.
Methods
: Between 2005 and 2012,10 patients underwent a modi-
fied Nikaidoh procedure at our institution, median age: 2.9 years (CI
25–75%
=
1–5.6) and median weight: 12.5 kg (CI 25–75%
=
8.7–19).
Two anatomical variants were identified: TGA with VSD and PS
(seven patients) and DORV with PS (three). All had a VSD distant
from the great arteries (inlet type, six; and muscular, four patients).
Results
: The mean CPB time was 244 min (SD
±
50) and aortic
cross-clamping was 181 min (DS
±
44). The median length of stay
was 11 days (CI 25–75%
=
8–45), MV six days (CI 25–75%
=
4.5–22) and inotropic requirement was eight days (CI 25–75%
=
5.5–23.5).
Early
outcome
: No mortality occurred; three patients suffered
transient arrhythmias (one AVB, two JET). One patient developed
infective endocarditis and needed a mitral valve and RV–PA homo-
graft replacement. Six patients presented some degree of ventricular
dysfunction controlled with medical treatment, except one who
needed ventricular assistance. There was no obstruction to either RV
or LV outflow tracts. None presented aortic insufficiency more than
trivial or pulmonary incompetence more than moderate.
Mid-term
results
: The median follow up was 4.3 years (2–5.6
years). No deaths occurred. All patients were free from re-operation
and re-intervention. All patients were in NYHA functional class I,
with no arrhythmias, no LVOTO and a good biventricular function.
The aortic valve was competent in 40%. In six patients the aortic
insufficiency was mild. Regarding the RV–PA conduit, there was a
mild stenosis in six patients and moderate in one. Mild pulmonary
insufficiency was found in four and it was moderate in six patients.
Conclusions
: Mid-term actuarial survival was 100% after the
Nikaidoh procedure. This surgical technique provides complete
freedom from significant insufficiency and left or right ventricular
outflow tract obstruction. The modified Nikaidoh operation is a
good surgical option in patientts with TGA, VSD and PS, and with
DORV and PS, particularly when some anatomical features, such as
the anatomical position of the VSD are considered inadequate for a
Rastelli procedure. Its long-term benefits need to be evaluated with a
larger number of patients and longer follow up.
626: ROLE FOR IMMUNE-MONITORING TO TAILOR
INDUCTION PROPHYLAXIS IN PAEDIATRIC HEART
RECIPIENTS
Elfriede Pahl, Jeffrey G Gossett
1
Philip Thrush, Kathleen L Matthews,
Reem Nubani, Hardik Bhagat, Carl L Backer and John M Costello
Lurie Children’s Hospital, Chicago, IL, USA
Background:
Rabbit antithymocyte globulin (rATG) is routinely
used for induction, but is costly and associated with increased risk of
infection and post-transplant lymphroproliferative disorder (PTLD).
Hypothesis:
We hypothesised that CD
3
monitoring to tailor rATG
induction would have less infection, reduced costs and similar rejec-
tion rate.
Methods:
Heart transplant (Htx) recipients who received rATG
between November 2006 and July 2011 were reviewed. We compared
patients with CD
3
monitoring used to adjust medications (group 1,
n
=
16) vs group 2 (patients with standard rATG dosing). Absolute CD
3
count
<
25 cells/mm
3
was used to adjust rATG in group 1. Outcomes
included first-year incidence of infection and rejection, direct costs
of rATG, and incidence of PTLD and all deaths. Statistics: Fisher’s
exact test, Wilcoxon rank sum and Wilcoxon sign rank test.
Results:
Demographics and cardiac diagnoses were similar between
the study and control cases. Compared to the controls, the study cases
received fewer daily doses of rATG [median 3 (3–7) vs 4 (2–7),
p
=
0.005] and less total rATG (median 3.1 vs 7.4 mg/kg,
p
<
0.001).
Compared to a fixed dosing regimen of 1 mg/kg/day × 5–7 days, the
drug cost savings for study cases were significant (total cost $58 432
vs $93 627,
p
=
0.001), a 37% reduction in total cost. There was no
difference in the incidence of infection (29 vs 44%), rejection (53
vs 31%), or mortality (6 vs 6%) during the first year following Htx.
There was one late death and one late case of PTLD in group 2 (
p
=
ns).
Conclusions:
CD
3
monitoring to tailor rATG induction in Htx
recipients is associated with reduced drug costs and similar rates of
rejection and infection. Longer follow up will determine if there is
extended benefit from tailored immunotherapy.
641: LIVOSEMENDAN VS MILRINONE IN PREVEN-
TION AND TREATMENT OF LOW CARDIAC OUTPUT IN
CHILDREN UNDERGOING CORRECTIVE OPEN-HEART
SURGERY FOR CONGENITAL HEART DISEASE
Prashant Bobhate, Mangesh Jadhav, Snehal Kulkarni, Swati Garekar,
Bipin Radhakrishnan, Suresh Rao
Kokilaben Dhirubai Ambani Hospital, Mumbai, India
Background:
Low-cardiac output (LCO) state is a well-known
complication in children undergoing corrective open-heart surgery;
it usually occurs eight to 10 hours after surgery. Milrinone has been
shown to be superior to conventional ionotropes in prevention and
treatment of LCOS in children. Recently, levosimendan, a Ca
2+
sensi-
