CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
32
AFRICA
Hypothesis:
The number of children and adults with congenital heart
disease has increased in recent years, but there are few studies corre-
lating changes in oral mucous and the mouth in this patient group.
Moreover, recent research in adults has shown that a relationship
exists between oral cavity diseases, especially periodontal infections
and systemic diseases, including atherosclerosis. The aim of our
study was to correlate the levels of LDL cholesterol in patients with
congenital heart disease and periodontal disease.
Methods:
We evaluated 33 patients with congenital heart disease
(group I: average age of nine years and seven months) and compared
with a control group of 28 patients without cardiac disease (group II:
average age nine years and eight months). We analysed the clinical
periodontal parameters of plaque index, clinical attachment level and
bleeding on probing and blood level of LDL cholesterol.
Results:
The LDL cholesterol levels were slightly higher in the
control group (group II: 87.23
±
23.94 mg/dl) than in the cardiac
group (group I: 85.49
±
19.83 mg/dl), with enough similarity
between the groups regarding clinical attachment level (group I:
1.91
±
0.31 mm, group II: 1.93
±
0.28 mm). Only when there was
an analysis of patients with LDL level higher than expected in theses
groups, was the level of clinical attachment greater in group I (2.11
±
0.31 mm) than group II (1.84
±
0.32 mm).
Conclusions:
Patients with congenital heart disease followed up in
our service have improved plaque control compared to the control
group, but the more periodontal disease is developed in this group
of patients, the more the LDL cholesterol levels can be changed. As
the percentage of hypercholesterolaemic patients was 24.59%, we
believe that to better assess this correlation in paediatric patients,
further studies should be performed.
761: SIMULTANEOUS REPAIR OF PECTUS EXCAVATUM
AND CONGENITAL HEART DEFECTS: A GOOD SURGI-
CAL OPTION OF A ONE-STAGE PROCEDURE
Nestor Sandoval, Rafael Meza, Renato Bresciani, Marisol Carreno,
Carlos Obando, Juan Garzon
Fundacion Cardioinfantil, Columbia
Background:
Simultaneous repair of pectus excavatum and congeni-
tal heart defect is highly efficient and reduces to one the number of
operative procedures in children.
Methods:
Case reports are presented of two patients operated on in a
one-stage procedure consisting of a simultaneous pectus excavatum
correction and congenital heart defect repair.
Results:
Between 2007 and 2010, two patients (seven years old)
received a simultaneous pectus excavatum repair with a modified
Ravitch technique and congenital heart defect repair by a multidisci-
plinary team of cardiac and thoracic surgeons. Both patients received
a transverse linear submammary incision. Deformed cartilages were
sub-perichondrially bilaterally resected and the sternum was lifted
anteriorly. Through a pericardiotomy the cardiac lesion was fixed.
One patient received an aortic valve-sparing and ascending aorta
replacement (Tirone David operation) for a severe aortic insuffi-
ciency and aortic anuloectasic disease. In the second patient an atrial
septal defect was repaired with an autologous pericardial patch. After
the cardiac defect repair, the sternum was positioned back to the
original position, the pectoral muscle was fixed to the sternum, the
xiphoid was fixed to the abdominal rectus and subcutaneous tissue,
and the skin was closed in a regular way. A vacuum system and a
pericardial tube were placed subcutaneously. Patients were ventilated
for 13 hours (12–13) in order to avoid tension during the first hour of
the post-operative period. The intensive care stay was 2.5 days (2–3).
No complications or mortality were observed. Aesthetic results were
good after 23 months of follow up, and the cardiac repair is still
satisfactory.
Conclusions:
Simultaneous repair of the pectus excavatum and
congenital heart defect is a good option for treatment since it reduces
to one the operative event, there is no increased risk of complications,
the patients tolerated it well, and the short-term results were good.
773: THE KONNO AORTO-VENTRICULOPLASTY PROCE-
DURE IS AN EXCELLENT ALTERNATIVE TO RELIVE
SEVERE LEFT OUTFLOW TRACT OBSTRUCTION AT ALL
AGES
Nestor Sandoval, Albert Guerreo, Rafael Meza, Jaime Camacho,
Marisol Carreao, Juan Umana
Fundacion Cardioinfantil, Columbia
Background:
Aortic root enlargement (ARE) procedures are
believed to allow implantation of larger valve prostheses; however,
little evidence exists to support the specific efficacy of various tech-
niques. The Konno procedure is the best technique used to enlarge
the aortic root and increase the size of the aortic valve implanted.
Methods:
This was a case series of six patients: three children
and three adults from January 2009 to March 2012. Patients had
aortic root enlargement surgery, ‘Konno aortoventriculoplasty’. We
present continuous variables in means or medians and SD or IQR,
and categorical variables in absolute and relative frequencies; paried
t
-test was used to compare continuous pre- and postoperative haemo-
dynamic variables.
Results:
Median age was 19.5 years (3–56) and 57.1% (4/7) were
women; 83.3% (5/6) of patients had symptoms at the diagnosis. All
patients had a previous cardiac procedure. The underlying anatomical
diagnoses were valve and subvalvar aortic stenosis in two, subaortic
fibromuscular tunnel with moderate aortic stenosis in two, severe
aortic stenosis and insuficiency in one patient and dehiscence of
a previous Konno operation in one. Mean ejection fraction 65.7
±
16.9%, aortic valve peak gradient mean was 74.2
±
61.1 mmHg and
mean aortic ring diameter was 17.7
±
3.4 mm. Mean aortic clamp
time was 107.6
±
20.0 minutes; 83.3% (5/6) of patients received a
new mechanic valve. There were no mortalities, one re-operation for
bleeding, and one new complete AV block. Postoperative aortic valve
peak gradient mean was 22.1
±
7.3 mmHg (
p
=
0.08) and ejection
fraction was 55.5
±
15.3 (I
=
0.08). At the follow up all patients were
alive.
Conclusions:
Konno aorto-ventriculoplasty is a safety operation.
Excellent results may be achieved despite previous aortic root
enlargement procedures, and it may even reduce the risk of re-opera-
tion in children by allowing placement of a larger prosthesis.
779: CONSTRUCTION AND VALIDATION OF AN INSTRU-
MENT TO DETERMINE THE DEGREE OF UNDERSTAND-
ING OF POSTOPERATIVE CARE ON CAREGIVERS OF
PAEDIATRIC PATIENTS UNDERGOING CARDIOVASCU-
LAR SURGERY
Sandra Romero, Juliana Ramirez, Marisol Carreno, Yurani Mahecha,
Estella Hidalgo, Nestor Sandoval
Fundacion Cardioinfantil, Columbia
Introduction:
The importance of postoperative care is widely
described in the literature, however there is no published scale that
measures the level of understanding of the information given by the
nursing service to patients and caregivers in the postoperative period
of cardiac surgery.
Objective
: To develop and validate an instrument to measure the
degree of understanding of postoperative care in cardiovascular
surgery given by the nursing service of the Fundación Cardioinfantil
to caregivers of paediatric patients undergoing cardiac surgery.
Methods:
This was a cross-sectional study conducted between
August and November 2011. The nursing team carried out the
construction of the instrument based on the instructions of postopera-
tive care following the guidelines of a self-care model of Dorothea
Orem. The instrument has five categories: (1) appointment with a
cardiovascular surgeon, (2) daily activities, (3) drug administration,
(4) endocarditis prevention, (5) warning signs. Constructive valida-
tion was performed by 10 experts in cardiovascular medicine. We
performed content validity and reliability through Cronbach’s alpha
test statistic, calculated in Stata 8.0.
Results:
One hundred caregivers were evaluated and 92% (92/100)
