CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
38
AFRICA
previous shunt palliation. Data on postoperative complications, long-
term outcome of valve function and frequency of re-operation were
assessed. Data are expressed as mean and range.
Results:
All patients survived surgery, one patient with AVSD and
Fallot died two months after surgery due to sepsis. Age at operation
was 9.9 months (one month – 11.1 years), median 5.3 months. After
surgery the RV/LV pressure ratio was 0.52 (0.32–0.77). Postsurgical
time on ventilator was 2.1 days (1–3). Stay in ICU was 2.9 days
(1–10). Two patients developed junctional ectopic tachycardia. Six
patients needed re-operation (10%), with implantation of valved
conduits, either homograft (two) or Contegra (three), and one
patient had enlargement of the RVOT with a new transannular patch.
Freedom from re-operation was 96% at two years, 89% at five years
and 72% at eight years. Retraction and stiffness of the monocusp
was revealed in most re-operation cases. No signs of calcification or
pulmonary embolisation and no risk of development of pulmonary
stenosis at valvular level were observed.
Conclusions:
The PTFE monocusp valve can safely be used in
combination with a transannular PTFE patch, with low risk of devel-
oping pulmonary stenosis or incompetence in the early and mid-term
postoperative period.
969: ANESTHETIC MANAGEMENT OF PLEUROPULMO-
NARY BLASTOMA IN A CHILD: CASE REPORT
Jagdish Shahani
KK Hospital for Women and Children, Singapore
Pleuropulmonary blastoma (PPB) is a rare malignancy of child-
hood arising from the lung or pleural cavity. Surgery is the mainstay
of treatment with the aim of resecting the neoplasm completely.
Anaesthesia management for surgical resection of PPB is challenging
because of the risk of respiratory and cardiovascular collapse due to
the diminished respiratory reserves, possible invasion into the medi-
astinal structures and likelihood of a concurrent lung infection. We
report a case of a massive PPB in a three-year-old child and discuss
an effective strategy of anaesthesia management for this high-risk
surgical resection.
The three-year-old girl had mild respiratory distress on pre-anaes-
thetic examination. The chest X-ray showed diffuse opacification of
the right hemithorax and significant mediastinal shift to the left. The
laboratory tests were essentially within normal limits. The anesthetic
technique involved induction with IV ketamine, gradual deepen-
ing with sevoflurane, intubation and manually assisted ventilation.
The monitoring included arterial line, CVP, urine output and nasal
temperature. IV fentanyl and morphine were used for analgesia. IV
atracurium was given after surgical exposure was completed, and the
child was connected to ventilation with pressure control mode.
There were many episodes of transient hypotension during surgi-
cal resection and manipulation, which were managed by co-coordi-
nating with the surgical team to release traction/pressure on chest/
lung and bolus administration of albumin and packed cells. The total
blood loss was ~ 600 ml. The child was kept intubated at the end of
surgery and was transferred to ICU. She was extubated 24 hours later
and had BIPAP for the next 24 hours. The rest of her stay in hospital
was uneventful and she was discharged from the hospital on the
eighth postoperative day.
1004:TRICUSPIDVALVEREPAIR IN PAEDIATRIC PATIENTS
WITH EBSTEIN ANOMALY: THE MAYO CLINIC EXPERI-
ENCE IN THE CURRENT ERA
Frank Cetta
1
, Joseph Dearani
2
, Michael Cetta
1
, Mark Norris
2
, Angela
Miller
1
, Sameh Siad
1
, Harold Burkhart
1
, Benjamin Eidem
1
1
Mayo Clinic, USA
2
University of Minnesota, USA
Background:
Historically, tricuspid valve (TV) repair for paediatric
patients with Ebstein anomaly (EA) has had varied results. Cone
reconstruction (CR) has revolutionised TV repair since it is at the
‘true’ anatomical annulus. We report our recent experience with TV
repair in EA patients
<
21 years old.
Methods:
Medical records were reviewed for all patients
<
21 years
with EA, having surgery at the Mayo Clinic from June 2007 to June
2012; 79 patients (41 males, 52%) had TV repair. Mean age
=
10.0
±
5.9 years (5 days – 20.8 years). Echo showed severe TR in 72 (91%)
patients. Six patients had prior TV repair elsewhere.
Results:
Initial CR was successful in 75 patients (95%). There
was one early death (a 19-day-old). There were three (3.8%) early
(before discharge) CR breakdowns. These patients had repeat surgery
[re-repair (two), replacement (one)] prior to discharge; 77/79 (97%)
patients were discharged with TV repair. Mean CPB was 107
±
23
(51–162) min, cross-clamp time (CX) was 84
±
17 (48–125) min.
Length of hospitalisation was 6
±
3 (3–16) days. Age, gender, CPB
and CX times were not associated with early CR failure. Use of an
annuloplasty ring correlated with successful initial CR (
p
=
0.01).
There have been no early CR breakdowns since 2010. Follow up
was available in 65 patients (83%). Mean follow up was 0.9
±
1.3
years. Longest follow up was 5.1 years. There were no late mortali-
ties or re-operations. Follow-up echo demonstrated: trivial/mild TR,
66/77 patients (90%); moderate, six (8%) patients; severe, two (2%)
patients. Two patients had TV stenosis (mean gradients
>
6 mmHg).
Conclusion:
Of the paediatric patients with EA, 97%were discharged
with TV repair. All CR failures presented before discharge. Since
current TV repair results for EA and durability were excellent, inter-
vention is recommended for younger patients.
1017: MID-TERM RESULTS AFTERAORTICVALVE REPAIR
P Aszyk
1
, N Sinzobahamvya
1
, C Arenz
1
, C Haun
2
, E Schindler
3
, M
Schneider
4
, V Hraska, B Asfour
1
German Paediatric Heart Centre Sankt Augustin, Germany
2
ICU, German Paediatric Heart Centre, Sankt Augustin, Germany
3
Anesthesiology, German Paediatric Heart Centre, Sankt Augustin,
Germany
4
Cardio-Thoracic Surgery, German Paediatric Heart Centre, Sankt
Augustin, Germany
Background:
Aortic valve repair (AVR) is considered a good tempo-
rary solution as it offers reduction of regurgitation (AR) and stenosis
(AS), and stabilisation of the ventricular dimensions until the patients
grow older, at which time the full range of possible treatment options,
including mechanical valve or the Ross procedure might be used. The
aim of the study was to analyse mid-term outcomes of AVR.
Methods:
From 2004 to June 2012, 167 AVRs were performed.
Mean age at operation was 109
±
88 months; 107 patients had
predominantly AS, 17 had pure AR, and combined lesions were
noted in 43 patients. The majority of patients (
n
=
134) had a primary
repair (PR) and the remaining 33 had balloon dilation before surgery.
Various surgical techniques were used including cusp extensions
(CE) (
n
=
41), resulting in bicuspid (BC) (
n
=
51) or tricuspid (TC)
(
n
=
116) morphology. In the TC group 46% (
n
=
53) had one cusp
replaced (CR) while preserving two native cusps.
Results:
There were two early deaths. Mean follow up was 48
±
24
months.
Discussion:
Valve repair is safe. The best results with reconstruction
are obtained by tricuspidalisation of the aortic valve with a cusp-
replacement technique and with primary repair. Trends for longer
durability after AVR were noticed in older patients and those with
AR, which might reflect the importance of the growth potential and
quality of tissue.
1020: GOOD INTERMEDIATE TO LONG-TERM RESULTS
OF THE SWITCHBACK ROSS OPERATION: A REPORT OF
TWO CASES
Walter Vicente, Cesar Ferreira, Jyrson Klamt, Paulo Manso, Oswaldo
Almeida Filho, Ana Paula Carlotti, Lidiane Arantes, Jorge Haddad
Hospital das Clinicas de Ribeirão Preto, Brazil
