CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
41
‘grow’ relative to somatic growth, final repair was facilitated, espe-
cially in the presence of additional VSDs. This approach provides a
safe alternative strategy in complex patients with IAA.
1111: RELATIONSHIP BETWEEN HEART DYSFUNC-
TION AND MANIFESTATION OF GASTRIC RESIDUAL OF
NEONATE SEPSIS
Sri LilijantiWidjaja, Maria Galuh K Sari
SebelasMaret University, Moewardi Hospital, Surakarta, Indonesia
Background:
Neonatal sepsis with diminished heart dysfunction is
regarded as the main pathology of sepsis. The death rate is double
in septic neonates with cardiovascular dysfunction. The myocardial
dysfunction is defined as the diagnostic criteria for severe sepsis in
the adult. The occurrence of sphlancnic and mesenteric hypoperfu-
sion impact disorder of the digestive system manifests as gastric
residue.
Objective:
To analyse the relationship between gastric residue and
heart dysfunction among neonates at risk of sepsis.
Methods:
This cross-sectional study was conducted from January
to October 2011 on neonates suspected of sepsis who were hospi-
talised at Neonatal HCU, Moewardi General Hospital, Surakarta.
A sample was selected by quota sampling. Sepsis was assessed by
clinical major–minor criteria. Gastric residue was defined when the
volume of gastric aspiration four hours after feeding reached 20% for
two days. Heart dysfunction was measured using two-dimensional
Doppler echocardiography. A Chi-square test was performed to
analyse the data using SPSS 17.0.
Results:
Among 48 septic-risk neonates, we found 27 (56.3%) mani-
fested gastric residue, 25 (64.1%) having heart dysfunction, of whom
17 (70.8%) had systolic function disorders. Neonates with impaired
heart function, especially disorders of systolic function, were at risk
of gastric residue (OR
=
6.25; 95% CI: 1.14–34.29 and OR
=
3.40;
95% CI: 1.03–11.26, respectively), and the results were significant.
Neonates with gastric residue of milk were at risk of heart dysfunc-
tion compared with no gastric residue but the results were insignifi-
cant (OR
=
8.00; 95% CI: 0.87 to 73.27).
Conclusion:
There was a relationship between gastric residue and
heart dysfunction among neonates at risk of sepsis. The presence of
gastric residue could become a marker of heart dysfunction among
septic-risk neonates.
1128: MULTIPLE VENTRICULAR SEPTAL DEFECTS: A
NEW STRATEGY
Antonio Corno
1
, Ahmed Abousteit
2
, Gordon Gladman
2
, Prem
Venugopal
2
, Nelson Alphonso
3
1
King Fahad Medical City, Riyadh, Saudi Arabia
2
Alder Hey Children’s Hospital, Liverpool, England
3
Mater Children’s Hospital, Brisbane, Australia
Objective:
This was a multicentre, prospective study to evaluate
a new strategy for infants with multiple ventricular septal defects
(VSDs).
Methods:
From 2004 to March 2011, 15 consecutive infants, mean
age 3.6 months (9 days to 9 months), mean weight 4.2 kg (3.1–6.1
kg), with multiple VSDs underwent pulmonary artery banding (PAB)
with adjustable FloWatch-PAB
®
. Associated cardiac anomalies were
patent ductus arteriosus (nine), aortic coarctation (two), hypoplastic
aortic arch (one) and left isomerism (one). Mean duration of pre-
operative mechanical ventilation was 22 days (0–240 days).
Results:
There were no early or late deaths during a mean follow
up of 45 months (12–89 months). FloWatch-PAB
®
adjustments were
required in all patients, a mean of 4.7 times/patient (1–9) to tighten
the PAB, and a mean of 0.8 times/patient (0–3) to release the PAB
with the patient’s growth. After a mean interval of 32 months (8–63
months) five/15 patients underwent re-operation: three/five PAB
removal and closure of a remaining peri-membranous VSD, and two/
five only PAB removal. All muscular multiple VSDs had closed in all
five patients. PA reconstruction was never required. In six/10 of the
remaining patients all muscular VSDs had already closed.
Conclusions:
This reproducible new strategy with adjustable PAB
simplifies the management of infants with multiple VSDs, provid-
ing the following advantages: (1) good results (0% mortality); (2)
delayed surgery with high incidence (11/15
=
73%) of spontaneous
closure of multiple muscular VSDs; (3) facilitated closure of residual
peri-membranous VSD at older age and larger body weight; (4) PAB
application and late removal remains the only procedure required for
Swiss cheese multiple VSDs without associated peri-membranous
unrestrictive VSD.
1129: CONCOMITANT ANTERIOR AND POSTERIOR
TRICUSPID LEAFLET AUGMENTATION WITH A SINGLE
PATCH: THE RESPECT OF THE GEOMETRY
Andrea Quarti, Stefania Nardone, Gaetano Santoro, Marco Pozzi
Ospedali Riuniti, Ancona, Italy
Objectives
: Isolated tricuspid anterior leaflet extension is an option
used to increase leaflet coaptation. Nevertheless the posterior leaflet
and the commissure between septal and posterior leaflets could lead
to residual valve regurgitation. We describe the augmentation of both
the anterior and the posterior tricuspid leaflets with a single patch.
Methods
: In the last year, four patients (mean age 37 years) present-
ed with severe tricuspid regurgitation with leaflet tethering and coap-
tation deficit. Mean coaptation deficit was 19.5 mm. They received
concomitant anterior and posterior leaflet augmentation with a single
patch. In one patient an extracellular matrix patch was used while
in the others an autologuous patch was implanted. The patch was
trimmed using a 32-mm ring sizer. After detaching of the leaflets
from the annulus, secondary chordae were removed. In all of them an
anuloplasty was performed using a prosthetic ring. CE no 32.
Results
: There were no deaths or major complications during in-hospi-
tal stay. No early residual regurgitation could be observed. After a
mean follow up of eight months, all patients demonstrated absence
of recurrent regurgitant jet. Mean gradient across the valve was 1.5
mmHg. After combined leaflet augmentation, the valve acts as a
single-leaflet valve, abolishing the effect of the septal leaflet tethering.
Comments
: Anterior leaflet augmentation to treat tricuspid valve
regurgitation might induce geometric disarray between anterior and
posterior, and posterior and septal valve leaflets. In the last year we
introduced the anterior and posterior leaflet augmentation using a
single patch, thus reducing the possible residual regurgitant jet in the
commissure between the anterior and the posterior leaflet. The patch
size was identical to the prosthetic ring in order to have a functional
single-leaflet valve and abolishing the detrimental effect of the poste-
rior-leaflet tethering. Immediate and early results are encouraging.
1130: CANNULATION OF THE BRACHIOCEPHALIC
TRUNK AND ANTEGRADE CEREBRAL PERFUSION IN
AORTIC ARCH REPAIR IN NEONATES
Andrea Quarti, Stefania Nardone, Gaetano Santoro, Marco Pozzi
Ospedali Riuniti, Ancona, Italy
Introduction:
Cannulation of the brachiocephalic trunk (BCT) with
the interposition of a goretex conduit allows easy antegrade cerebral
perfusion (ACP) and possibly coronary artery perfusion during arch
surgery. ACP is advocated as a factor protecting the abdominal
organs, which are supposed to be perfused through the collaterals. We
describe our series of aortic arch repair in neonates.
Methods:
Between April 2005 and June 2012, 18 neonates presented
with aortic arch hypoplasia (age 2–27 days, mean weight 3.39 kg).
Eleven patients presented with an associated VSD: seven received
pulmonary artery banding while five had concomitant VSD surgical
closure. The BCT was cannulated through a Goretex conduit in all
patients. The arch was clamped distally to the BCT, distal to the isth-
mus and then both the left carotid and left subclavian arteries were
clamped. The arch was reconstructed under cardio-cerebral perfusion
