Cardiovascular Journal of Africa: Vol 24 No 1 (February 2013) - page 8

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013 6 AFRICA
half an hour after CPB, and before and after surgery, but not in the
controls, with the highest values half an hour after CPB (p < 0.0001,
p < 0.001 and p < 0.001, respectively). S-100B protein levels were
elevated in the cyanotic compared to the acyanotic group (p < 0.001).
S-100B protein levels half an hour after CPB correlated positively
with aortic clamping time, and negatively with body temperature (p
< 0.01 and p < 0.001, respectively).
Conclusion: Patients with CHD are susceptible to subtle brain
damage, which increases during surgical intervention, as evidenced
by increased S-100B protein levels.
44: PERI-OPERATIVE ASSESSMENT OF PATIENTS WITH
REPAIRED TETRALOGY OF FALLOT UNDERGOING
PULMONARY VALVE REPLACEMENT
Xavier Iriart, Jean-Bernard Selly, Philippe Mauriat, Francois
Roubertie, Jean-Benoit Thambo
Division of Paediatric and Congenital Cardiology, Bordeaux, France
Bordeaux, France
Aim: Pulmonary valve replacement (PVR) is commonly performed
in adults with repaired tetralogy of Fallot (TOF) to avoid late compli-
cations related to severe pulmonary regurgitation or residual RVOT
obstruction. However, few data are available concerning peri-oper-
ative complications. The aim of this study was to evaluate the peri-
operative complications and to determine predictive factors of the
low-cardiac output syndrome (LCOS) in patients undergoing PVR.
Methods: Thirty patients with TOF who underwent PVR between
2008 and 2009 were retrospectively enrolled. LCOS was defined
according to lactate level > 3 mmol/l, use of inotrope drug for more
than 24 hours, and renal dysfunction. Mean age at valve surgery was
29.5 years (range: 6.5–56.5). Indications were RVOT stenosis (n =
4), severe pulmonary regurgitation (n = 25), and mixed lesions (n
= 1). RVOT replacement was conducted with a beating heart using
a normothermic CPB (mean time 77 ± 25 min) in 16 patients; 14
patients underwent additional surgery requiring aortic cross-clamp.
In these patients, CPB mean time was 113 ± 21 min.
Results: Overall survival rate was 97% at 90 days. Post-operative
complications were uncommon (ventricular tachycardia in 6%,
mechanical ventilation over 24 hours in 6%, renal dysfunction in
10%) except for LCOS (46%). Prolonged duration of CPB over 80
min ( p < 0.01) and aortic cross-clamp (p = 0.03) increased LCOS (OR
33, 95% CI: 3.18–342.2, p < 0.01). Surprisingly, age, right ventricular
or left ventricular volume and function, and pre-operative additional
lesion (tricuspid regurgitation, residual pulmonary stenosis) were not
significatively predictive of peri-operative complications.
Conclusion: These data underline the major role of myocardial
protection during PVR in TOF patients. Short-beating heart and
normothermic CPB without aortic cross-clamping led to a decrease
in LCOS. Additional surgical repair requiring aortic cross-clamping
and longer time of CPB should be well balanced with the risk of peri-
operative complications.
52: RETROSPECTIVE ANALYSIS OF SURGICAL TREAT-
MENT AND LONG-TERM RESULTS IN CHILDREN WITH
TAKAYASU’S ARTERITIS
Maria Elena Soto1 , Cuauhtémoc Vásquez1 , Eleazar Muruato-
Ontiveros1 , Samuel Ramírez1 , Felipe Santibáñez1, Nuria Illana
Flores2, Nilda Espinola Zavaleta1,2, Rafael Bojalil1, Rodolfo Barragan1
1National Institute of Cardiologia Ignacio Chavez, Mexico City,
Mexico
2Medical Center ABC, Mexico City, Mexico
Background: Takayasu’s arteritis (TA) affects the aorta and its major
branches. The inflammatory activity is subclinical and there is no
consensus on its evaluation. It leads to occlusion stenosis or aneu-
rysm. Clinical manifestations depend of the location and extent of
arterial damage, and whether it is reversible, affects the organs and
surgical treatment is necessary.
Objective: To evaluate the evolution, presence or absence of inflam-
matory activity and survival of children and adolescents with TA who
received surgical treatment in childhood.
Methods: This was a retrospective study from 1977 to 2006 of
222 cases of TA, classified according to the American College of
Rheumatology criteria. Seventy-one received surgical treatment, 14
were children. Arterial damage was classified according to Hata,
inflammation by Dabague-Reyes criteria, and type of surgery accord-
ing to: organ sparing, for lesions with stenosis/occlusion (shunt/
replacement), exclusion, and cardiac.
Results: Eleven females were enrolled, mean age was 13 ± 3 years.
Symptoms were arterial lesions type I: 14%, III: 21%, IV: 29% and
V: 36%; systemic hypertension 64%; dyspneoa 57%; headache 50%;
angina pectoris 29%; dizziness 29%; syncope 29%; paresthesias
29%; abdominal pain 29%; and blurred vision 21%. Organ-sparing
surgery was carried out in seven patients, bypass in three, exclusion
in two, replacement in one and cardiac surgery in two. Inflammatory
activity was found in 57%. Twelve survived and the median surgi-
cal survival time was 12 years (0–26). Two patients died: seven and
five years old. Of those who survived: a woman who presented with
terminal renal failure 10 years after surgery. In another two, surger-
ies were performed, and four cases had inflammatory activity at the
time of surgery.
Conclusion: Surgery is safe in the long term. Cardiac and vascular
surgery with critical lesions should be performed early. Surgical
techniques depend on the affected organ and type of arterial damage.
Medical treatment must be prior to, during and after surgery to
maintain the remission of inflammatory activity, which requires a
consensus on evaluation and thereby improves results in the surgical
evolution and survival.
53: THE EFFECT OF MECHANICAL PERIODONTAL
TREATMENT IN HYPERLIPIDAEMIA
Ahmed Tawfig1, Hani Elamin2
1Periodontology Department, Khartoum Dental Teaching Hospital,
Khartoum, Sudan
2Cardiac Surgery Department, Ahmed Gasim Cardiac and Renal
Transplant Centre, Sudan
Background: Periodontitis is a bacterial infection which has been
classified as a local chronic inflammation. This and cardiovascular
disease may share common risk factors.The study aimed to evaluate
whether local non-surgical periodontal therapy may influence plasma
lipid level in hyperlipidaemic patients with chronic periodontitis.
Methods: Thirty patients (11 female and 19 male, age 30–70 years)
were randomly assigned to the study and control groups. Lipid
profile, C-reactive protein (CRP) and dental variables were measured
at baseline and at the end of the study in both groups.
Results: In the third month, there was a significant decrease in low-
density lipoprotein (LDL), cholesterol and CRP levels in the study
group compared with baseline values. Also the reduction in pocket
depth, attachment loss, plaque index and gingival index were statisti-
cally significant in the study group.
Conclusion: The study indicated that periodontitis causes changes
in total and LDL cholesterol and CRP levels, and local non-surgical
periodontal treatment resulted in a significant decrease in these
markers. These results suggest a potential effect of periodontitis-
driven systemic inflammation on lipid metabolism.
56: RIGHT VENTRICULAR BYPASS: COMPLICATIONS
AND SURVIVAL IN MID-TERM FOLLOW UP
Mariettaa Victoria Lafuente1, Marisa Di Santo1, Mariela Mouratian1,
Claudia Villalba1 , Alberto Sciegata1, Ariel Saad2 , Juan Pablo Laura1,
Horacio Capelli1
1Hospital JP Garrahan, Argentina
2Hospital de Clinicas, Argentina