CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
48
AFRICA
encourage tissue regeneration with growth potential. The quest for an
optimal material for vascular and intracardiac tissue repair is ongo-
ing. Here we describe our experience with an extracellular matrix.
Methods:
From April 2011 to June 2012, 109 CorMatrix patches
were used in 89 operations on 82 patients aged one day to 81 years. In
82 cases, the ECM was used for cardiac or great vessel repair: pulmo-
nary arterioplasty in 34, intracardiac tissue repair in 16, pulmonary
monocusp valve creation in 10, ascending aortoplasty in five, aortic
arch augmentation in five, right ventricular outflow tract patch in
five, superior vena cava patch in four and valve leaflet augmentation
in four patients. In 27 cases, the ECM patch was used for pericardial
closure. Follow up was complete.
Results:
There were no deaths, and at a mean follow up of 7.1
months (1.1–15.4), there was no evidence of ECM-related intra-
cardiac or intravascular thrombosis. Two patients had pericardial
effusions due to bleeding from the anastomosis. Six patients who
underwent pulmonary arterioplasty had some element of re-stenosis
but later had successful balloon dilatation in the catheterisation labo-
ratory. Eight of the 10 monocusp valves were competent and none
were stenotic.
Conclusions:
Repair of congenital and acquired heart defects using
CorMatrix ECM is feasible and safe. We particularly like this product
due to the way it curves and conforms to the native tissue. It is also
amenable to balloon angioplasty. These early results are encouraging
but longer follow up is needed to evaluate the ability to grow and to
determine the full potential of this material.
1299: CARDIAC OUTPUT MONITORING USING FEMORAL
ARTERIALTHERMODILUTION DURING LEVOSIMENDAN
INFUSION IN A NEWBORNWITH MYOCARDITIS
Anna Deho
1
, Alessandro Simonini
2
, Lara Petrucci
2
, Sara Frontalini
2
,
Alessia Franceschi
2
, Franco Lerzo
2
, Elena Ribera
2
1
Necker-Enfants Malades Hospital, France
2
Gaslini Children Hospital, Italy
Background
: The pulse-induced continuous cardiac output (PiCCO)
system is a method of continuous measurement of cardiac output
by thermodilution in the femoral artery and analysis of the pulse
contour curve. Levosimendan (Levo) is a calcium sensitiser that
exerts inotropic action by binding to cardiac troponin C and increas-
ing the sensitivity of the contractile apparatus to calcium. There are
few reports on the use of Levo in children with myocarditis and no
data exist on cardiac monitoring using PiCCO during Levo infusion.
We analysed haemodynamic variations with PiCCO during Levo
administration in a newborn with myocarditis.
Methods and Results
: A 10-day-old term baby with acute myocardi-
tis and severe cardiac dysfunction (FS 15%, FE 25%) received a Levo
loading dose of 12
μ
g/kg over 10 minutes, followed by an infusion
of 0.2
μ
g/kg/min for 24 hours. The femoral artery was catheterised
using a 3-Fr PiCCO arterial thermodilution catheter, and a femoral
central venous line was inserted. A total of 10 haemodynamic meas-
urements before and during Levo infusion was performed using a
3-ml bolus of cold normal saline injected rapidly through the central
venous catheter. Cardiac index (CI), cardiac function index (CFI),
stroke volume index (SVI), systemic vascular resistance (SVR), and
global ejection fraction (GEF) were recorded. Indicators of blood
volume were also measured. Mixed venous saturation (SvO
2
), NIRS
and serial measurements of troponin I and pro-BNP were obtained.
Conclusions
: To our knowledge, this is the first report of continuous
haemodynamic monitoring with PiCCO during Levo administration.
Levo significantly improved cardiac output. No side effects second-
ary to PiCCO were observed.
1300: DEFIBRILLATOR SURGERY IN PATIENTS WITH
CONGENITAL HEART DISEASE
Theodor Tirilomis, Dieter Zenker, Martin Friedrich, Wolfgang
Ruschewski
University of Goettingen, Goettingen, Germany
Introduction:
Congenital heart diseases (CHD) may develop signifi-
cant arrhythmias resulting in implantation of a cardioverter-defibril-
lator device (ICD). In this study, we analysed the procedures and the
indications for ICD surgery.
Methods:
In a 12-month period (January to December 2010) ICD
surgery was performed in 28 patients with CHD, 15 were male and
13 were female. The age ranged from three to 50 years.
Results:
Twenty patients (71%) had undergone surgery for the
underlying CHD. A new ICD device was implanted in 15 patients
(54%); one-chamber device in seven patients, two-chamber device
in five, and three-chamber device in three. A previously implanted
device was changed in four patients (one-chamber device:
n
=
3,
two-chamber device:
n
=
1). In three patients the complete (two-
chamber) device including electrodes had been exchanged (in two
cases with a staged approach). An upgrade of an implanted pace-
maker was performed in four patients (one-chamber device:
n
=
1 or
two-chamber device:
n
=
3). Finally, the previously implanted ICD
was upgraded in two patients (from one- and two-chamber devices to
three-chamber device, respectively).
Conclusion:
Surgery for ICD in patients with CHD is challenging
and increasingly complex. Therefore careful follow up is mandatory.
1304: HAEMODYNAMIC EFFECTS OF WEANING FROM
POSITIVE-PRESSURE VENTILATION IN PRETERM
NEWBORNS
Davide Buzzi, Giulia Tuo, Margherita Serafino, Maria Derchi,
Maurizio Marasini
Cardiology Unit, G Gaslini Institute, Genova, Italy
Background:
To study haemodynamic and echocardiographic
changes during weaning from synchronised conventional ventilation
(sCV) to nasal continuous positive airway pressure (nCPAP) (T1)
and from nCPAP to spontaneous breathing (T2) in uncomplicated
preterm newborns.
Methods:
We conducted a prospective study on preterm infants with
gestational age (GE)
≤
32 weeks. Each subject had an echocardio-
graphic evaluation (echo) respectively one hour before, and after T1
and T2, for assessing left and right ventricular output (LVO and RVO),
superior vena cava (SVC) diameter and flow, left ventricular end-
diastolic diameter and shortening fraction (SF). Cardiorespiratory
vital parameters and emogas analysis were also collected just before
each echo was performed. Patients with haemodynamically relevant
PDA and/or needing pharmacological closure were excluded.
Results:
We identified 16 patients (mean GE 27.6
±
1.9 week). We
observed a significant increase of RVO, superior vena cava flow and
SVC diameter, both at T1 and T2. There were no significant varia-
tions of ductal morphology and flow patterns or significant associa-
tion between different ventilatory support and both LVO and SF. No
significant variations were found in cardiorespiratory parameters and
emogas analysis.
Conclusion:
T2 was associated with significant increase in pulmo-
nary output and superior vena cava flow, as previously reported. We
found that weaning from sCV produced significant haemodynamic
effects as well, influencing the same echo parameters. All studied
variations were clinically well tolerated with no changes in cardi-
orespiratory parameters and systemic perfusion. Further studies are
planned to show haemodynamic changes and any clinical deteriora-
tion, at both T1 and T2, in more ‘complicated’ preterm newborns (i.e.
large PFO or PDA, reduced left ventricular function).
1316: DOSE INTERVENTIONAL CLOSURE OF ISOLATED
ATRIAL SEPTAL DEFECT WITH SEVERE PULMONARY
HYPERTENSION IMPROVES THE LONG-TERM CLINICAL
OUTCOME IN ADULT PATIENTS
Ling-Yi Wei, Chung-I Chang, Kang-Hong Hsu, Shu-Chien Huang,
Yih-Shang Chen, Ing-Sh Chiu, Jou-Kou Wang, Mei-Hwan Wu
1
National Taiwan University Hospital, Taipei, Taiwan
