Cardiovascular Journal of Africa: Vol 24 No 1 (February 2013) - page 58

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013 56 AFRICA
being performed in 1/70 (1%) in the initial years of 1983–1989,
9/70 (13%) in 1990–1999 and 23/70 (33%) in the recent 2000–2008
period.
Results: All patients underwent an initial procedure at a median of
six days (4–12) consisting of PA banding (four), PA band and arch
repair (31), Damus and shunt (33) and other (two). A total of 26
patients died before Fontan completion. Three survivors were denied
Fontan completion, and two are still awaiting discussion. Thirteen
of the 35 patients who had initial banding later required a Damus
and only three required outflow tract obstruction relief. Thirty-nine
patients underwent Fontan completion at a median of five years
(2–6). There was no hospital mortality, and after a mean follow up
of 5 ± 6 years there was one death and no further adverse outcomes.
Overall survival at 10 years was 60% (95% CI: 45–70).
Conclusion: Patients born with single-ventricle physiology and arch
obstruction have a high risk of mortality in the first two years of
life. Their outcomes seem excellent once they reach Fontan status.
It is likely that in patients with single-ventricle and arch obstruc-
tion, strategies to avoid systemic outflow tract obstruction should be
implemented early in life.
1493: DOES LIMITED RIGHT VENTRICULOTOMY
PREVENT RIGHT VENTRICULAR DILATATION AND
DYSFUNCTION IN PATIENTS WHO UNDERGO TRANSAN-
NULAR REPAIR OF TETRALOGY OF FALLOT? ANALY-
SES OF MAGNETIC RESONANCE IMAGING DATA IN 113
PATIENTS
Cheul Lee, Chang-Ha Lee, Jae Gun Kwak, Seong-Ho Kim, Woo-Sup
Shim, Sang Yun Lee, Jae Suk Baek, So-Ick Jang, Yang Min Kim
Cardiovascular Centre, Sejong General Hospital, Bucheon, Republic
of Korea
Background: In the hope of decreasing long-term complications of
conventional transannular repair with a large right ventriculotomy
(RV-tomy) in patients with tetralogy of Fallot (TOF), a transatrial
and transpulmonary approach with limited (< 1 cm) transannular
RV-tomy has been adopted by many centres. However, long-term
benefits of this technique have not been demonstrated.
Methods: Between June 2002 and April 2012, 113 patients (mean
age of 18.5 ± 6.6 years) with transannular repair of TOF underwent
magnetic resonance imaging (MRI) for evaluation of pulmonary
regurgitation (PR). Patients were divided into limited RV-tomy group
(n = 39) and conventional RV-tomy group (n = 74). We compared the
MRI parameters of the two groups to test the hypothesis that limited
RV-tomy in the setting of transannular TOF repair would result in
less right ventricular (RV) dilatation and dysfunction compared with
conventional RV-tomy.
Results: The interval between TOF repair and MRI examination was
shorter in the limited RV-tomy group (limited: 12.7 ± 3.8 years vs
conventional: 17.2 ± 4.7 years, p < 0.001). There was no difference
in PR fraction between groups (43 ± 10 vs 45 ± 9%, p = 0.270).
Indexed RV volumes were similar between groups (RV end-diastolic
volume index: 149 ± 31 vs 152 ± 42 ml/m2, p = 0.704, RV end-
systolic volume index: 70 ± 24 vs 77 ± 38 ml/m2, p = 0.313). There
was no difference in RV ejection fraction between groups (54 ± 9 vs
51 ± 9%, p = 0.160).
Conclusions: We could not demonstrate long-term benefits of limit-
ed RV-tomy compared with conventional RV-tomy in patients who
underwent transannular TOF repair, at least in terms of RV size and
function. Further studies are necessary to define the role of limited
RV-tomy in patients who undergo transannular TOF repair.
1525: DEEP SEDATION VERSUS GENERAL ANAESTHESIA
IN CHILDREN UNDERGOING PERCUTANEOUS CARDIAC
INTERVENTION IN THE CATHETER LABORATORY
Ayman Tharwat1,3, Alaa Roushdy2,3, Sherein Abd el salam 3, Maiy El
sayed2,3, Magdi Yacoub 4,3
1Anaesthesia Department, Ain shams University, Cairo, Egypt
2Cardiology Department, Ain shams University, Cairo, Egypt
3Aswan Heart Centre, Magdi Yacoub Heart Foundation, Egypt
4Cariothoracic Surgery, Harefield Heart Science Centre, London, UK
Background: Paediatric patients require sedation/anaesthesia more
often than adults during both diagnostic and therapeutic procedures.
Moreover the paediatric population represents the highest risk,
lowest error-tolerance subgroup. The safety and efficacy of deep
sedation versus general anaesthesia in children undergoing percuta-
neous cardiac intervention in the catheterisation laboratory is rarely
discussed in the literature.
Methods: All patients under 18 years of age who were referred for
elective percutaneous cardiac intervention during a period of six
months were included in the study. The patients were divided into
two subgroups; group 1, who were subjected to deep sedation using
ketamine infusion and group 2 who completed the procedure under
general anaesthesia. Different numerical and categorical data were
collected using a custom-made sheet, and anaesthesia-related compli-
cations were analysed and compared between the two subgroups.
Results: Anaesthesia-related complications occurred in 14.1% of
the study group, all were self limiting and none was life threaten-
ing. The commonest complications were delayed recovery (n = 2)
and post-procedural vomiting (n = 2). There was no significant
difference between the two subgroups regarding age, body weight,
height, body surface area, procedure duration, anaesthesia duration
and recovery time. There was also no significant difference between
the two subgroups as regards the occurrence of anaesthesia-related
complications (p = 0.551)
Conclusion: Both deep sedation and GA were as safe and effective
as each other in establishing adequate sedation/anaesthesia in chil-
dren with congenital cardiac malformations undergoing percutane-
ous cardiac intervention in the catheterisation laboratory.
1526: OUTCOMES OF INTRA-ATRIAL BAFFLING FOR
PARTIAL ANOMALOUS PULMONARY VENOUS CONNEC-
TION
Han Ki Park1, Hyungyoon Choi1, Jung-Hwan Kim1, Young-Hwan
Park1, Su-Jin Park2 , Nam Kyun Kim2, Jae Young Choi2
1 Gangnam Severance Cardiovascular Hospital, South Korea
2Yonsei University College of Medicine, South Korea
Background: Intra-atrial baffling for partial anomalous pulmonary
venous connection (PAPVC) has been performed with excellent
outcomes. However, there is the risk of superior vena cava (SVC) or
pulmonary venous obstruction, as well as sinus node dysfunction. We
studied the long-term results for this procedure.
Methods: From January 1992 to July 2012, 18 patients underwent
intra-atrial baffling for anomalous right-side pulmonary vein drain-
ing to SVC. The median age was 10 years (45 days to 66 years). Two
patients had bilateral PAPVC and the left-side anomalous pulmonary
vein drain was repaired simultaneously. Two patients had intact atrial
septum and the remaining 16 patients had atrial septal defect. The
PAPVC was baffled to the left atrium through ASD using single-
patch in 11 patients (61.1%) and two-patch in seven patients (38.9%).
The duration of mean follow up was 47.4 months (1.0 months – 15.8
years) and two patients were lost to follow up. Medical records and
echocardiographic data were retrospectively reviewed.
Results: There was no early or late mortality. Transient sinus node
dysfunction occurred in three (16.7%) patients, but all patients were
in normal sinus rhythm at the last follow up. SVC stenosis and throm-
bosis was noted in one patient who required stent insertion. Right
superior pulmonary venous stenosis and thrombosis, and subsequent
pulmonary infarction developed in a patient. In the other patients,
there was no evidence of pulmonary vein or SVC stenosis.
Conclusions: Intra-atrial baffling of right-side PAPVC draining SVC
does not affect the sinus node function. However, there is a risk of
pulmonary vein or SVC stenosis. Thereore other surgical options
should be considered for patients requiring long tunnel for intra-atrial
baffling.