High pre-operative lactate levels have been associated with neuro-developmental delay in patients. Our objective is to determine whether pre-natal diagnosis has early neuro-developmental benefit in patients with complex congenital cardiac disease.

ment for differences in baseline and operative characteristics, administration of the current formulation of PPC brand heparin was associated with the highest likelihood of receiving FFP (A OR 1.00; B OR 1.73, p 0.04; C OR 1.94, p 0.01; D OR 1.01, p 0.98) and PLT (A OR 1.00; B OR 1.88, p 0.03; C OR 2.44, p 0.001; D OR 1.26, p 0.42). CONCLUSION: In patients undergoing cardiac surgery, PPC brand heparin resulted in increased heparin dosing, peri-operative bleeding and peri-operative blood product transfusion in patients undergoing cardiac surgery. The results of this study suggest that an alternative to PPC brand heparin be used when placing patients on cardiopulmonary bypass.

Clinical pediatric cardiology practice in Manitoba has observed a non-aboriginal/Caucasian predisposition in the presentation of dextro-Transposition of the Great Arteries (D-TGA). In contrast to D-TGA, native Manitoba aboriginals were observed to have a predisposition to Total Anomalous Pulmonary Venous Return (TAPVR). We sought to determine if a unique distribution of congenital heart disease exist in Manitoba. Retrospective review of all pediatric patients diagnosed with any form of D-TGA and TAPVR from 1991-2010 in Manitoba was undertaken. Epidemiological parameters were collected. Ethnicity was collected on a self-identification basis: aboriginal (First Nation/Metis/Inuit) versus non-aboriginal. Birth rates were collected from statistics Canada. Odds ratio calculations using 5-year moving rates were used to compare groups. Ninety-three percent (93/100) of D-TGA patients were non-aboriginal with a incidence of 1 in 2866 live births compared to 1 in 7620 for Aboriginals (Odds Ratio 2.3, 95% CI 1.12-4.74, p=0.024). In TAPVR 59 % (29/57) of patients were aboriginal with an incidence of 1 in 1838 live births, compared to 1 in 10253 in non-aboriginals (Odds ratio 5.58, 95% CI 3.28-9.47), p < 0.0001). In isolated TAPVR, without any complex concomitant abnormalities or heterotaxia syndromes, the aboriginal odds ratio was 8.57 (95% CI 4.43-16.57, p<0.0001). Clinically and statistically, TAPVR was significantly more common in Manitoba aboriginals, compared to non-aboriginals. The occurrence of D-TGA was observed to be almost 2 times less likely in the Manitoban Aboriginal populace studied. This distinct pattern of congenital heart disease warrants future research to investigate the epidemiological factors and/or genetic etiology causing these observed ethnical differences.

Supra-valvular pulmonary stenosis (SVPS) is the most common complication after Arterial Switch Operation (ASO) for D-Transposition of the Great Arteries (D-TGA) in neonates. While the majority improve over time some require re-intervention to relieve symptomatic lesions. We hypothesize that early post-operative echocardiography will predict which patients are at higher risk of re-intervention for significant SVPS following ASO. Retrospective review of Manitoba newborns (n=63) who had ASO for D-TGA from 1991-2010. First post-operative- and most recent trans-thoracic echocardiograms (TTE) of all surviving patients (n=59) were reviewed for SVPS. Patients were categorized as needing re-intervention for SVPS ("re-intervention"-group) versus those who did not ("no re-intervention"-group). Univariate analysis using Fisher's Exact Test was used to analyze parameters summarized in table 1. Significant TTE parameters (gradients > 40mm Hg plus 2 or more levels of stenosis) were analyzed using the Kaplan-Meier method to calculate probability of freedom from re-intervention.Tabled 1 Mean follow-up period was 9.8 (SD+-6) years. First post-operative TTE demonstrating 2 or more levels of stenosis, stenosis gradients > 40mm Hg, both last mentioned parameters combined, as well as D-TGA plus VSD, were all significantly more prevalent in the "re-intervention"-group (see Table 1 below). For patients that had gradients >40 mm Hg and stenosis at 2 or more levels, the 5 year probability of freedom from re-intervention for SVPS was 40% compared to 100% for those without the two aforementioned parameters (Log Rank p=0.0001). SVPS with multiple levels of stenosis causing a gradient >40mmHg at initial TTE post-ASO, allows pediatric cardiologists to identify patients at higher risk of future re-intervention for supra-valvular pulmonary stenosis. These findings need to be validated in a larger cohort.

Post-cardiac surgery, patient care transitions from specialized care to primary caregivers at the time of discharge. Unfortunately family physicians (FP) have minimal exposure to patients that had undergone cardiac surgery. The extent of the FP's knowledge is tested in this survey study. A survey was constructed which included knowledge based questions (6) of common post-cardiac surgery issues, as well as 1 question testing FP awareness of new technology. The survey was completed by 96 FP and 12 cardiac surgery team members (control group). Answers to knowledge based questions were compared between groups for each question (Fisher's Exact test). Fifty-one percent (49/96) of FP had > 4 correct answers, and 23% (22/96) had >5 correct, compared to 100 % (12/12, p=0.0006) and 83% (10/12, p<0.0001) in the control group respectively. Univariate analysis indicated less than 5 years since qualifying as FP, as well as wanting to see patients as soon as possible after discharge, were the only variables significantly predicting >5 correct answers under FP. There was no significant difference in the number of correct answers between FP that self-reported being knowledgeable or comfortable, compared to those that didn't. Less than 12.5% of FP's (control group: 83%, p<0.0001) knew what a ventricular-assist device was. FP have limited exposure and knowledge pertaining to the care of post-cardiac surgery patients after cardiac surgery. More energy needs to be focused on improving transition of care from specialized cardiac surgery services to primary family physicians.