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Funding Acknowledgements Type of funding sources: None. Background. In patients with transposition of great arteries (TGA) post atrial switch operation or with congenitally corrected TGA (ccTGA), the morphologically right ventricle (RV) has to adapt to the chronically increased systemic pressure. Purpose. To investigate the functional adaptation of the systemic RV in patients with TGA post Mustard repair or ccTGA.  Methods. RV volumes and EF were measured by 3D echocardiography in 33 patients with the systemic RV (21 TGA and 12 ccTGA; 45 ± 13y, 61% male), and in 33 healthy volunteers (44 ± 13y, 61% male).  The 3D RV model was postprocessed by the ReVISION software and its contraction was decomposed along the longitudinal, radial and anteroposterior directions (Fig.A, Systemic RV in TGA) providing longitudinal, radial and anteroposterior EF (LEF, REF and AEF). Relative contribution of each component was measured as the ratio between LEF, REF and AEF to the global RVEF (LEFi, REFi and AEFi). Results. Systemic RV was significantly larger with reduced function compared to controls (Tab). 3D RVEF demonstrated stronger correlation with BNP (Rho -0.76, p < 0.0001) compared to other parameters of RV function (free wall strain 0.55, p = 0.0083; FAC -0.47, p = 0.024; S’ -0.39 and TAPSE 0.06, p > 0.05). While in healthy volunteers, all 3 components of RV systolic function contributed equally to the global RV EF, in patients with TGA the relative contribution of the anteroposterior component was dominant and differed significantly from longitudinal and radial components (AEFi 0.48 ± 0.06 vs LEFi 0.31 ± 0.07 vs REFi 0.36 ± 0.09, p < 0.0001)(Fig. B,C). In patients with ccTGA the longitudinal component was dominant and provided a relative compensation for the reduced anteroposterior and radial components (LEFi 0.47 ± 0.07 vs AEFi 0.34 ± 0.07, p = 0.0002 and vs REFi 0.36 ± 0.09, p = 0.0023)(Fig. B,C). Relative contribution of the radial contraction was significantly reduced in all systemic RV patients. Conclusions. Systemic RV contraction patterns change significantly with anteroposterior contraction being dominant in patients with TGA post Mustard repair and longitudinal component being dominant in ccTGA. 3DE should be a part of routine assessment of the systemic RV, especially in TGA since no conventional echo parameters take into account anteroposterior RV contraction. Parameters of RV systolic function Parameter Control group (N = 33) All SRV patients (N = 33) TGA (N = 21) ccTGA (N = 12) 3D EF, % 60 ± 3.8 36 ± 8.6* 34 ± 7.3* 38 ± 10* FAC, % 41.4 ± 3.7 25.9 ± 9.3* 25.1 ± 9.2* 27.1 ± 9.9* TAPSE, mm 24.6 ± 4.2 11.9 ± 3.9* 11.1 ± 2.9* 13.2 ± 5.1* RV free wall strain, % -32.5 ± 4.2 -14.5 ± 3.5* -14.5 ± 2.9* -15.5 ± 3.5* * p < 0.0001 Abstract Figure.

BackgroundPatients with cancer are at high risk of infections and subsequent complications. Due to the high prevalence of multidrug resistant pathogens in ventilator associated pneumonia (VAP) in those patients, most studies and guidelines exclude this population in their analysis. In the present study, we sought to investigate the clinical and laboratory presentation, as well as prognosis of cancer patients diagnosed with VAP in a large tertiary care center in Brazil.MethodsWe included all cancer patients admitted to the intensive care unit who were diagnosed with culture positive VAP matching the CDC diagnostic criteria from 2013 to 2016. We collected a detailed clinical, laboratory and microbiological profile of those individuals. Additionally, all patients were followed for 30-day all-cause mortality.ResultsA total of 25 individuals (mean age 58 ± 14 years, 88% males) were included. Among them, 88% presented with solid tumors and 12% with hematologic cancers. The median length of stay at the hospital prior to VAP diagnosis was 30 days (interquartile range (IQR): 13 - 39), with a median duration of ICU admission of 16 days (IQR: 8 – 23) and a median mechanical ventilation duration of 12 days (IQR: 8 – 16). The most common causative agents for VAP were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa with seven cases (28%) each, followed by Staphylococcus aureus and Stenotrophomonas maltophilia with two cases (8%) each. From the 21 gram-negative bacteria 20 (90%) were carbapenem-resistant, 5 (24%) were colistin- resistant, while all S. aureus were MRSA. The 30-day mortality rate was 84% (21/25 individuals). The mortality was high across the spectrum of clinical and laboratory presentations, and none of the clinical predictors evaluated, including age, gender, diabetes, smoking, radiotherapy, chemotherapy, post-surgery, reintubation, dialysis, or antibiotic susceptibility, was associated with lower mortality.ConclusionVentilator associated Pneumonia in cancer patients has an extremely high 30-day mortality (88%), with a low in vitro susceptibility for broad spectrum antibiotics, such as carbapenems. No clinical predictors are independently associated with lower mortality.Disclosures All authors: No reported disclosures.

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