CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
99
Case report:
A 16-year-old pregnant woman (37 weeks’ gestation)
was referred for foetal echocardiography evaluation which demon-
strated a large pericardial effusion with partial right atrium collapse
and a great number of myocardial well-delimitated masses distrib-
uted in the right and left ventricle walls and left atrium posterior
wall without outflow obstruction. Magnetic resonance images were
performed to study the heart tumours distribution and screening to
search for extracardiac anomalies confirming the tuberous sclerosis
complex diagnosis. Restrictive pericardial effusion was postnatally
observed and pericardiocentesis was performed. A new effusion was
observed; the newborn evolved a severe sepsis and died on the 7
th
day of life. Unfortunately neither an autopsy nor a cytological study
of the pericardium effusion was performed. The teenage mother was
referred for paediatric ambulatory attendance because she also had
tuberous sclerosis diagnosis.
Discussion:
Supportive evidence was obtained for the theoretical
rhabdomyomas diagnosis in this case. Foetal echocardiography can
provide an accurate diagnosis and the necessary follow-up consider-
ing the disorder morbidity. Serious complications can occur such
as cardiac arrhythmia, flow obstruction with low cardiac output,
hydrops foetalis, and sudden death. Knowledge of the outcome of
affected foetuses and the association of tuberous sclerosis complex
with cardiac rhabdomyoma is necessary for adequate prenatal coun-
selling and planning of prenatal or postnatal treatment.
1804: REFERRAL PATTERNS FOR FOETAL ECHOCARDI-
OGRAPHY AND IMPACT OF PRENATAL DIAGNOSIS OF
CONGENITAL HEART DISEASE AT A TERTIARY CARE
CENTRE IN GREECE
Maria Kiaffas
1
, Cleo Laskari
1
, Ariadne Malamitsi-Puchner
2
,
Athanasios Gouliamos
3
, Eystathios Iliodromitis
4
, Spyridon Rammos
1
1
Pediatric Cardiology Department, Onassis Cardiac Surgery Center,
Greece
2
Neonatology, Aretaieio General Hospital, Athens, Greece
3
Radiology, Aretaieio General Hospital, Athens, Greece
4
Attikon General Hospital, Athens, Greece
Objective:
The aim of this study is to follow the patterns of refer-
ral for foetal echocardiograms (FE) and the impact of the prenatal
diagnosis of congenital heart disease (CHD) at a tertiary paediatric
cardiology/cardiac surgery care centre in Greece.
Methods:
This is a retrospective study; all FE performed from 2005
to 2011 at our centre were reviewed. The main indication for the
study, and the positive diagnoses of CHD were documented and
analysed.
Results:
A total of
4 694 FE studies were performed between 2005
and 2011 in 4 120 patients at our centre. The gestational age (GA) at
which the examination was performed ranged from 16 to 37 weeks.
There was gradual rise of the annual number of studies with the rate
of detection of significant CHD being almost constant. There was
a gradual increase in the number of patients being referred because
of findings during the first trimester foetal scan – increased nuchal
translucency, tricuspid regurgitation, flow reversal at the ductus veno-
sus. Referral rate for suspicion of CHD at the anomaly scan, positive
family history of CHD, arrhythmias, maternal diabetes and treatment
with medications, as well as suspicion of chromosomal anomalies,
remained important factors for cardiac evaluation of the foetus by a
specialist. A total of 392 cases of significant CHD were diagnosed
and 145 terminations of pregnancy occurred.
Conclusions:
This is a large series of FE in a small country’s rather
homogeneous population in regard to racial, cultural and religious
aspects. Our study suggests that first trimester findings in the foetus
have influenced the referral patterns for FE over the last few years
compared to known pre-existing indications, and that the GA for
initial cardiac evaluation by a specialist is gradually decreasing.
Termination of pregnancy is also the preferred option for significant
CHD in our country, despite availability of appropriate postnatal
interventional or surgical treatment.
1805: MATERNAL DRUG LEVELS AND RESPONSE TIME
TO MATERNAL ANTIARRHYTHMIC TREATMENT IN
FOETAL TACHYARRHYTHMIA
Orhan Uzun, Kadir Babaoglu, Yusuf I Ayha, Katie L Hardingham
1
,
Anju Sinha, Bryan Beattie
Cardiff, UK
Background:
Foetal tachycardia is an emergency and requires rapid
evaluation of foetal rhythm and prompt initiation of antiarrhythmic
medication. Foetal mortality is unacceptably high even in treated
cases. Foetal response time and maternal antiarrhythmic drug levels
may play an important role in unfavourable outcomes.
Methods:
We undertook a 10-year review of foetuses presenting
with tachyarrhythmia to a tertiary institution. Flecainide and digoxin
combination was preferred treatment. Maternal antiarrhythmic levels
and foetal response time to tachycardia resolution have been evaluated.
Results:
There were 44 patients, and 37 foetuses were given
flecainide and digoxin combination treatment. The sinus rhythm
was restored in a mean of 4.85 days (range 1–14 days) in foetuses
with supraventricular tachycardia (96%). The foetal response time in
atrial flutter was slightly longer with a mean of 10 days (range 1–18
days) but all hydropic foetuses had complete resolution of ascites,
pleural, and pericardial effusions with rate control. Resolution of
hydrops took as long as 2 weeks after normalisation or reduction of
foetal heart rate below 160 bpm. There was no correlation between
maternal drug levels and maternal electrocardiographic parameters
or foetal response time to tachycardia.
Conclusion:
Combination treatment is well tolerated by pregnant
women, and there was no major side-effect requiring withdrawal of
antiarrhythmic medication. The 2-drug combination was effective in
improving foetal haemodynamics in most cases but foetal response
time showed no significant correlation with maternal drug levels.
1824: TRANSCATHETER OCCLUSION OF LARGE
CONGENITAL CORONARY CAMERAL FISTULAE USING
THE AMPLATZER VASCULAR PLUG II
Farirai Fani Takawira, Greenwood Sinyangwe
Steve Biko Academic Hospital, and University of Pretoria, Pretoria,
South Africa
Background:
A coronary cameral fistula is a rare connection between
a coronary artery and a cardiac chamber or vein. Most of these fistu-
lae have a congenital origin; though they can be acquired. Congenital
coronary cameral fistulae (CCCF) are rare abnormalities. Their
management has ranged from cardiac surgery to transcatheter occlu-
sion using multiple coils, bags, glue, and more recently the Amplatzer
devices. The most recently developed Amplatzer Vascular Plug II
(AVPII), for peripheral vascular occlusions has only been used for the
occlusion of coronary cameral fistulae in few published case reports.
Case 1:
A 28-year-old woman presented with a history of decreased
effort tolerance and episodes of chest pain on exertion. On examina-
tion she was in NYHA (cardiac failure) class II. Her pulse was 75
beats/min and was collapsing in nature. All pulses were palpable. Her
blood pressure (BP) was 120/50 mmHg. A 2/6 continuous murmur
was audible in the left lower sternal border. Echocardiography demon-
strated a large right CCCF draining into the right ventricle. At cardiac
catheterisation under general anaesthesia, a 14 mm AVPII was select-
ed and deployed into the distal portion of the fistula with successful
occlusion of the CCCF. She remains well 2 years after the procedure.
Case 2:
An 8-year-old boy presented with an incidental murmur
found during evaluation for an upper respiratory tract infection
(URTI). He had no cardiac symptoms. On examination he had a
pulse of 80/min and bounding pulses. His BP was 110/45 mmHg
with a wide pulse pressure. Echocardiography demonstrated a large
left CCCF draining into the left ventricle (LV). During cardiac cath-
eterisation the fistula was successfully embolised using the AVPII.
Results:
Both patients had successful transcatheter occlusion of
the CCCF. They have remained well more than 18 months since the
procedures.No complications were encountered.
