CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
100
AFRICA
Conclusion:
We report successful occlusion of large CCCF using
the AVPII. The advent of the Amplatzer vascular plug for peripheral
vascular applications has added another tool in the interventionist’s
armamentarium for closing large coronary artery fistulae.
1835: SUBPULMONARY STENOSIS ASSESSED IN MID-
TRIMESTER FOETUSES WITH TETRALOGY OF FALLOT:
A NOVEL METHOD FOR PREDICTING POSTNATAL
PULMONARY VALVE Z-SCORE AND SURGICAL MANAGE-
MENT
Elena NKwon, Ira Parness, Shubhika Srivastava, James Nielsen,Miwa
Geiger
Mount Sinai Medical School, New York, USA
Background/hypothesis:
The severity of right ventricular outflow
tract obstruction impacts postnatal outcomes in tetralogy of Fallot
(TOF). There are no existing data relating sub pulmonary stenosis
(SPS) severity in the second trimester to postnatal TOF course.
We hypothesised that quantification of prenatal SPS in the second
trimester would identify infants with smaller pulmonary valves who
would require earlier surgery and/or undergo trans annular patch
(TAP) repairs.
Materials and methods:
We retrospectively identified foetuses with
TOF from 1998 to 2010 diagnosed at
≤
26 weeks gestation. Data
evaluated included prenatal and postnatal pulmonary valve z-scores
(PVZ). To quantify foetal SPS, we created a novel index, the SPS/
DAO ratio, measured as the ratio of the minimum infundibular
diameter to descending aorta diameter (DAO) at the level of the
diaphragm. Multiple linear regression was used to predict postnatal
PVZ from prenatally determined parameters, including SPS/DAO.
Foetal parameters were analysed by logistic regression for association
with postnatal outcomes: timing of surgery (
<
1 month) and type of
surgery (TAP)vs ‘valve-sparing’).
Results:
Twenty-three foetuses met inclusion criteria. Mean gesta-
tional age was 21.8
±
1.9 (16.6–25.4 weeks). There was excellent
correlation between predicted and measured PVZ-, r
=
0.82,
p
<
0.0001, using the derived equation:
-3.68 + 0.91*prenatal PVZ – 4.44*SPS
_____________________________
DAO – 3.19 (prenatal PVZ*SPS/DAO).
An SPS:DAO value of
<
0.5 had 100% sensitivity and 56 % speci-
ficity for repair
<
1 month and
<
0.47 had 100% sensitivity and 75%
specificity for TAP repair.
Conclusions:
Postnatal PVZ can be predicted using prenatal
PVZ with the SPS/DAO ratio in
<
26-week foetuses with TOF.
Quantification of SPS with the SPS/DAO ratio identifies patients
who may require early intervention and/or TAP repair, thereby
impacting prenatal counselling.
1252: RADIOFREQUENCY PERFORATION IN THE TREAT-
MENT OF PULMONARY ATRESIA - INTACT VENTRICU-
LAR SEPTUM: CHALLENGES FACED IN THE CATH LAB
OF DEVELOPING COUNTRIES
Sonia El Saiedi, Amal El Sisi, Wael Lotfy, Wael Attia, Osama Abd
El Aziz
Cairo University Children’s Hospital, Cairo, Egypt
Background
: Pulmonary atresia with intact ventricular septum
(PA-IVS) is an infrequent disorder with significant morphological
heterogeneity. The use of percutaneous radiofrequency (RF)-assisted
perforation of the atretic valve and subsequent balloon dilation
provides an easy but expensive overall procedure that is expected to
establish ante-grade flow successfully through the pulmonary valve
in most of patients.
Methods:
Twenty patients presenting with PA-IVS presenting to
Cairo University Children Hospital (CUCH) were taken for RF
perforation using Baylis RFP-100 generator with trials for cost limi-
tations. Cost limitation methods to minimise expenses included the
following: we stopped using the Protrack microcatheter and replaced
this in most cases with the ‘wire tracks a wire’ technique; we also
replaced the use of the micro-snare from the arterial end to mark
the pulmonary valve by looping a coronary wire; telescopic Luma
catheter was replaced by using Mullin long sheath 5 or 6F through
which the 4F catheter is passed; fixing the wire and trying to limit the
number of balloons used, replacing the Tyshak Mini balloons which
were not always available with regular coronary balloons which are
readily available; if 4F sheath with special curve was unavailable we
mostly used 4F VER and reshaped it.
Results
: Successful opening of the atretic valve with cost limitation
was successful in 70% of cases. We resorted to a hybrid procedure
with the surgeon opening the chest and fixing the sheath in RV
directed towards the pulmonary valve in case of failed peripheral
vascular access.
Conclusion
: Cost limitation is essential in our developing countries
and innovative ideas to reduce cost are essential, especially if they
give the same rate of success.
