CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
162
AFRICA
pressure (SBP) was used to calculate LV end-systolic pressure
(LVESP). LV end-systolic volume (LVESV) and stroke volume (SV)
were calculated using standard M-mode dimensions and indexed for
BSA. E
AI
(LVESP/SV
I
) and E
LVI
(LVESP/LVESV
I
) were calculated.
HE was calculated from carotid pulse applanation tonometry tracings
and Doppler flows.
Results:
Age, BSA and SBP were similar between groups. E
AI
was
lower in CoA vs TOF patients (
p
=
0.027). E
LVI
was higher in CoA vs
TGA patients (
p
=
0.048). E
AI
:E
LVI
was lower in CoA vs Marfan (
I
<
0.001), TOF (
p
=
0.001) and TGA patients (
p
=
0.005). There was no
correlation between HE and E
AI
, E
LVI
or E
AI
:E
LVI
.
Conclusion:
V-VC appears to be optimal in CoA and less so in
Marfan, TOF and TGA patients. These groups may have to work
at suboptimal V-VC to maintain HE and this may contribute to the
ventricular dysfunction seen in these groups.
395: LEAD REMOVAL IN YOUNG PATIENTS WITH A
CONGENITAL HEART DISEASE IN VIEW OF LIFELONG
PACING
Peter Zartner, Nicole Toussaint Goetz, Martin Schneider
Cardiology, German Paediatric Heart Centre, Sankt Augustin,
Germany
Aims:
In children and young patients with or without a congenital
heart disease, transvenous leads for pacemakers or implantable cardio-
verter defibrillators can cause later vascular obstruction or infection.
Removal of non-functional leads is controversial as it bears the risk
of vascular disrupture and embolisations. Early lead removal in our
clinic was evaluated retrospectively.
Methods:
Over the last six years in 22 patients with a mean age of
12.9 years (range: 3.6–29.5 years) removal of 30 transvenous leads
(mean lead age: 5.1 years) was attempted. The main indications for
removal were vascular obstruction, increased threshold, and lead
dislocation. Commercially available retraction tools were used, if
necessary. Twenty-seven leads (90%) were retrieved with clinical
success, of which 23 (77%) were removed with complete procedural
success. In three leads the lead tips were retained, while three leads
could not be retrieved. No major complications occurred. Additional
interventions such as recanalisation, balloon dilation, or stent implan-
tation were performed as indicated. Procedure and X-ray times could
be correlated to the implant age of the leads.
Conclusion:
Using only mechanical techniques (no electro or
laser sheaths), transvenous lead removal could be performed with
a clinical success rate of 90%. In the case of vessel obstructions,
lead replacement should be performed early, as the older the lead,
the more prolonged and more hazardous the extraction procedure
becomes. The use of new leads and precautionary implantation tech-
niques may facilitate later lead removal.
396: TELEMONITORINGIN CHILDRENWITHA CONGENI-
TAL HEART DISEASE AND ELECTRONIC DEVICES
Peter Zartner, Rolf Kallenberg, Nicole Toussaint Goetz, Martin
Schneider
Cardiology, German Paediatric Heart Centre, Sankt Augustin,
Germany
Aim:
In children and young adults self-perception and self-respon-
sibility is not fully developed. An automated cardiac monitoring
system can assist to early diagnose clinical problems or to anticipate
device failure in the seriously affected patients with congenital heart
diseases (CHD).
Population:
Out of 200 patients, 65 received a pacemaker (PM) or
defibrillator (ICD) with the home monitoring (HM) option. Patients’
age at implantation ranged from five weeks to 37.6 years (median
12.4 years). The individual follow-up time from the daily monitoring
data was seven days to 7.3 years (mean 2.1 years).
Results:
The evaluation period summarises up to 80 patient years
with successful transmission on 72% of the days; 17% of all
messages were categorised as ‘emergency’ with the need to imme-
diately react to the incoming data. Consequences were system or
lead revisions, electro-physiological studies, reprogramming of
parameters, modifications in medication and sport, or to further
observe. Transmitted intracardiac electrograms (IEGM) reflect the
proper function of the system as well as the actual cardiac electric
performance. In 14 patients with an ICD, tachycardia with the need to
treat was found in seven patients. Five patients had 19 episodes with
anti-tachycardic pacing (ATP).
Conclusion:
The day-to-day transmission of data routinely and
continuously monitored in every PM or ICD markedly improves
safety and reliability of electronic device therapy in young patients.
High transfer rates increase the probability of early event detection
and offer the chance for early intervention. Despite some impact
on our clinical workload and legal aspects regarding liability and
organisation of procedural steps, this system improves therapy in our
most critical patients.
398: NORWOOD PROCEDURE: A SUCCESS STORY FOR
THE CHILD OR THE SURGEON, AND FOR HOW LONG?
Ayman Almasri, Hesham Menshawy, Nasreldeen Almeeri, Ahmed
Dohain, Olga Ristovic, Adel Mustafa, Mohamed Metwally, Abdulla
Alsanae
Chest Disease Hospital, Kuwait
Introduction:
The Norwood procedure is a series of three open-heart
surgeries that gradually improve certain life-threatening forms of
congenital heart disease. The first successful use of the procedure
was reported by Norwood and colleagues in 1981. It is used most
often to treat hypoplastic left heart syndrome, but variations of the
procedure may also be used to treat other congenital heart diseases in
which one or both of the lower chambers of the heart (ventricles) are
defective. Each of the three surgeries is done at a different age, begin-
ning from infancy and spanning through the toddler years. The first
two surgeries (stage I and stage II) are used to temporarily relieve
blood flow problems to and from the lungs. The third surgery (stage
III) is used to further improve circulation. The Norwood procedure
cannot cure the underlying heart defects.
Methods:
This was a
retrospective review of our unit’s experience
with more than 20 patients who underwent the Norwood proce-
dure between 1 January 2010 and 30 June 2012. We also reviewed
significant numbers of cases done abroad but regular follow ups
done locally.
Results:
Although the results of the modified Norwood procedure
as palliation for the hypoplastic left heart syndrome have improved
considerably, in-hospital mortality remains high (up to 46%) while
one-year survival is only 1%.
Conclusion:
Our study and supporting data from the literature have
shown that the Norwood procedure, despite being life saving for
infants less than week old with HLHS, has failed to give strong
evidence of long-term survival. The poor surgical outcome also has
social implications, which may necessitate a religious input as to the
validity of such a procedure in light of the overall results.
399: THE IMPACT OF CONGENITAL HEART DISEASE ON
OUTCOMES OF INFANTS WITH OESOPHAGEAL ATRESIA
Francesca Pluchinotta
1,4
, Offir Ben-Ishay
1,2
, Samuel Schecter
3
, Wayne
Tworetzky
1
, Terry Buchmiller
1,2
, Hanmin Lee
3
, Anita Moon-Grady
3
1
Boston Children’s Hospital, Boston, USA
2
Boston Children Hospital and Harvard Medical School, Boston,
USA
3
University of California, San Francisco, USA
4
University of Padova, Italy
Background:
The presence of associated congenital anomalies in
children with oesophageal atresia (EA) with or without tracheo-
oesophageal fistula (TEF) is well described, but few studies have
examined the impact of congenital heart disease (CHD) on the
