CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
214
AFRICA
ture, for a total incidence of systemic venous anomalies
=
18.1%
(vs 4–14% in the literature), with the presence of PLSVC
=
13.5%
(vs 4–11%), IVC interruption
=
3.2% (vs 0.6–2%), and retro-aortic
innominate vein
=
1.9% (vs 0.2–1%).
Conclusions
: This study showed a higher incidence of systemic
venous anomalies in the Middle East population with congenital
heart defects than in the previous literature reports. In a substantial
percentage of patients (21.4%) the diagnosis was intra-operative.
Better pre-operative screening should be performed in all patients
with congenital heart defects to identify all systemic venous anoma-
lies for a more precise planning of the surgical approach.
1134: ECHOCARDIOGRAPHIC RIGHTVENTRICULAR-TO-
LEFT VENTRICULAR RATIO IN SYSTOLE CORRELATES
WITH CARDIAC MRI MEASUREMENTS IN CHILDREN
WITH PULMONARY HYPERTENSION
Pei-Ni Jone, Brian Fonseca, Dunbar D Ivy, Adel Younoszai
Paediatric Cardiology, Children’s Hospital Colorado, University of
Colorado, Colorado, USA
Background:
Pulmonary hypertension (PH) increases right ventricu-
lar (RV) pressure resulting in RV dilation and ventricular septal shift
towards the left ventricle (LV). A ratio of systolic RV/LV diameter
seeks to combine these effects into a single measure and has been
shown to correlate well with pulmonary vascular resistance in chil-
dren with PH. In this study we sought to validate the measure by
comparing this ratio to the identical ratio by cardiac MRI (CMR) as
well as CMR indices of biventricular volume and function.
Methods:
Seventeen children with PH, median age 12 years,
(4–23), had 18 echocardiograms and CMRs within 72 hours.
Echocardiographic data included: RV end-systolic diameter
(RVESD), LV end-systolic diameter (LVESD) (parasternal short
axis) and RV/LV ratio. CMR data included: RVESD, RV end-dias-
tolic volume, RV end-systolic volume, RV ejection fraction (RVEF),
LVESD, LV end-diastolic volume, LV end-systolic volume, LV ejec-
tion fraction (LVEF), and RV/LV ratio. Echocardiographic measures
were correlated with CMR.
Results:
Echocardiographic RV/LV ratio correlated significantly
with CMR RV/LV ratio. However, systolic RV/LV ratio does not
correlate with CMR indices of RV or LV size or systolic function.
Echocardiographic RVESD correlated significantly with CMR RV
volume and function. Although echocardiographic LVESD had a
negative correlation with CMR LVEF (
r
=
–0.62,
p
<
0.001), there
were no significant correlations between echocardiographic LVESD
and CMR LV volumes.
Conclusion:
There was good agreement between the systolic RV/LV
ratio obtained by echocardiography and CMR. Interestingly, echo-
cardiographic RVESD in isolation appears to be an easily obtainable
and accurate descriptor of RV size and function in children with PH.
1137: CLINICAL PERFORMANCE OF SMALL-CALIBRE
HIGH-VOLTAGE IMPLANTABLE CARDIOVERTER DEFI-
BRILLATION (ICD) LEADS IN CHILDREN AND YOUNG
ADULTS
Maully Shah, Karen Smoots, Akash Patel, Christopher Jansen
The Children’s Hopsital of Philadelphia, University of Pennsylvania,
USA
Recent reports have called attention to ICD lead-related adverse
events with small-calibre leads. This study sought to define the inci-
dence of lead-related adverse events of small-calibre ICD leads at a
single-site paediatric centre.
Methods:
Clinical and lead performance information was collected
retrospectively on patients
≤
30 years of age with small-calibre right
ventricular (RV) ICD lead implantation between 1995 and 2011.
Small-calibre ICD leads were defined as lead diameter
≤
7.6 French,
and standard ICD leads were of diameter
≥
8.6 French.
Results:
Out of 142 patients with RV ICD lead implantation, 37
(26%) had small-calibre ICD leads, and 85% of these were single-
chamber ICDs. The most frequent small-calibre ICD lead implanted
was Medtronic Sprint Fidelis 6931 (Medtronic, Minneapolis, MN) in
43% (
n
=
16), followed by Medtronic Sprint Fidelis 6949 in 24% (
n
=
9), Riata 1582 (St Jude Medical, St. Paul, MN) in 19% (
n
=
7), and
Riata ST 7002 in 14% (
n
=
5). In addition, 105 patients had standard-
calibre ICD leads. The mean age at ICD implantation was 15.8
±
5.7
years, with a mean follow-up time of 3.4
±
1.6 years. All implanta-
tions were associated with acceptable lead performance at initial
implant. Lead fractures occurred in 13 (35%) patients at an average
of 3.1
±
1.2 years after ICD implantation. Medtronic Sprint Fidelis
6931 and 6949 leads were most frequently affected (92% of all
conductor fractures). When compared to standard-sized leads (five
lead failures), small-calibre ICD leads had a significantly increased
complication rate: 35 vs 5% (
p
<
0.05).
Conclusion:
ICD lead-related complication rates were higher with
small-diameter ICD leads than standard-calibre ICD leads. The lead-
related adverse events were more frequent in the Sprint Fidelis leads
when compared to the Riata leads, emphasising that lead design in
addition to diameter size may play a significant role in lead perfor-
mance.
1139: CARDIOVASCULAR MAGNETIC RESONANCE IN
PATIENTS WITH REPAIRED TETRALOGY OF FALLOT:
THE GOAL STANDARD IN ASSESSMENT OF INJECTABLE
PULMONARY VALVE IMPLANTATION AND FOLLOW UP
Stefano Marianeschi
1
, Aurelio Secinaro
2
, Benedetta Leonardi
3
,
Giacomo Pongiglione
3
, Antonio Amodeo
4
, Simone Ghiselli
1
, Nicola
Uricchio
1
, Stefano Pedretti
5
, Giuseppe Annoni
6
, Alberto Roghi
7
1
Congenital Heart Surgery, Niguarda Hospital, Milan, Italy
2
Radiology Department, Bambino Gesù Hospital, Rome, Italy
3
Paediatric Cardiology Department, Bambino Gesù Hospital, Rome,
Italy
4
Paediatric Cardiac Surgery, Bambino Gesù Hospital, Rome, Italy
5
Cardiology Department, Niguarda Hospital, Milan, Italy
6
Paediatric Cardiology Department, Niguarda Hospital, Milan, Italy
7
Imaging Cardiology Department, Niguarda Hospital, Milan, Italy
Background:
Severe pulmonary regurgitation, progressive dilatation
and dysfunction of the right ventricle are the most frequent causes
of late morbidity post tetralogy of Fallot repair. Pulmonary valve
replacement is often indicated in these patients. Bio-integral inject-
able pulmonary valve (IPV) is an innovative and less invasive tech-
nique, often done off cardiopulmonary bypass (CPB). Cardiovascular
magnetic resonance (CMR) is fundamental to assess patient suitabil-
ity for IPV insertion and to control the follow up.
Methods:
From January 2006 to June 2012 we performed 10 pre-
operative CMRs. Of these, five patients also underwent a CMR three
months to six years post IPV insertion. We measured the diameters of
the right ventricular patch, pulmonary valve and pulmonary bifurca-
tion and the length of the pulmonary trunk.
Results:
Ten patients were implanted with an IPV. Three months to
six years post IPV insertion, CMR showed an improvement in the
right ventricle end-diastolic volume. The IPV was continent and
the mean transvalvular gradient was lower than that of a traditional
pulmonary valve prosthesis.
Conclusions:
CMR is a safe and effective method. It is necessary
before IPV insertion to exclude contraindications and to determine the
need for CPB. In the follow-up CMR, the pulmonary valve efficiency,
the transvalvular gradients and the right ventricular function must be
measured. IPV is also better detected by CMR than traditional pros-
thetic valves that present focal
artefacts
that can obscure small jets.
1143: DOUBLE-CHAMBERED RIGHT VENTRICLE. CLINI-
CAL AND ECHOCARDIOGRAPHIC CHARACTERISTICS
OF A SERIES OF 11 CASES
Emilia Josefina Patio Bahena, Nilda Espinola- Zavaleta, Mirna
Yabur, Maria Elena Soto, Juan Calderãn, Alfonso Buendia
Instituto Nacional de Cardiologica, Mexico
