CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
241
diogram and a follow-up echocardiogram after device closure or
valvuloplasty. Percutaneous cardiac interventions were done by a
paediatric cardiologist with a minimum of five years’ experience.
A dedicated paediatric anesthetist was responsible for the general
anesthesia/deep sedation throughout the procedure. The patients were
admitted in a specialised post-catheterisation care unit for 24 to 48
hours post procedure. All demographic data as well as periprocedural
hospital period including the procedural outcome and any complica-
tions were recorded and analysed.
Results:
The study included 214 patients; 146 patients underwent
157 interventional procedures while the remaining 68 underwent
diagnostic catheterisation. The interventional procedures included,
ASD device closure (
n
=
50), PDA device closure (
n
=
42), valvu-
loplasty (
n
=
38), VSD device closure (
n
=
4) and coarctation stent
(
n
=
8). The mean age was 4.7
±
4.1 years; the youngest patient was
two months old while the oldest was 18 years old. The success rate of
the interventional procedures was 96.6% (
n
=
141) and the mortality
rate was 0%.
Conclusion:
Establishing a specialised paediatric cardiac catheteri-
sation centre in a remote area with results comparable to highly quali-
fied international centres is feasible with the help of experienced
local and international teams as long as continuous funding and
development plans can sustain such centres.
1447: THE USE OF IMPLANTABLE CARDIOVERTER DEFI-
BRILLATORS IN PAEDIATRIC PATIENTS
Ana Maria Rocha Pinto E Silva
1
, Valquiria P Campagnucci
1
, Wilson
L Pereira
1
, Alexey P Peroni
1
, Eduardo G Chamlian
1
, Sylvio MA
Gandra
2
, Argemiro Scatolini Neto
2
, Uelra R Lourenaso
8
, Barbara O
Eira
2
, Luis A Rivetti
1
1
Heart Surgery Unit, Faculty of Medical Sciences, Santa Casa de São
Paulo, Brazil
2
Arrhythmia Unit, Faculty of Medical Sciences, Santa Casa de São
Paulo, Brazil
Background:
The implantation of devices in children is always a
challenge. Implantable cardioverter defibrillator (ICD) therapy has
been indicated in 14 children from March 2003 to June 2012 at Santa
Casa de Sao Paulo Hospital. Ages ranged between eight and 16 years
old. The objective was to analyse all pathologies, techniques, medical
treatment and events related to these children.
Methods:
The following diagnoses were observed: long QT syndrome
(
n
=
2), hypertrophic cardiomyopathy (
n
=
3), Brugada syndrome (
n
=
1), LV non-compaction (
n
=
1), congenital heart disease – postop-
erative (
n
=
3), dilated cardiomyopathy (
n
=
1), catecholaminergic
ventricular tachycardia (
n
=
1), rhythmogenic right ventricular tachy-
cardia (
n
=
1) and idiopathic VT (
n
=
1). Syncope (
n
=
4), ventricular
tachycardia (
n
=
6), or recovery from sudden death (
n
=
4) was the
indication for ICD. In all cases an endovascular endocardial approach
for implanting ICDs was used. The prostheses were located below
the left pectoralis major muscle, in 12 patients and below the rectus
abdominis muscle in two patients. The defibrillation threshold was
distributed as follows: 15 J (
n
=
1), 20 J (
n
=
11), and 36 J (
n
=
2).
Results:
The children were followed from one month to nine years.
Each patient received pharmacological treatment for the arrhythmias
with specific drugs. Seven patients had no events. Inappropriate
shocks occurred in six patients. Three of them needed ablation due to
atrial tachycardia. One patient had appropriate shocks. Two patients
had lead dysfunction and needed replacement.
Conclusion:
Cardioverter defibrillator implantation was successfully
done by endovascular approach in our paediatric patients. The follow
up of this group has showed that ICDs are the solution for those
children with tachyarrhythmia whose medical treatment has failed.
1449: ANTENATAL DIAGNOSIS OF CONGENITAL HEART
DISEASE IN NOVA SCOTIA: A 20-YEAR RETROSPECTIVE
ON SURVIVAL AND SURGICAL OUTCOMES
Paul D’Alessandro
1
, Krista Jangaard
1,2
1
Dalhousie University, Halifax, Nova Scotia, Canada
2
IWK Health Centre, Halifax, Nova Scotia, Canada
Background:
Effective antenatal diagnosis of congenital heart
disease can improve outcomes and survival in certain conditions. Our
aims were to examine antenatal detection rates for hypoplastic left
heart syndrome (HLHS), transposition of the great arteries (TGA),
and tetralogy of Fallot (TOF) among live births at our tertiary care
centre, and measure outcomes in infants with antenatal diagnoses.
We hypothesised high, moderate, and low detection rates for HLHS,
TOF and TGA respectively.
Methods:
Charts for live births between July 1989 and December
2010 were identified from the Nova Scotia Atlee Perinatal Database
and reviewed retrospectively. Stillbirths and infants with extra-cardi-
ac abnormalities were excluded.
Results:
Of the 215 618 live births in Nova Scotia during this time,
23 infants were born with HLHS, 25 with TGA and 40 with TOF.
The rates of antenatal diagnosis of HLHS, TOF and TGA among live
births were 57.7, 60.0 and 68.9%, respectively. The number of HLHS
live births declined to zero by 2008. One-year survival for all infants
born with HLHS was zero, regardless of the timing of diagnosis. A
prenatal diagnosis of TOF was not associated with increased survival
or decreased morbidity rates. A prenatal diagnosis of TGA was associ-
ated with significantly shorter time to NICU admission (1.1 vs 29.5
hours,
p
<
0.03). There were no significant differences between mater-
nal or neonatal factors between cohorts. The commonest morbidities
at most recent follow up were ADHD and behavioural difficulties.
Conclusions:
The low incidence of antenatal HLHS diagnosis with
a decline in HLHS live births suggests an increase in terminations.
Incidence and benefit of antenatal diagnosis of TOF remains moder-
ate. Preliminary data suggest that antenatally diagnosed infants born
with TGA receive definitive management faster. Further review of
TGA outcomes is pending. The notable incidence of ADHD could
reflect latent hypoxic sequelae or chronic disease-related psychoso-
cial issues.
1451 DONOR–RECIPIENT SIZE MATCHING IN PAEDIAT-
RIC HEART TRANSPLANTATION: IS WEIGHT THE MOST
APPROPRIATE PARAMETER TO PREDICT OUTCOMES IN
ALL AGE GROUPS?
Ahmed Bayoumi, Hua Liu, Francis Fynn-Thompson
Department of Cardiac Surgery, Boston Children’s Hospital, USA
Background
: The aim was to retrospectively review our practice of
donor–recipient (D/R) size matching by weight criteria alone and
simultaneously reassess and compare post-transplant outcomes using
the additional variables of height and body surface area (BSA).
Methods
: We retrospectively reviewed the medical records of 211
patients who underwent orthotopic heart transplantation at Boston
Children’s Hospital over the past 20 years. The patients were divided
into the following age groups:
<
one year (
n
=
30), one to 12 years (
n
=
107) and
>
12 years (
n
=
74). Donor–recipient weight, height and
BSA ratios were determined for each age group at the date of trans-
plantation. Outliers were identified for each variable and analysed
separately. We compared the average and median of continuous
outcomes such as length of stay, need for open chest, post-transplant
filling pressures and survival.
Results
: In our cohort the median D/R weight ratio was 1.276 (0.2–
5.0), BSA ratio was 1.172 (0.2–2.0) and height ratio1.061 (0.3–2.0).
There was no difference in post-transplant survival when comparing
outcomes by weight, BSA or height ratios. Increased D/R size ratio
was associated with significantly increased likelihood of delayed
chest closure, ICU and total hospital length of stay at all ages. The
odds ratio was highest for the youngest age group with disproportion-
ate number of outliers (33.3%) but this effect was less significant
when D/R matching was done by BSA. The younger patients were
more likely to receive size-mismatched hearts than older recipients.
Conclusions
: The current practice of using weight for donor–recipi-
ent size matching in paediatric heart transplantation does not seem
