CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
258
AFRICA
1664: A SINGLE INSTITUTIONAL EXPERIENCE OF USING
CARDIAC MAGNETIC RESONANCE AS THE PRIMARY
INTER-STAGE DIAGNOSTIC SCREEN, PRIOR TO SURGI-
CAL COMPLETION OF TOTAL CAVOPULMONARY
CONNECTION FOR PATIENTS WITH FUNCTIONALLY
SINGLE VENTRICLES
Henning Clausen
1
, Emma Stockton
1
, Michael Broadhead
1
, Oliver
Tann
1
, Vivek Muthurangu
1,2
, Troy Dominguez
1
, Andrew Taylor
1,2
,
Marina Hughes
1,2
1
Great Ormond Street Hospital for Children, London, UK
2
University College, London, UK
Background:
Cardiac magnetic resonance (CMR) is proposed as a
sensitive diagnostic tool to guide decision-making after bidirectional
cavopulmonary connection (BCPC) and prior to total cavopulmonary
connection (TCPC). Our unit has adopted a protocolled, CMR-based
screening method, performed under general anaesthetic with trans-
duced central venous pressure (CVP) measurement from the internal
jugular vein.
Methods
: We did a retrospective review of single-centre, medium-
term TCPC experience, in relation to pre-operative CMR data.
Non-parametric statistical methods were used. Results were expressed
as median (interquartile range).
Results:
The cohort included 192 local patients undergoing BCPC
since 2005. Of those, 86 had undergone TCPC at age 4.0 (3.3–4.6)
years; 47 (55%) had right ventricular dominance. Weight at surgery
was 15.1 (13.6–16.9) kg. Fifty-six (65%) were non-fenestrated at
the time of initial surgery.Seventy-six (88%) operated patients are
alive without heart transplantation, with duration of follow-up 2.2
(1.1–3.7) years. Interstage CMR was carried out in 55 (64%) of the
86 operated patients. The remaining patients required early investiga-
tion and intervention following BCPC, and underwent out-of-proto-
col CT scan or cardiac catheterisation. These patients experienced a
2.9-fold higher mortality; 6/31(19.4%) deaths occurred in this group,
compared with 4/61(6.6%) deaths in the CMR group. Of those under-
going CMR median CVP was 12 (11–14) mmHg. Patients with CVP
>
13 had a greater proportion of pulmonary venous return contrib-
uted by systemic to pulmonary collateral flow (median 32% vs 42%,
p
<
0.05). The CVP measured at CMR was not significantly related
to pulmonary artery stenosis/hypoplasia, and did not predict length
of hospital stay or mortality. However, mortality following TCPC was
strongly associated with prominent venous channels visible on MR
angiography, and off-loading superior vena cava (SVC) into inferior
vena cava (IVC) territory (
p
<
0.05).
Conclusions:
Interstage CMR prior to TCPC offers a comprehensive
assessment of morphology and physiology, can elicit risk factors of
postoperative outcome, and may identify confounding factors for
pulmonary artery pressure, such as SVC to IVC collateralisation.
1669: SPOT THE DIFFERENCE: CAN YOU TRANSFER 1.5 T
REFERENCE VALUES TO THE 3T ERA?
Marcus Fischer
1
, Hermann Kãrperich
2
, Deniz Kececioglu
1
, Kai
Thosten Laser
1
1
Center of Congenital Heart Disease, Heart and Diabetes Center North
Rhine-Westfalia, Ruhr-Universität of Bochum, Bad Oeynhausen,
Germany
2
Institute for Radiology, Nuclear Medicine and Molecular Imaging,
Heart and Diabetes Center, North Rhine-Westfalia, Ruhr-Universität
of Bochum, Bad Oeynhausen, Germany
Background:
Cardiac MRI is important in the treatment of children
with congenital heart disease. It is the reference standard for the
assessment of ventricular dimensions and function. Most published
reference values were obtained by 1.5 T MR scanner.
Methods:
Quantitative volumetric cardiac MR measurements were
performed on a 3T TX MRT (Philips ACHIEVA) and a 1.5T MRT
(Philips Intera) using a multi-slice multi-phase steady-state free
precision gradient-echo acquisition in breath hold (TR/TE/flip
=
2.9
ms/1,45 ms/40°; Matrix
=
1.4–1.5
×
1.5–0.7 mm²; 22–30 phases, 5
mm slice thickness). Patient sample included 17 healthy persons (7
male, 10 female, mean age 13.5
±
4.3 y; range 6–20). Calculated
stroke volume was controlled by flow derived stroke volumes using
phase-contrast MRI. Data were quantified by a single expert.
F-test and unpaired t-test were performed.
Results:
There were no significant differences for both left and right
ventricle.
Conclusion
: There is no relevant difference in ventricular size when
using a 1.5T or 3T scanner.
1672: SINGLE-CENTRE EXPERIENCE OF DEVICE
CLOSURE OF CONGENITAL VENTRICULAR SEPTAL
DEFECTS
Sivakumar Kothandam, Sreeja Pavithran, Anilkumar Singhi, Anpon
Bhagyavathy
MIOT Hospital, Chennai, India
Background:
Routine transcatheter closure of perimembranous
ventricular septal defects (VSD) is controversial because of atrioven-
ticular nodal conduction disturbances. Muscular and postoperative
VSD do not pose such risks, but are rare.
Methods:
In a retrospective review of 80 patients who underwent
VSD device closure, 59 had perimembranous VSD, 11 had muscular
defects, two had intraconal outlet VSD, one had subpulmonary VSD,
and five had residual defects after surgery. Indications for closure
were symptoms, pulmonary hypertension and cardiac enlargement.
Asymmetric devices were chosen in membranous VSD without
aortic margin, intraconal and subpulmonary VSD. Other devices
were used in membranous defects with septal aneurysm.
Results:
A total of 78 procedures were successful. Age ranged from
8 months to 50 years and body weight from 6 to 79 kg. Two patients
had echocardiographic guided perventricular closure; others had
closure in the catheterisation lab. Asymmetric VSD occluder was
used in 17 patients, symmetric VSD occluder in 2, muscular VSD
occluder in 2, atrial septal occluder in 1, standard duct occluder in 30
and Amplatzer duct occcluder II in 26 patients. With the exception of
hybrid closures and duct occluder II devices, all others needed forma-
tion of arteriovenous loop. Two perimembranous defects needed two
duct occluder II devices. One perimembranous VSD measuring 13
mm procedure failed and was closed in surgery. Another patient
with postoperative residual VSD refused repeat surgery. None had
complete atrioventricular nodal block or need for pacing. One post-
operative patient with aortic regurgitation and ventricular dysfunc-
tion had closure of residual large VSD with atrial septal occluder but
died of progressive heart failure after 2 years. All others are free of
any residual shunt at a mean follow-up of 2 years.
Conclusion:
Closure of VSD with devices in various locations is safe
and feasible. Atrioventricular nodal disturbances are not seen when
duct occluders are used.
1673: SURGICAL CORRECTION OF TOTAL ANOMALOUS
PULMONARY VEIN CONNECTION: A SINGLE-CENTRE
EXPERIENCE
Ruben Movsesian, Natalia Fedorova, Nikolai Antsygin, Aleksej
Shikhranov, Vladimir Bolsunovsky, Andrey Tsytko, Anatoly Kagan
Children’s City Hospital #1 St Petersburg, Russia
Background:
Total anomalous pulmonary venous connection
(TAPVC) is a rare cardiac anomaly often associated with other
cardiac malformations and with a poor prognosis without surgical
treatment. We present a 15-year single-centre experience in surgical
treatment of different types of TAPWC.
Methods:
Between January 1998 to May 2012, 58 patients under-
went TAPVC surgery at Children’s City Hospital #1 St Petersburg,
Russia. Data collection occurred retrospectively. Mean age at the
time of surgery was 7.2 days. TAPVC was supracardiac in 30 patients
(51.7%), intracardiac in 19 (32.8%), infracardiac in 4 (6.9%) and
mixed in 5 patients (8.6%). TAPVC obstruction was confirmed by
