CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
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AFRICA
CATHETER INTERVENTIONS FROM FOETUS TO ADULT
enced in one case. On echocardiography, right ventricle pressure was
reduced to normal by 3 months in all cases except two.
Conclusion
: Tubular PDA associated with severe PHT could be
successfully closed by ductal occluders. After occlusion, pulmonary
pressure had definite reduction and results in our centre are encour-
aging.
39: IMPACT OF FENESTRATION CREATION ON MANAG-
ING PATIENTS WITH PROTEIN-LOSING ENTEROPATHY
COMPLICATING FONTAN PROCEDURE
Mashail Binobaidan, Jasim Abdulhameed
Prince Sultan Cardiac Center, Armed Force Hospital, Riyadh, Saudi
Arabia
Introduction:
Protein-losing enteropathy (PLE) is a well-known
complication following the Fontan procedure and one way of manag-
ing such complication is to create fenestration if it is not present, or
enlarging it if it is small, to reduce the Fontan pressure and reduce
venous congestion which results in intestinal protein loss.
Aim:
To evaluate the effect of such a procedure in our population.
Method
: From February 2006 through October 2011, 9 patients who
underwent fenestration creation due to development of PLE were
assessed with regard to clinical, laboratory result and haemodynamic
effect prior to and post procedure.
Result:
Median age was 7 years (range 4–21), median weight 23 kg
(15–52), and male: female ratio was 3.5:1 (7 male and 2 female).
Median saturation pre and post procedure was 93% and 82% respec-
tively, median albumin pre and post procedure was 18 g/dl and 31 g/
dl during the first 2 wks and 36 g/dl thereafter, and median pulmo-
nary artery pressure before and after was 25 mmHg (17–32 mmHg)
and 16 mmHg (14–19 mmHg). Transpulmonary pressure gradient
reduced from a median of 11 mmHg to 5 mmHg. There were no
immediate deaths; 2 patients needed redilatation, and there were 2
(22%) late deaths (1 had stent thrombosis 1 month after the proce-
dure, followed by fulminant pulmonary embolism, though all patients
were on anticoagulant; 1 with sudden arrest could not be resuscitated
at the emergency unit). Three (33%) patients have persistent low
albumin though the fenestration is patent.
Conclusion:
Transcatheter fenestration creation as a management of
PLE following Fontan procedure is a feasible procedure, can be done
in the catheter laboratory with little morbidity and mortality and with
beneficial effect; however, late complications and complete resolving
of PLE is of concern, especially if procedure is done late.
40: RIGHT VENTRICULAR OUTFLOW TRACT STENTING
IN THE SYMPTOMATIC INFANT WITH TETRALOGY OF
FALLOT
Mashail Binobaidan, Jassim Abdulhameed
Prince Sultan Cardiac Center-Armed Force Hospital, Riyadh, Saudi
Arabia
Background:
Debate continues regarding the initial management
of cyanotic or duct-dependent infants with tetralogy of Fallot (TOF)
especially those patients with pulmonary artery hypoplasia. While
repair can and has been performed in these patients, it is associated
with increased morbidity.
Objective:
We review the effectiveness of right ventricular outflow
tract (RVOT) stenting in the symptomatic young infant with TOF.
Methods:
Clinical, echocardiographic, angiographic and haemody-
namic data were reviewed for 13 patients who underwent 17 RVOT
stenting procedures from March 2008 to Januay 2012.
Results:
There were 8 girls and 5 boys; median age was 3 months
and weight 3.5 kg . The pulmonary valve was hypoplastic in all
patients. Median pulmonary valve diameter was 3.1 mm (range
2.7–5.2), Z-score -5.5 (range -8.9 to -4.4) RVOT stenting improved
arterial oxygen saturation from a median of 60% (55–66%) to 91%
1054: RHYTHM AND CONDUCTION ABNORMALITIES
AFTER TRANSCATHETER CLOSURE OF VSDs: A SINGLE-
CENTRE EXPERIENCE
Sevcan Erdem, Nazan Ozbarlas, Abdi Bozkurt, Alev Kiziltas, Osman
Kucukosmanoglu
Faculty of Medicine, Cukurova University, Adana, Turkey
Background:
We describe our experience focusing on the acute and
mid-term disturbances of conduction and arrhythmias after transcath-
eter ventricular septal defect (VSD) closure and review their therapy
and follow-up.
Material and methods:
The medical records of consecutive 45
patients undergoing transcatheter closure of VSD were retrospec-
tively assessed fromAugust 2007 to July 2012. All electrocardiogram
(ECG) and 24-hour ECG-Holter monitoring records were analysed
for disturbances of conduction and arrhythmias.
Results:
Patients’ ages at implantation range between 15 months
and 58 years (mean 10.8 years, median 8 years). Mean body weight
was 30.2 kg (range 8.7–78 kg, median 24.5 kg). The diameters of
VSDs were between 3.5 and 8.5 mm measured by echocardiog-
raphy (mean 5.6 mm). All defects were occluded with Amplatzer
devices. Amplatzer perimembranous VSD occluders were used for
14 patients (mean size of device 6.4 mm, range 4–9 mm), muscular
VSD occluder for 26 patients (mean size of device 6.9 mm, range
4–10 mm) and duct occluder for 5 patients (3 of them 6/4, and 2 of
them 8/6). Mean device diameter to defect diameter ratio was 1.2 +
0.13 (range 1–1.4). The mean duration of follow-up was 25.7 + 14.2
months (range 1–49 months). Two of the 29 patients with perimem-
branous VSDs developed cAVB within 2 and 6 days of the closure.
Insignificant rhythm disturbances developed in 26.7% (12/45) of the
patients after transcatheter closure of VSDs.
Conclusion:
With early and late occurrence of cAVB, careful
monitoring of rhythm and atrioventricular conduction is essential
during the follow-up period. However, Holter monitoring should
be performed before the procedure to understand the insignificant
rhythm disturbances which were related to the procedure.
23: DEVICE CLOSURE OF LARGE TUBULAR PATENT
DUCTUS ARTERIOSUS WITH SEVERE PULMONARY
HYPERTENSION: ANALYSIS OF FORTY-SEVEN CASES
Nurun Nahar Fatema Begum
Combined Military Hospital, Dhaka, Bangladesh
Objective
: Large patent ductus arteriosus (PDA) can cause severe
pulmonary hypertension (PHT) as a result of increased blood flow
or increased pulmonary vascular resistance (PVR). Surgical ligations
of these large tortuous hypertensive ducts are very difficult. Device
closure is an alternative option and here we report 47 such cases of
device closure in our centre.
Patients and methods
: A total of 47 patients (29 male) had large
tubular PDA with severe PHT from January 2009 to December 2010.
A retrospective review of data was done from the records kept in the
department.
Results
: The median age of the patients was 4.5 years (2 months to
45 years); median weight was 9.7 kg (3.5–60 kg). Narrowest PDA
diameter varied from 3.4 to 14 mm (median 4.8 mm). Pulmonary to
systemic blood flow ranged from 1.1:1 to 6.7:1. PVR ranged from
4.2 to 8.1 Wood units. Pulmonary arterial pressure ranged from 60/45
(50) to 120/84 (97) mmHg. Systemic blood pressure ranged from
65/40 (48) to 120/88 (99) mmHg. With 100% oxygen, pulmonary
arterial pressure was reduced in 26 cases and remained the same in
9. In 12 cases the device was implanted without this test. Minimum
PDA device size was 5/4 mmADO 11 and maximum device size was
18 mm Amplatzer septal occluder. Forty-three patients had complete
occlusion and 4 had residual shunt. Three patients had complete
occlusion within the first month. One patient developed haemolysis
and was managed with coil implantation. Embolisation was experi-
