CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
67
(82–94%). Median Z-score for the left pulmonary artery increased
from -4.2 (-7.2 to -2.9) before stent implantation to -1.8 (-4.6 to -0.8)
at time of surgery. Median Z-score for the right pulmonary artery
increased from -3.1 (-6.2 to -2.1) to -0.5 (-2.1 to 0.2). There were no
complications. Nine patients have undergone successful repair. There
were no immediate or early deaths.
Conclusions:
In the symptomatic young infant with TOF in whom
surgery has been abandoned for any reason or patients at high risk,
stenting of the RVOT provides a safe and effective management
strategy, improving arterial oxygen saturation and encouraging
pulmonary artery growth.
113: TRANSCATHETER VSD CLOSURE: COMPARISON OF
DIFFERENT DEVICES AND METHODS IN SUCCESS RATE
Hojjat Mortezaeian Langeroudi, Yasaman Khalili, Akbar
Shahmohamadi, Mahmoud Meraji, MY Aarabi, Avisa Tabib, PN
Davari, M Vesal
Refugee Health Care University of Medical Sciences (TUMS),
Tehran, Iran
Background
: Ventricular septal defects (VSD) were previously
treated surgically. With the introduction of percutaneous VSD closure
with different devices, the management of PM VSD, muscular VSD
and residual VSDs has evolved. In our centre, Amplatzer and coil
devices have been implanted for selected PM VSD, muscular VSD
and residual post surgical VSDs since 2006.
Methods
: The charts of all VSD closures since 2006 were reviewed
retrospectively. Clinical, electrocardiographic, and echocardiograph-
ic data were analysed. The pre closure, immediate post closure, and
1-month, 6-month, and 12-month post closure results were assessed.
Results
: One hundred and seven patients (50 male 46.7%, 57 female
53.3%) with mean age 9.40
±
4.22 years (0–18 years) were evaluated
.The mean diameter was 4.69
±
1.79 mm (minimum 2 up to maximum
12 mm) and mean pulmonary artery pressure (PAP) patients was
17.98
±
6.86 mmHg (13–70 mmHg). The mean ratio QP:Qs 1.4
±
0.13 was calculated respectively (1.3–1.8). Nineteen patients (17.9%)
had LVH before the procedure. Twelve patients (11.2%), had trace,
5 patients (4.7%) mild and 11 patients (10.3%) had moderate aortic
regurgitation. Sixteen patients (15%), had trace, 22 patients (20.6%)
had mild and 7 patients (6.5%) had moderate tricuspid regurgitation.
The results showed successful closure in 104 cases; 3 cases failed.
Completely closed shunts were detected in 91.6% of patients (98
patients), while shunt remained in 5 patients (4.7%) and there was
a trace tricuspid regurgitation in 4 patients (3.7%). Onset for all
arrhythmias was within the first 24 hours of the procedure, and right
bundle branch block was the most common.
Conclusion
: Congenital VSD closure using transcathether devices
resulted in stable improvement in clinical status and decreased
interventricular shunting. Transcatheter device closure is an effective
management option for patients with complex muscular VSDs that
are difficult to approach surgically and for postoperative residual
VSDs. The selection of patients with VSD still remains a challenge
to avoid intervention complications such as complete heart block and
aortic insufficiency. The selection of suitable device size and shape
is most important for success rate.
115: OUTCOME AFTER PRENATAL DIAGNOSIS OF
CARDIAC MALFORMATIONS PREDICTED TO REQUIREA
UNIVENTRICULAR PATH AFTER BIRTH
Mats Mellander
1
, Oscar Svensson
1
,Annika Ãhman
2
, Katarina Hanseus
3
1
Sahlgrenska University Hospital, Gøteborg, Sweden
2
Uppsala University Hospital, Uppsala, Sweden
3
Skåne University Hospital, Lund, Sweden
Background:
Data on the prognosis for children with univentricular
(UV) hearts is mainly based on surgical follow-up. During prenatal
counselling however, knowledge of the outcome after foetal diagno-
sis is necessary.
Materials and methods:
This two-centre study analyses the outcome
in 105 consecutive foetuses predicted to certainly (
n
=
79) or prob-
ably (
n
=
26) require a UV path. Termination was an option at
<
22
weeks.
Results:
The most common diagnoses were hypoplastic left heart
syndrome (HLHS) + variants (37+7), unbalanced AVSD (17),
coarctation of the aorta (CoA) + left ventricular (LV) hypoplasia (9),
pulmonary atresia with intact ventricular septum (PA-IVS) (8), TA
(8), AS (6), double inlet left ventricle (DILV) (5). Eight had aneu-
ploidy, and another 9 extracardiac malformations. Eighty-eight had
isolated cardiac defects. Forty of 67 (60%) diagnosed at
<
22 weeks
chose termination. Five foetuses died: AVSD + heart-block, CoA +
diaphragmatic hernia, Ebstein + large TR, HLHS + trisomy 18, and
PA-IVS + large TR. Of 60 live births, 12 died unoperated: 5 were
inoperable, 4 preterm, 1 hydrops, 1 trisomy 18, 1 with extracardiac
malformations. Forty-eight were operated on; 40 stage I, 32 stage I
+ II, 20 stage I–III, 1 stage I–III + transplant and 8 with biventricu-
lar (BV) correction (1 certain and 7 probable prenatal prediction of
UV). Thirteen of the 48 operated on died (27%), 7 between stages
I and II, 1 after an HLHS-hybrid procedure, 2 after stage II, 1 from
malignancy after transplant and 2 after BV correction. Median age
at postoperative death was 3 months (0.2–40). Median follow-up in
survivors was 5.6 years (0.3–10). Diagnoses in survivors were HLHS
+ variants (15), TA (6), DILV (3), CoA (3), AVSD (2), PA-IVS (2),
VSD + hypoplastic RV (1), complex UV (2) and complex transposi-
tion of great arteries (TGA) (1). Survival rate was 33% (35/105)
after foetal diagnosis, 54% (35/65) in continuing pregnancies, 58%
(35/60) after live birth and 73% (35/48) after surgery. Survival to
surgery in continuing pregnancies was 74% (48/65).
Conclusions:
Seventy-four per cent of the foetuses in continuing
pregnancies survived to have surgery. Medium-term surgical survival
was 73%. If diagnosed before 22 weeks, 60% chose termination. This
is useful information in prenatal counselling.
144: CAN PRENATAL INTRACARDIAC ECHOGENIC FOCI
AFFECT POSTNATAL CARDIAC FUNCTION?
Rima Bader
King Abdul Aziz University Hospital, College of Medicine, Jeddah,
Saudi Arabia
Objective:
To determine whether prenatally diagnosed intracardiac
echogenic foci (ICEF) are associated with neonatal cardiac dysfunc-
tion and persistence.
Methods:
Foetuses with ICEF shown on prenatal sonography
(between January 2010 and December 2011) at 1 perinatal centre
underwent postnatal echocardiography at ages 1 month to 1 year. A
single perinatal cardiologist assessed cardiac function by measur-
ing the left ventricular shortening fraction (LVSF) and myocardial
performance index (MPI). The presence of tricuspid valve regurgita-
tion (TR) was sought.
Results:
Prenatally, 24 foetuses had ICEF, mean age at diagnosis was
25
±
3.1 weeks. Eighteen (75%) foetuses had left ventricular intra-
cardiac echogenic foci (LVIEF) and 6 (25%) had right ventricular
intracardiac echogenic foci (RVIEF). Postnatally, those infants, 14
(58%) males and 10 (42%) females were examined. at a mean age of
8.2
±
4.1 months. Prenatally, all infants had normal LVSF. The overall
mean left ventricular MPI (reference value, 0.36
±
0.06), was normal
for both infants with LVIEF (0.34
±
0.06) and RVIEF (0.33
±
0.04).
Trace TR was noted in 12 (50%) of the infants. LVIEF persisted in 14
infants (77%), whereas RVIF persisted in 2 infants (33%).
Conclusions:
Prenatally diagnosed ICEF can be persistent but is not
associated with myocardial dysfunction in the first year of life.
150: OVAL FOSSA DEFECTS: MORPHOLOGICVARIATIONS
AND IMPACT ON TRANS-CATHETER CLOSURE
Joseph Vettukattil
1
, Zaheer Ahmed
1
, Anthony Salmon
1
, Timothy
Mohun
2
, Robert Anderson
3
1
University Hospital, Southampton, UK
