CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
69
2 from extracardiac lesions. Of the current survivors, 100% of ASP
have undergone cardiac surgery compared to 53% of PSP. Starting
with foetal Dx, 64/93 (69%) of PSP are still alive, 57% with biven-
tricular circulation. Of the ASP, 17/61 (28%) are still alive, only 5%
biventricular.
Conclusion:
After foetal Dx, there were significant perinatal survival
differences between ASP and PSP. ASP had higher rates of TOP and
postnatal mortality. The majority of PSP were biventricular compared
to few ASP. CHB was a risk factor for foetal demise. Neonatal deaths
were cardiac related in both groups whereas late deaths were due to
extracardiac causes in PSP and to pulmonary vein stenosis in ASP.
249: VENTRICULAR SEPTAL DEFECT CLOSURE WITH A
NEW PLATINUM-COATED NITINOL DEVICE
Pornthep Lertsapcharoen
1
, Suphot Srimahachota
1
, Phingphol
Charoonrut
2
, Kanyalak Vithessondhi
1
1
Chulalongkorn University, Bangkok, Thailand
2
Mahidol University, Bangkok, Thailand
Background
: Three types of new platinum-coated nitinol VSD
(COCOON
TM
) devices were designed: perimembranous, aneurys-
mal perimembranous and muscular VSD devices, according to the
morphology of ventricular septal defect (VSD). This study reports
the animal trial and early clinical results.
Materials and methods
: In the animal trial, VSD was created in 12
pigs by retrograde aortic approach for ventricular septal puncture
with Brokenborough needle and followed by balloon dilation of the
septum. The clinical trial included 16 VSD patients; age ranged from
2 to 56 years, weight from 10 to 72 kg. There were 8 perimembra-
nous, 5 aneurysmal, 2 muscular and 1 post myocardial infarction
VSDs.
Results
: In the animal study, the device was successfully deployed to
close the created VSD in the 12 pigs. Imaging studies demonstrated
complete VSD closure in 11 animals. The autopsy findings demon-
strated minimal and complete neo-endothelialisation over the device
at 1 week and 8 weeks after implantation, respectively. In the clinical
trial, the device was successfully deployed in 14 patients. Two unsuc-
cessful cases underwent surgical closure. Two of the 14 successfully
deployed cases developed haemolysis after the procedure; one due to
residual VSD leakage and another due to undiagnosed aortic regur-
gitation with the regurgitant flow hitting the device. Both of them
had surgical device removal and VSD closure. During the echocar-
diographic follow-up period (1 to 6 months), 3 cases still had slight
leakage. There was no device-related complication.
Conclusion
: The new nanoplatinum-coated nitinol VSD devices had
a good outcome in animal trials. They also had attractive results in
the early clinical trial.
287: OUTCOME OF TRANSCATHETER DEVICE CLOSURE
OF PERIMEMBRANOUS VENTRICULAR SEPTAL DEFECT
Fang Liu, Wu Lin, Feng Sheng, Lan He, Chunhua Qi, Haiyan Deng,
Lifeng Zhang
Heart Center, Children’s Hospital of Fudan University, Shanghai,
China
Purpose:
To evaluate the safety and efficacy of transcatheter closure
for perimembranous ventricular septal defect (PmVSD).
Methods:
From September 2002 to June 2011, 155 PmVSD patients
were admitted for percutaneous device closure (age 26 months to
21 years, weight 11–67 kg. Among these 155 patients, 12 patients
were post surgery residual VSD, 1 patient was associated with Down
syndrome. All patients had transthoracic echocardiography(TTE),
ECG and 24h Holter pre- and post occlusion, and were asked to
attend follow-up at 1 m, 3 m, 6 m, 12 m, and then once every year
for 5 years, and then every 3 years. ECG and TTE were performed at
every follow-up, and 24h Holter was performed only when necessary.
Results:
Devices were deployed successfully in 151 patients (97.5%).
The VSD size measured by left ventricle angiogram was 2.0–8.46mm
on right ventricle side with multiple shunt in most patients with aneu-
rism, and Qp/Qs was 1.4–2.18. The device used included 4 types with
the difference in the shape of the left disc and the height of device,
and the size of the device was 4–12mm. All patients were followed up
until June 2012, with the follow-up duration 12–82m. During follow-
up, 15 immediate adverse events (9.9%) were reported, including
2 complete atrioventricular block (AVB), 5 CRBBB, 3 CLBBB, 1
premature ventricular contraction, and 4 moderate TR. Almost all
recovered, except 3 CRBB and 2 moderate TR were still present with
normal heart chamber and function. There was also 1 late complete
AVB at 3-month follow-up. To date no patient has required perma-
nent pacemaker implantation or surgery.
Conclusions
: Transcatheter PmVSD closure can be performed safely
and successfully with low morbidity and mortality. Medium- to long-
term prognostic results are favourable; however, late complications
especially high-degree AVB should be additionally considered by all
interventional cardiologists.
301: OUTCOME AND FEASIBILITY OF TRANSCATHETER
ATRIAL SEPTAL DEFECT OCCLUSION UNDER TRAN-
STHORACIC ECHOCARDIOGRAPHY GUIDANCE IN
LIMITED RESOURCES CENTRE: INITIAL REPORT
Rahmat Budi Kuswiyanto, Sri Endah Rahayuningsih
Sadikin Hospital, Faculty of Medicine Padjadjaran University,
Bandung, Indonesia
Background
: Transcatheter atrial septal defect (ASD) occlusion has
become the established treatment of secundum ASD under transoe-
sophagal echocardiography (TOE) guidance in many centres; never-
theless TOE may not be available in several areas.
Aim:
To evaluate the outcome and feasibility of transcatheter ASD
occlusion under transthoracic echocardiography (TTE) guidance in
our institution
Methods
: TTE was performed to assess the suitability of transcath-
eter occlusion. The occlusion procedures were performed under seda-
tion and local anaesthesia. Routine right heart catheterisation was
performed in all cases to assess the pulmonary vascular resistance.
Balloon sizing was done in case of inadequacy of the rims. Amplatzer
septal occluder device was used for occlusion. TTE and angiogram
were done to assess the position of the device and the result of occlu-
sion. All patients were followed up periodically clinically, with ECG
and TTE at 24 hours and 1, 6 and 12 months after closure.
Results
: Of a total of 45 patients who underwent non-surgical cardiac
interventions from April 2011 to December 2011, there were 9 cases
of secundum ASD which were suitable for occlusion. The median
age, weight, and diameter of defect were 15 years (range 10–42
years), 32 kg (27–54 kg), and 24 mm (16–34 mm), respectively.
Seven patients achieved complete immediate closure, and two cases
failed as a result of deficit of inferior and floppy of posterior rim.
There were no complications during procedures and follow-up. All
patients were discharged the next day. Complete closure was seen on
further follow-up.
Conclusions
: Transcatheter ASD occlusion may be performed under
TTE guidance which showed effectiveness and safe therapy, but it has
limitations in assessing the inferior and floppy posterior rim. Further
evaluation of this method is mandatory.
317: HEART SOUNDS AT HOME: PROSPECTIVE MATER-
NAL SURVEILLANCE OF SSA POSITIVE PREGNANCIES
USING A HAND-HELD FOETAL HEART RATE MONITOR
Bettina Cuneo
1
, Farhan Hanif
2
, Carolyn Sullivan
1
, DWoodrow Benson
3
1
Advocate Hope Children’s Hospital, Chicago, IL, USA
2
Advocate Lutheran General Hospital, Chicago, IL, USA
3
Children’s Hospital of Wisconsin, Milwaukee, WI, USA
Background:
The purpose of this study was to test a simple hand-held
Doppler foetal heart rate (FHR) monitor in the ambulatory setting to
prospectively identify the onset of atrioventricular (AV) block. This
