CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
70
AFRICA
may be useful in monitoring in maternal SSA/SSB disease.
Methods:
We recruited pregnant women with SSA and/or SSB anti-
bodies at gestational age (GA) 16–17 weeks from a large perinatal
cardiology practice. Mothers were instructed and then given hand-
held Doppler FHR monitors. Between 17 and 27 weeks, mothers
were instructed to listen for 1 minute twice daily and seek attention
immediately if there were ‘skipped beats’ or a ‘slow rate (
<
120
bpm). The mothers returned to clinic every other week until GA
27 weeks for a foetal echocardiogram to assess the mechanical PR
interval, endocardial fibroelastosis (EFE) and AV valve insufficiency.
At the conclusion of the monitoring period the mothers filled out a
questionnaire rating their experience. Newborns were evaluated by
12-lead ECG to confirm and verify conduction.
Results:
Between 2009 and 2012, 11 mothers with SSA (9) or SSA/
SSB (2) antibodies were given monitors at GA 16.5–18 weeks. Three
mothers had previously had a child with AV block. Foetal AV block
recurred in 2 of 3 foetal siblings. Each foetus had ‘skipped beats’
at GA 17.5 and 18 weeks, 12 hours after auscultation of normal
foetal heart tones. The mother of foetus #1 sought medical attention
24 hours later; the foetus had EFE and 3° AV block. The mother of
foetus #2 was seen within 4 hours; her foetus had intermittent 2°
AV block. Both mothers were given high-dose vitamin D, IVIG and
dexamethasone. Sinus rhythm was restored in foetus #2 and AV block
unchanged in foetus #1. No foetus with normal FHR Doppler moni-
toring (
n
=
9) had echocardiographic abnormalities; echo did alter
later management in foetuses #1 and #2. Ninety per cent of mothers
were reassured by the FHR monitor, would recommend it and use it
during subsequent pregnancies.
Conclusions:
This pilot study suggests that, using a simple FHR
monitor, mothers can prospectively detect the onset of SSA-mediated
conduction system abnormalities; this capability may make early
successful treatment feasible.
322: PERCUTANEOUS BALLOON ANGIOPLASTY FOR
SEVERE NATIVE AORTIC COARCTATION IN YOUNG
INFANTS UNDER 6 MONTHS
Fang Liu, Wu Lin, Lan He, Chunhua Qi, Haiyan Deng, Lifeng Zhang,
Guoying Huang
Heart Center, Children’s Hospital of Fudan University, Shanghai,
China
Purpose:
To assess the effects and the potential role of percutaneous
transcatheter balloon angioplasty as an alternative therapy to surgical
operation.
Methods:
Thirty patients aged 6 d to 6 m (body weight 2.5–6.1 kg)
with severe coarctation of the aorta (CoA) were admitted for balloon
angioplasty. All 30 patients had cardiac dysfunction, and 8 patients
had cardiac shock with severe metabolic acidosis. Ten patients
had isolated CoA, while the others had other associated cardiac
malformations. Cardiac catheterisation and aortic angiogram were
performed under general anaesthesia with intubation. Balloon size
was from 3 × 20 mm to 8 × 20 mm, and PTCA balloon was preferred
for its low profile and small sheath.
Results:
The femoral artery was successfully punctured in all patients
except for 1 with further carotid artery puncture. The pressure gradi-
ent (PG) across the coarctation was 13–76 (40
±
17.0) mmHg. The
narrowest diameter was 0.5–2.8 (1.7
±
0.6) mm. All patients had
successful dilatation with PG significantly decreased to 0–40 (14.7
±
11.7) mmHg, and the diameter significantly improved to 2.5–4.8
(3.7 + 0.9) mm. No intraoperative complications occurred. However,
in the 1 case with carotid arteries puncture, a giant aneurysm at
the puncture site needed surgical repair. During 6-month to 5-year
follow-up, it was shown that: (1) PG crossing coarctation measured
by echocardiography further decreased or remained stable in 28 cases
(the remaining 2 patients, whose PG gradually increased, needed a
second dilatation; no case needed further surgery because of CoA);
(2) aortic aneurysm formation occurred in 1 case, which disappeared
within 18 m; (3) tricuspid regurgitation and pulmonary hypertension
improved in all patients; and (4) all patients were asymptomatic.
Conclusions:
Percutaneous balloon angioplasty is relatively safe
and effective and should be considered a valid alternative to surgical
operation in view of its good effect, less trauma and low incidence
of complications.
356: PRENATAL FOETAL ECHOCARDIOGRAPHIC FIND-
INGS IN TOTAL ANOMALOUS PULMONARY VENOUS
RETURN IN A SERIES OF 25 PATIENTS
Suguna Ganesan, Michael Brook, Norman Silverman, Anita Moon-
Grady
University of California, San Francisco, USA
Background/hypothesis:
Prenatal diagnosis of total anomalous
pulmonary venous return (TAPVR) is crucial given the possibility
of clinically important obstruction to venous return which manifests
postnatally. Optimal perinatal management in these cases involves
timely identification and delivery at an appropriate centre. Antenatal
diagnosis has been considered a challenge. We aim to show that
consistent prenatal echocardiographic features exist in this condition.
Methods:
This was a retrospective cohort review of foetal echo-
cardiographic studies performed at the University of California,
San Francisco from 2001 to 2012. We systematically reviewed the
sonographic features that led to the diagnosis of TAPVR in each case.
Results:
Over the study period, 25 patients were diagnosed prena-
tally with TAPVR, at a mean gestational age of 24 weeks. Four were
isolated cases of abnormal pulmonary venous return, 21 had hetero-
taxy syndrome with additional cardiac abnormalities. Abnormal
connections were supracardiac in 18 cases, cardiac in 1 and infracar-
diac in 6. Identification of a venous confluence posterior to the left
atrium on axial images and presence of additional vertical venous
channels apart from the vena cavae on the 3-vessel view or sagittal
views were consistent diagnostic markers on 2D imaging. Cardiac
asymmetry was not consistently noted. The most consistent Doppler
finding was one of low-velocity mildly pulsatile mono- or bi-phasic
flow in individual pulmonary veins, seen in 24/25 (96%) of the
patients studied, irrespective of presence or absence of downstream
obstruction.
Conclusions:
The diagnosis of TAPVR can be suspected by a target-
ed approach with attention to important B-mode and spectral Doppler
clues. Diagnosis can be suspected from standard cardiac views used
in routine anomaly screening. The spectral Doppler waveform pattern
is extremely helpful in identifying patients with abnormal connec-
tions and in patients with isolated TAPVR may be the most useful
finding upon screening when gross 2D and colour Doppler appear-
ance is apparently normal.
358: LEFT HEART STRUCTURES IN FOETUSES WITH
CONGENITAL DIAPHRAGMATIC HERNIA AND THE
EFFECT OF FOETAL ENDOSCOPIC TRACHEAL OCCLU-
SION
Luciane Rocha
1
, Francesca Byrne
2
, Roberta Keller
2
, Doug Miniati
2
,
Michael Brook
2
, Norman Silverman
2
, Anita Moon-Grady
2
1
University Federal of Sao Paulo, Brazil
2
University of California, San Francisco
Background/hypothesis:
Small left heart structures have been
observed in foetuses with left-sided congenital diaphragmatic hernia
(CDH). Compression from herniated abdominal organs, and reduced
filling of the adjacent left ventricle, seem to be the main pathophysi-
ologic mechanisms. Fetoscopic tracheal occlusion (FETO) is a novel
procedure performed in mid-gestation which seems to promote lung
growth in foetuses with CDH, however, the cardiac effects of FETO
are poorly described. Our aim was to study the effects of FETO on
the heart and analyse the left cardiac structures size at birth.
Methods:
This is a retrospective case-control study. We performed
measurements of mitral, tricuspid, aortic and pulmonary valve and
pulmonary artery diameters, ventricular lengths, left ventricular
end-diastolic volume indexed (LVEDVi) to body surface area.
