CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
71
Comparisons were made between foetuses who underwent FETO
and matched controls with similar CDH disease severity and foetal
cardiac dimensions who did not undergo foetal intervention.
Results:
A total of 35 foetuses were studied, 9 with FETO and 26
controls. All had liver herniation and lung-head ratio
<
1 at foetal
evaluation (average gestational age (GA) 24 wks). At birth, prior to
CDH repair, the intervention group had: larger LVEDVi (16.8 ml/m
2
vs 12.76 ml/m
2
,
p
=
0.04), increased LV length z-score (-2.05 vs -4,
p
=
0.006), larger LV:RV length ratio (1.43 vs 1.04,
p
=
0.03), increased
LPA diameter z-score (1.71 vs -1.04,
p
=
0.021), better growth of
aortic valve (-1.66 foetal to -2.18 neonatal in FETO, -1.09 foetal to
-3.3 neonatal in controls,
p
<
0.005). A trend towards better growth
of mitral and tricuspid valves was observed.
Conclusions:
Left heart structures and LPA were larger postnatally
in foetuses with CDH who underwent FETO than in those who did
not. These data suggest that haemodynamic alterations are introduced
with foetal tracheal occlusion which are associated with alterations in
ventricular loading and may influence growth; further study of these
observations is necessary to determine overall significance.
365: RELATIONSHIP BETWEEN LEFT HEART HYPO-
PLASIAAND CONGENITAL DIAPHRAGMATIC HERNIA IN
HUMAN FOETUSES
Francesca Byrne, Roberta Keller, Jeffery Meadows, Doug Miniati,
Michael Brook, Norman Silverman, Anita Moon-Grady
University of California, San Francisco
Background:
Congenital diaphragmatic hernia (CDH) is associated
with small left ventricle (LV), mitral valve (MV) and aortic valve
(AV)
in utero
, but the pathophysiologic processes behind this obser-
vation and implications for prognosis are not well known.
Hypotheses:
We hypothesised that both left and right-sided CDH
severity would correlate with worsening left heart hypoplasia and
lower left cardiac output. We analysed factors leading to abnormal
foetal blood flow patterns that potentially contribute to left heart
hypoplasia: compression, altered ductus venosus and reduced pulmo-
nary blood flow.
Materials and methods:
Retrospective cohort of foetuses with
CDH, 2000-2010. Ultrasound-derived lung:head ratio (LHR), liver
position, and hernia side were recorded. CDH severity was catego-
rised as severe (LHR
≤
1.0 and liver herniated into thorax) or mild
(LHR
>
1.0 or no liver herniation). Cardiac dimensions and combined
ventricular output (CVO) were measured on echocardiogram at pres-
entation. Foetuses with anomalies other than CDH were excluded.
Results:
A total of 171 left CDH and 17 right CDH were included.
Foetuses with severe left CDH had smaller MV (z -2.24
±
1.3 vs
-1.33
±
1.08), AV(z -1.39
±
1.21 vs -0.51
±
1.05), and LV length
(z -1.66
±
1.28 vs -1.11
±
1.45) z-scores and had a lower mean LV
output as percentage of CVO (26%
±
10% vs 32%
±
10%) versus
those with mild CDH (all
p
<
0.01). Although LV outputs were simi-
lar in severe right vs severe left CDH, right CDH average dimensions
were larger (MV z -0.9
±
1.25, AV z -0.8
±
1.1, LV z -1.0
±
1.34).
Severe dextroposition and abnormal liver/ductus venosus position
were independently associated with smaller left heart structures,
while LHR and branch pulmonary artery measures were not.
Conclusions:
Severity of left heart hypoplasia correlates with severity
of CDH when the left diaphragm is affected, but not when the lesion
is right-sided. Results suggest that both compression by left CDH and
preload alterations from changes in ductus venosus flow are present
and may be responsible for poor ventricular growth in LCDH.
389: USE OF LOCALANAESTHETIC (0.25% BUPIVACAINE)
FOR PAIN CONTROL IN PAEDIATRIC CARDIAC CATH-
ETERISATION: A RANDOMISED CONTROLLED TRIAL
Jacqueline Viegas, Amy Palma, Lee Benson, Cedric Manlhiot, Brian
McCrindle
Labatt Family Heart Centre, The Hospital for Sick Children, Toronto,
Canada
Background:
In paediatric cardiac catheterisation procedures
performed under general anaesthesia, local anaesthetic is used
for some patients prior to femoral sheath removal. We found no
published reports of the impact of local anaesthetic on pain after
paediatric cardiac catheterisation, and mixed reports on its effective-
ness in adults. Our purpose was to investigate the effects of local
infiltration of 0.25% bupivacaine on self-report measures of pain
and analgesic use up to 6 hours post-procedure in paediatric patients
undergoing cardiac catheterisation procedures.
Hypothesis:
We hypothesised that administering 0.25% bupivacaine
around the femoral catheter insertion site in children under general
anaesthetic at the end of cardiac catheterisation procedures would
have no effect on pain scores and use of analgesics up to 6 hours
post-procedure.
Materials and methods:
A randomised controlled trial with 140
participants aged 7 to 18 years undergoing cardiac catheterisation
under general anaesthesia via femoral vein/artery is being conducted.
Participants were randomised to the intervention group receiving
usual care plus subcutaneous infiltration of 0.25% at the femoral site
just prior to sheath removal or to the control group who had femoral
sheaths removed under general anaesthetic but without subcutaneous
bupivacaine.
Results:
To date 133 of 140 participants have been recruited and
followed; the remaining 7 will be recruited by September 2012.
Blinded midpoint data analysis was conducted for data safety
monitoring purposes and found that recruitment should continue.
Full results will be available by October 2012. Primary outcomes
are patient-rated pain scores and use of analgesics post-operatively.
Procedural information, such as size and number of catheters used
and post-operative bleeding, will also be compared between groups.
Conclusion:
This study’s results will be the first to contribute to
an evidence base regarding the effectiveness of 0.25% bupivacaine
given just prior to femoral sheath removal for pain control after
paediatric cardiac catheterisation.
391: CORONARY INTERVENTIONS IN CHILDREN WITH
CONGENITAL HEART DISEASES
Peter Zartner, Martin Schneider
Cardiology, German Paediatric Heart Centre, Sankt Augustin,
Germany
Background
: The small vascular anatomy of infants and children
makes interventional treatment of impaired coronary perfusion, such
as stenoses, complete occlusions and fistulae, demanding. Materials
and techniques, appropriate for this young age group, have to
demonstrate their ability to effectively treat these lesions and avoid
problems, such as disruption, myocardial infarction or malfunction.
Methods and results
: Between 2004 and 2011, 14 patients with an
age of 9 days to 25 years (median 4.6 years) and a bodyweight of
1.7 to 65 kg (median 14 kg) underwent coronary intervention. In
three cases emergency revascularisation of the left coronary artery
was performed successfully, followed by stent implantation in one
patient. Embolisation of coronary arterial fistulae with coils and
vascular plugs was effective in 10 patients. An antegrade, retrograde
or combined approach to achieve the most distal device placement
preserved all side branches. One infant with pulmonary atresia and
an intact ventricular septum was prepared for biventricular repair by
step-by-step closure of the right ventricular to the coronary artery
connections. No procedure-related deaths occurred.
Conclusion
: Congenital and post-procedural coronary obstructive
lesions can be treated effectively and safely with balloon dilation
at any age. In coronaries impaired by external compression stent
implantation can restore perfusion, but long-term results are still
awaited. Interventional closure of coronary fistulae improves periph-
eral coronary arterial perfusion. A combination of these strategies
allows the preparation of patients with pulmonary atresia and intact
ventricular septum for biventricular repair.
