CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
72
AFRICA
392: INTERVENTIONAL CLOSURE OF MUSCULAR VSDs
AT AYOUNG AGE
Peter Zartner, NicoleToussaint Goetz,Viktor Hraska, Martin Schneider
German Paediatric Heart Centre, Sankt Augustin, Germany
Purpose
: The presence of muscular ventricular septal defects
(mVSD) may pose a high circulatory burden in young patients.
Surgical closure is difficult because of the multilayer structure of
these malformations. We present the course of 13 patients (age
10 days – 7.3 years, median 9 months; bodyweight 2.2 and 18 kg,
median 8.7 kg) undergoing transcatheter closure of such defects.
Method
: All closures were assisted by transoesophageal echo guid-
ance. For transvascular closure of 5 singular and 8 multiple mVSDs
5 Amplatzer PDA II occluder, 6 Amplatzer VSD occluder and 4
Amplatzer vascular plugs IV were used. Follow-up time ranged from
23 days to 2.8 years (mean 1.2 years).
Results
: Three defects were closed immediately; 9 mVSD showed a
residual shunt immediately after the implantation procedure, which
further reduced during follow-up in all patients. Two intra-procedural
complications occurred. A sudden complete atrioventricular (AV)
block led to transcatheter explantation of the device in one patient.
This patient with a restrictive cardiomyopathy died during follow-up.
In one patient on ECMO a left ventricular perforation with the device
already in place had to be oversewn in an emergency operation.
Conclusion
: With some of the newer devices available, which pass
through smaller delivery sheaths of 4–6 F, interventional closure of
mVSD has become a feasible option in the treatment of patents of
all ages and a bodyweight from 2.2 kg on, who present with elevated
right ventricular pressures and high shunt volume. The procedure is
challenging in newborns and infants and severe complications may
occur.
422: AMPLATZER DUCT OCCLUDER II IN ALIEN POSI-
TIONS
IB Vijayalakshmi
Sri Jayadeva Institute of Cardiovascular Sciences and Research,
Bengaluru
Background:
Amplatzer Duct Occluder II (ADO II) is specially
designed for closing long ducts in infants. There are few reports of
‘off-label’ use of ADO II in alien positions.
Aim:
To evaluate the advantages and disadvantages of ADO II in
alien positions.
Material and results
: In this prospective study 51 cases of ventricu-
lar septal defect (VSD) and one case of coronary artery venous
fistula (CAVF), as well as one aorto-right ventricular tunnel (ARVT)
were closed with ADO II. Seventy-two cases of VSDs were closed
with regular devices. Age ranged from 8 months to 21 years (mean
9.7 years). M:F sex ratio: 1.1:1. In 2 patients associated atrial septal
defects (ASDs) were simultaneously closed with ASD devices. One
patient had dextrocardia, 11 cases had mid or high muscular VSDs,
38 had perimembranous VSDs, and 2 had Gerbode defect. In one
patient, 2 ADO II were used. The shortest fluoroscopic time was 4.2
min (mean 8.4
±
4.1 min). Complete closure was achieved in all. One
case of Gerbode defect closed with ADO II developed complete heart
block and recovered with temporary pacing and steroids. None of the
patients developed tricuspid regurgitation or aortic regurgitations.
Fluoroscopic time was greater (5.6
±
3.4 min) in the control group;
3 cases had residual shunt, and transient complete heart block and
haemolysis occurred in one patient each.
Discussions:
The advantages of ADO II are a very low profile and
easy delivery through a 5F guiding catheter with short fluoroscopic
time, at one-third of the cost of a ventricular septal occluder. A disad-
vantage is that it is not useful in VSDs of more than 6 mm.
Conclusions
: ADO II is an excellent device in an alien position like
VSD, Gerbode defects, CAVF, ARVT. The procedure time and the
cost are significantly less than regular devices. The success rate is
very high and complication rate is very low.
425: TRANSCATEHETER CLOSURE OF ATRIAL SEPTAL
DEFECTS : SINGLE CENTRE EXPERIENCE IN A LIMITED
RESOURCES PAEDIATRIC HEART CENTRE
Sukman Putra, Mulyadi Djer, Nikmah Idris, Dedy Wilson, Sudigdo
Satroasmoro
Department of Pediatrics, University of Indonesia/ RSCM Jakarta,
Indonesia
Background:
Transcatheter closure of atrial septal defects (ASD)
has been accepted worldwide as an alternative to surgical closure
with good clinical results. This procedure plays an important role
in most developing countries with limited resources: lack of cardiac
surgeons and paediatric cardiac intensivists, limited intensive care
unit (ICU) beds and limited funding.
Objective:
To report our clinical experience in transcatheter closure
of ASD in a paediatric heart centre where very limited funding and
few human resources are available.
Materials and methods:
We have performed successful transcath-
eter closure of 118 ASD, out of a total of 556 various interventional
procedures of congenital and structural heart disease (21.2 %) from
September 2002 to June 2012. The procedures were performed under
general anaesthesia guided by fluoroscopy and transoesophageal
echocardiography.
Results:
The median age was 7.6 yrs (range 1.3–69.3yrs) with 93
(78.8%) female and 25 (21.2 %) male. Most patients’ body weight
was between 10 and 30 kg. The defect size was 17.8 mm (range 4–36
mm) and the implanted device size was 22 mm (range 10–38 mm).
All devices were Amplatzer septal occluders. The mean procedure
time was 109 minutes (range 50–74 minutes) with fluoroscopic time
30 minutes (range 12–83 minutes). One patient had an embolised
right ventricle requiring surgical intervention; the success rate was
99.1%.
Conclusion:
Transcatheter closure of ASD is an effective and safe
procedure. In a country with limited resources this procedure can
play an important role as an alternative to surgery in treating ASDs.
432: TAILORED MANAGEMENT APPROACH FOR CRITI-
CALLY SICK CHILDREN AND LATE PRESENTERS WITH
CONGENITAL HEART DISEASE
Milad El-Segaier
1,2
, Mohammed Omar Galal
1,3
1
King Fahad Medical City, PSHC, Riyadh, Saudi Arabia
2
Skåne University Hospital, Lund, Sweden
3
University of Essen, Germany
Background and objectives:
Re-conditioning before cardiac surgery
in critically sick children is often needed. We report our experience
using a tailored management approach in these patients.
Methods and patients:
The charts of patients with congenital heart
disease (CHD) who were judged to have high operative risk were
reviewed.
Included
were patients with: large left to right shunt and
ventilation for longer than 2 months, significant left to right shunts
at multiple levels combined with malnutrition or recent infection,
severely impaired cardiac function needing inotropic support and
antifailure medications, recent infection, severe malnutrition (body
weight
<
5
th
centile), and critically sick patients during early postop-
erative course.
Excluded
were patients with: significant left to right
shunts, who presented early, with minor growth retardation, and
without recent active infection.
Results:
Six patients were included. The median age was 13 months
(2–48 months) and median weight was 4.6 kg (2.3–12.6 kg). Two
patients had multiple left to right shunts and ventilator dependency.
One with huge ventricular septal defect (VSD) presented at 4 years
of age. Another had low body weight, large VSD and impaired left
ventricular (LV) function, while the other two had early postoperative
complications and ventilator dependency.
In the first category, a staged approach was essential. This was
done by transcatheter closure of the patent ductus arteriosus (PDA),
followed by pulmonary artery banding. This approach led to extuba-
tion. After proper nutrition, total correction was done. The patient
