CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
74
AFRICA
Ornella Milanesi, Nicola Maschietto, Luca Semplicini, Helen Poser,
Giulia M De Benedictis, Giulio Ceolotto, Luca Aresu, Gabriele
Gerardi, Ilaria Iacopetti, Andrea Semplicini
University of Padova, Italy
Background:
Stenting of the isthmus has been increasingly adopted
for treatment of the aortic coarctation in children and adolescents.
However it is not ascertained whether this technique can contribute
to the development of late systemic hypertension.
Hypothesis:
Stent implantation in the isthmus in growing subjects
can affect haemodynamic, hormone incretion, arterial pressure and
gene expression in an animal model.
Methods:
Sheep 3–5 months old underwent 2D-echocardiography,
cardiac catheterisation, haemodynamic study and stent implantation
in the isthmic region. Pressure was measured in the LV, ascending and
descending aorta before and after stent implantation; sham animals
underwent the same procedure without stent implantation. All were
followed for 1 year, to adulthood. Quarterly pressure measurements
and echocardiography were performed; blood samples were drawn
for determination of renin-angiotensin-aldosterone levels. A second
catheterisation, with haemodynamic study and a dobutamine test,
was carried out 1 year after the enrolment, before the sacrifice.
Samples were taken from myocardium, ascending and descending
aorta for molecular biology examination.
Results:
Four sheep received stent implantation, 4 sham animals
were enrolled. The stent was oversized, considering the future
growth. No differences in echocardiographic parameters or pressure
measurements have been detected between the two groups in the
interim evaluations. No pressure gradient across the isthmus was
present at the follow-up; angiography did not show any narrow-
ing. The dobutamine challenge test did not reveal differences, or
differences in renin-angiotensin-aldosterone levels .The oxidative
stress genes expression (MMP-9 and Caspase-3), showed a trend in
significance in the expression of the MMP-9 that resulted higher in
the ascending aorta of the animals with a stent.
Conclusion
: Stent implantation in growing sheep does not affect
haemodynamic, hormonal, or pressure parameters. The increased
expression of MMP-9 in ascending aorta of stented animals could
indicate a subliminal endothelial dysfunction, promoted by the pres-
ence of a rigid metal segment.
492: IMPACT OF FOETAL ECHOCARDIOGRAPHY ON
PATIENTS’ DECISIONS IN CHINA: A PRELIMINARY
REPORT FROMA SINGLE CENTRE IN SHANGHAI
Lin Wu
1
, Luming Sun
2
, Yingjun Yang
2
, Gang Zou
2
, Guoying Huang
1
1
Children’s Hospital of Fudan University, Shanghai, China
2
Shanghai First Maternity and Infant Hospital of Tongji University,
Shanghai
Background
: Foetal echocardiography allows for prenatal diagnosis
of congenital heart disease or severe arrhythmia, and now serves as a
routine screening tool for foetal cardiac anomalies in Shanghai. The
aim of this retrospective study was to evaluate the impact of prenatal
echocardiography diagnosis on parents’ decisions.
Materials and methods:
A total of 112 patients were referred to the
prenatal counselling clinic in Shanghai First Maternity and Infant
Hospital from July 2010 to Dec 2011, for detailed foetal echocar-
diography and prenatal counselling. The serial echocardiographic
assessment was performed by an experienced foetal sonographer and
paediatric cardiologist. Based on the diagnosis of foetal echocardi-
ography, the paediatric cardiologist, obstetrician and neonatologist
provide prenatal counselling for the couples, to outline the treatment
options and to provide a clear picture of prognosis.
Results:
Among these 112 patients, 41 foetuses (36.6%) were diag-
nosed with congenital heart disease, 5 (4.5%) with severe cardiac
arrhythmia leading to haemodynamic compromise and 1 with a huge
cardiac tumour. There was 1 stillbirth. A total of 23 patients (56.1%)
with prenatally diagnosed congenital heart disease, 4 (80%) with
severe arrhythmia and 1 with a cardiac tumour chose abortion. After
birth two patients abandoned treatment, including 1 diagnosed with
transposition of great arteries with abnormal coronary arteries and 1
with congenital complete atrioventricular block with extremely low
heart rate.
Conclusions:
In China, most parents are not willing to accept multi-
ple staged surgical repair and possible long-term complications.
Medical cost, neurodevelopmental outcome and ultimate quality of
life play important roles in influencing parents’ prenatal decisions.
533: NON-CONVENTIONAL USE OF OCCLUDER DEVICES
Savitri Shrivastava
Fortis Escorts Heart Institute (Fehi), Okhla Road, New Delhi, India
Device closure is now an accepted modality of treatment for cardiac
septal defects .We report the efficacy of closure of non-septal defects
with devices conventionally used for septal cardiac defects.
Study design:
Retrospective study.
Material and methods:
We studies 46 patients, age group 2–67
yrs. These were divided into two groups: group 1: with no available
customised device, group 2 : For which customised devices are avail-
able but alternative devices have been used. These included 37 in
group 1: ruptured sinus of Valsalva (duct occluder 11), coronary arte-
riovenous (CAV) fistula (duct occluder 5), closure of paravalvular
leak (5), mitral (4; duct occluder devices 3,ventricular septal defect
(VSD) device 1) and aortic (duct occluder 1), closure of AP window
(duct occluder 3), Fontan fenestration closure (3; atrial septal defect
(ASD) occluder, patent foramen ovale device, vascular plug,1 each),
pulmonary atrioventricular (AV) fistula (duct occlude 2), systemic
AV fistula (vascular plug 1), closure of ascending aorta perforation
(septal occluder 1), occlusion of subclavian artery (vascular plug1),
splenic artery (duct occluder1), Blalock Taussig shunt (duct occluder
1). In group 2 there were 9 patients, VSD closure by ADO II device
(6), PDA closure by muscular VSD device (2) and ASD device (1).
Results:
Residual shunt was detected in 2 patients each of coro-
nary AV fistula and mitral paravalvular leak. No shunt detected in
ruptured sinus of Valsalva, fenestrated Fontan and ascending aorta
perforation. Complications: Local site haematoma was observed in
4 patients. Haematuria was observed in 4 patients. There was one
mortality in a large RSOV with gross congestive heart failure. On
follow-up (2 months–6 years), all patients are asymptomatic with no
late complications.
Conclusion:
It is feasible to treat selected lesions successfully
with the use of non-prototype occluder devices without significant
complications.
535: SUCCESSFUL TREATMENT OF MULTIPLE MYCOTIC
ANEURYSMS OFAORTIC COARCTATIONWITH COVERED
STENTS
Mehnaz Atiq
1
, Imran Iftikhar
2
, Ahmed Noor
2
, Sajid Dhakam
2
, Zahid
Amin
3
1
Department of Pediatrics and Child Health, Aga Khan University
Hospital, Pakistan
2
Department of Cardiology, Indus Hospital, Karachi, Pakistan
3
Rush Medical Center, Chicago, USA
Introduction:
Coarctation of the aorta constitutes 7% of all congeni-
tal heart diseases and is 2–5 times more prevalent in males. Infective
endarteritis has been reported in18% of aortic coarctation and the
resulting mycotic aneurysm has a high mortality. The treatment
reported in different case reports for these aneurysms has been
surgical. We report a case of a long segment coarctation treated with
multiple covered stents.
Case report:
A 22-year-old female was investigated for hypertension
and fever for 3 months. She was known to have autoimmune disease
with anaemia and moderate splenomegaly. Transthoracic echocardio-
gram revealed coarctation of aorta and transoesophageal echocardio-
gram showed multiple vegetations and aneurysms in the post stenotic
segment. She was treated with ceftrioxone (for 4 weeks) and genta-
