CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
76
AFRICA
died during catheterisation following RV perforation. In the remain-
ing 8 cases the coronary catheter was advanced to the descending
aorta. Pulmonary valvuloplasty was successful in 5 cases using cath-
eters with a 6 mm long balloon; postmortem showed minimal haem-
orrhage without cardiac trauma. The procedure was unsuccessful in
2 cases (both survived) using a 12 mm long balloon which could not
be turned into the pulmonary artery; postmortem showed small RV
perforations. In 1 case the PTCA catheter could not be inserted as the
cannula became dislodged.
Conclusions:
Foetal pulmonary valvuloplasty by percutaneous tran-
shepatic cardiac catheterisation is feasible, providing an alternative
route for human foetal cardiac intervention.
572: SPECTRUM AND OUTCOME OF CARDIOMYOPA-
THIES DIAGNOSED DURING FOETAL LIFE
Edgar Jaeggi
1
, Paul Kantor
1
, David Chitayat
2
, Greg Ryan
2
, Cedric
Manlhiot
1
, Roland Weber
1
1
The Hospital for Sick Children, University of Toronto, Toronto,
Canada
2
Mount Sinai Hospital, University of Toronto, Toronto, Canada
Background:
Primary cardiomyopathies (CM) are potentially irre-
versible, life-threatening heart muscle disorders that typically affect
the cardiac filling and/or contractility in the absence of any anatomi-
cal abnormality. These are rare
in utero
diagnoses and, in conse-
quence, there is a paucity of knowledge on the entity. We sought to
clarify the foetal disease spectrum and to identify early echocardio-
graphic predictors of outcome.
Methods:
We reviewed 53 consecutive cases with prenatally detected
CM at our tertiary care centre since 2000. Hypertrophic CM (HCM)
was defined by the presence of ventricular wall thickness
>
2
z-scores. Non-hypertrophic CM (NHCM) was defined by cardiac
dysfunction in the absence of myocardial hypertrophy. Excluded
were cases with cardiac hypertrophy secondary to maternal diabetes
and twin-twin transfusion.
Results:
NHCM was diagnosed in 34 and HCM in 19 cases at 24.5
+ 5.6 weeks’ gestation. Aetiology included familial (9%), inflam-
matory (17%), and genetic-metabolic disorders (36%), while 38%
were idiopathic. The pregnancy was terminated in 9/53 (17%). Of
44 actively managed cases, 20 (64%) survived to infancy and 3/17
(18%) with HCM versus 14/27 (52%) with NHCM remain alive
(Hazard ratio (HR) 2.9; 95% confidence interval (CI) 0.98–8.7;
p
=
0.03). Baseline echocardiographic variables associated with mortal-
ity of actively managed cases included ventricular septal wall thick-
ness (HR 1.15 per z-score increase; 95% CI 1.03–1.29;
p
<
0.02);
foetal hydrops (HR 5.22; 95% CI 1.13–24.16;
p
<
0.03); umbilical
vein pulsations (HR 9.5; 95% CI 2–45.3;
p
=
0.005);
>
2 diastolic
Doppler flow abnormalities (HR 3.54; 95% CI 0.98–12.77;
p
<
0.02);
left ventricular myocardial performance index (HR 2.6 per 10% rise
in index; 95% CI 1–9;
p
<
0.05) and cardiovascular profile score (HR
1.45 per deducted point; 95% CI 1.10–1.90;
p
<
0.01).
Conclusions:
Foetal CM is caused by a broad spectrum of causes and
associated with significant perinatal mortality, especially those with
HCM. Early echocardiographic detection of diastolic dysfunction is
most useful in predicting adverse outcomes.
574: PERCUTANEOUS RECONSTRUCTION OF FUNCTION-
AL AORTIC INTERRUPTION USING PERFORATION AND
COVERED STENT
Tarek Momenah
1
, Muhammad Khan
1
, Yahya Almasham
1
, Tarek
Kashour
2
, Mohammad Alhamadi
3
, Nabeel Almashrki
3
1
Prince Salman Heart Centre, King Fahad Medical City, Riyadh,
Saudi Arabia
2
King Saud University, Riyadh, Saudi Arabia
3
Althourah Hospital, Sana, Yemen
Introduction:
Coarctation of aorta is usually surgically treated in
infancy and childhood, if untreated may lead to mortality. Rarely may
result in acquired interruption.
Objective:
Reconstruction of functional aortic interruption using
perforation technique and covered Stent.
Methods:
Three cases were suspected clinically and diagnosis
confirmed by echocardiogram, cardiac CT and/or MRI. Cardiac
catheterisation was done under general anaesthesia. Pre and post
interruption areas were accessed by radial artery/transseptal puncture
and femoral artery respectively. Pre and post interruption areas were
assessed by angiograms. Transseptal needle 6 Fr with dilator and
sheath was advanced from femoral access and with aid of angiogram
through other access. The needle was used to perforate the atretic
part into the ascending aorta, position confirmed by pressure and
angiogram. Then with help of a PTCA (0.014) wire, dilator and
sheath were advanced and the sheath was replaced to Mullens 12 Fr.
After appropriate measurements, a covered stent was selected and
mounted in BIB balloon taking into consideration the diameter of
the transfer aortic arch and length to cover the whole atretic part of
aortic arch and extended to descending aorta about 10–15 mm avoid-
ing left subclavian artery origin. Post stent deployment pressure and
angiograms were recorded.
Results:
There were no early or late complications. All patients were
discharged home within 3 days. Mean follow-up was at 2 years and
the gradients obtained were unchanged.
Conclusion:
Percutaneous treatment of functional aortic atresia is a
safe, feasible and effective alternative
593: FOETAL ECHOCARDIOGRAPHY IN A DEVELOP-
ING COUNTRY: REFERRAL PATTERNS AND IMPACT ON
PREGNANCY OUTCOMES
Balu Vaidyanathan
1
, Deepa Sarala
1
, Kumar RK
1
, John Simpson
2
,
Gurleen Sharland
2
1
AIMS, Kochi, India
2
Consultant, Evelina Children’s Hospital, London, UK
Background:
Limited data exist about the practice of foetal echo-
cardiography in developing countries with logistic limitations to treat
complex congenital heart disease (CHD).
Objective:
To report referral patterns for foetal echocardiography
and its impact on outcomes of affected pregnancies in a newly estab-
lished foetal cardiology unit in India.
Patients and methods:
A foetal cardiology service was started
in January 2008. Prospective data (2008–2010) was collected in a
dedicated database; retrospective data (2006–2007) was obtained
from hospital records. Outcomes were tracked by direct evaluation of
newborns, questionnaire or telephonic interviews.
Results:
A total of 1 084 women were referred for foetal echocar-
diography; mean gestational age at referral was 24.9 + 5.9 weeks.
The most common indication for referral was abnormal screening
ultrasound (38.4%). Referrals for indications other than suspected
CHD were more in the current period (2008–2010) (63.8% vs
50.5%;
p
=
0.0006). CHD was diagnosed in 297 foetuses (27.5%),
114 (38.4%) were simple and 183 (61.6%) were complex. The most
common outcome was termination of pregnancy (36 %) or intra-
uterine/neonatal death (18.9%). Termination rates were higher for
complex CHD (47% vs 18.4%;
p
<
0.0001). Continuation of preg-
nancy with planned perinatal care was more common in the current
period (25.5% vs 10 %;
p
=
0.02) and for simple CHDs (36.4% vs
14.2%;
p
<
0.001).
Conclusions:
Referral patterns for foetal echocardiography were
characterised by late referrals, especially when CHD was suspected.
Although half of the pregnancies affected with CHD resulted in
termination or foetal/neonatal deaths, with improved awareness,
there was a trend towards planned deliveries and postnatal care,
especially for repairable CHDs.
619: THE EDWARDS VALEO LIFESTENT
®
FOR TREAT-
MENT OF CARDIOVASCULAR LESIONS IN CHILDREN
Caroline Ovaert
1
, Debora Luciano
1
, Anass Assaidi
1
, Issam
Kammache
1
, Bernard Kreitmann
2
, Loic Mace
2
, Alain Fraisse
1
