CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
77
1
Pediatric Cardiology, Timone Enfant AP-HM, Marseille, France
2
Pediatric Cardiac Surgery, Timone Enfant AP-HM, Marseille, France
Background
: The Edwards Valeo Lifestent
®
is a stainless steel,
premounted, open cell stent. Easy dilation to larger diameters and low
profile are advantages in growing children. Radial force is however
poor.
Results
: Between April 2011 and July 2012, 26 VALEO
®
stents were
placed in 22 children during 23 procedures. Median age was 1 year
(5 d–14.3 yrs), median weight 8 kg (2–53). Most insertions (87%)
were percutaneous (group 1) while 3 were peri-operative (group
2). Indications and locations were: right pulmonary artery (RPA) or
left pulmonary artery (LPA) (rehabilitation strategy) in pulmonary
atresia with intact ventricular septum (PA-IVS) in 6; LPA stenosis
in tetralogy of Fallot, PA-IVS or ventricular septal defect (VSD) in
4 (3 peri-operative); PA stenosis in single ventricle in 2, PA stenosis
after arterial switch in 2, sub-hepatic vein thrombosis in 1, patent
ductus arteriosus (PDA) stenting (hybrid approach) for hypoplastic
left heart syndrome (HLHS) in 6 and for complicated IAA in 2
patients. In group 1, stent placement was straightforward, through
femoral venous access in all except 3 (2 jugular, 1 transhepatic).
Predilation was performed in 5, all with PA stenosis; subsequent
postdilation was performed in 2. Immediate angiographic and/or
haemodynamic results were considered satisfactory in all. Acute
complications occurred in 3 (haemoptysis in 2, reperfusion oedema
in 1). Six patients have so far been recatheterised, a median of 1.7
mo after initial procedure. The stent remained fully patent in all but
1. In group 2, the stents were always secured with a single proxi-
mal stitch and flared at their proximal end. All 3 patients had early
post-op recatheterisation (median 6 mo). All stents were redilated to
achieve better wall apposition. In 1 a possible stent fracture without
obstruction was seen.
Conclusion
: The VALEO
®
stent is an easy and effective stent for
use in growing children. Radial force was sufficient in the lesions
we encountered. When used peri-operatively, early recatheterisation
is warranted to improve wall apposition. Longer-term follow-up is
needed.
628: HEMOPTYSIS AFTER FENESTRATED EXTRACAR-
DIAC FONTAN - A MULTIDISCIPLINARY APPROACH TO
MANAGEMENT
Usha Pratap, Prashant Mishra, Mukul Mutatkar, Vinayak Desurkar,
Ranjit Jagtap
Deenanath Mangeshkar Hospital, Pune, India
Background:
Haemoptysis after fenestrated Fontan repair for
univentricular physiology is a well-known complication of chronic
cyanosis. We present our management of a 10-year-old who present-
ed with massive haemoptysis 5 years after completion of extracardiac
Fontan.
Summary:
TD underwent a superior cavopulmonary anastomosis at
age 2 for his transposition of great arteries with a small left ventricle
(LV) and PS. He had a fenestrated extracardiac Fontan done at age
5. At age 10 he presented with sudden-onset haemoptysis. After
stabilisation he underwent a right heart catheterisation to delineate
the conduit-anatomy; an aortic digital subtraction angiogram (DSA)
was also performed to delineate possible bronchial collaterals. Right
heart catheterisation revealed a 7 mm conduit-right atrium (RA)
fenestration while the aortic DSA revealed multiple and large bron-
chial collaterals. Our interventional radiologist used 300–500 PVA
(polyvinyl alcohol) particles to successfully embolise the bleeding
collaterals. We planned to close the large conduit-fenestration at
a staged setting with an ASD occlusion device. Angiography and
trans-oesophageal echocardiogram (TEE) revealed an anatomy
which favoured using a Amplatzer Duct Occluder -2 (ADO-2, St
Jude Medical) device for closing the fenestration. This was success-
fully achieved using an ADO-2 6-6 device under fluoroscopy and
TEE guidance. Post procedure angiogram revealed no right-to-left
shunting. Pressure in the venous-PA conduit prior to device closure
was 11/5 mmHg and post-procedure was 10/5 mmHg. Arterial blood
gas oxygen saturations improved to 96%. He remains well and fully
saturated 3 months later.
Conclusion:
We would like to report this case as using a multidis-
ciplinary approach helped in reducing procedure time and radiation
time in a haemodynamically unstable patient. It was also a novel use
of PVA particles for successful embolisation of the bronchial collat-
erals (with possible advantages over coil occlusion). There have been
no reports of using of ADO-2 device for percutaneous closure of the
fenestration.
638: BALLOON VALVULOPLASTY IN PREMATURE
INFANTS WITH SEVERE AORTIC AND PULMONARY
VALVE STENOSIS OR PULMONARY ATRESIA
Michael Rigby, Margarita Bartsota, Alan Magee, Zdenek Slavik
Royal Brompton Hospital, London
Background:
The rationale for foetal balloon valvuloplasty is to
prevent the development of left or right ventricular hypoplasia in
the setting of severe aortic, pulmonary stenosis or pulmonary atresia
intact septum.
Material and methods:
A retrospective review of premature infants,
weight
<
2 kg, gestation
<
36 weeks, undergoing balloon valvulo-
plasty was performed
Results:
There were 6 with severe aortic stenosis, gestational age
32–36 weeks, birth weight 1.4–1.9 kg. treated in the first 10 days of
life. Nine with severe/critical pulmonary valve stenosis, gestational
age 28–36 weeks, birth weight 1.2–1.9 kg were treated during the
first 9 days. Three with pulmonary atresia, weights 850, 1700 and 1
900 g, had radiofrequency assisted balloon pulmonary valvuloplasty.
Three with aortic stenosis developed transient loss of a femoral artery
pulse. The systolic gradient or left ventricular systolic pressure fell
in every case. One developed severe aortic regurgitation and required
a Ross operation at two months. One patient required repeat aortic
valvuloplasty at 6 months. In 2 cases a Ross operation was undertaken
at 5 and 7 years respectively. One patient has reached 9 years without
a second intervention. Relief of pulmonary stenosis occurred in every
case. In one case repeat pulmonary valvuloplasty was required at the
age of 12 months but no other patient has required re-intervention 6
months to 12 years following the initial valvuloplasty.
Of 3 patients with pulmonary atresia one born at 27 weeks died
10 days later from non-cardiac causes. The 2 others did not require
an additional source of pulmonary blood supply and have required no
further intervention 8 and 1 year later.
Conclusions
: Balloon valvuloplasty is a safe procedure in premature
infants. Elective premature delivery before 36 weeks’ gestation with
postnatal balloon valvuloplasty could be an alternative to foetal inter-
vention in selected cases.
689: PRENATAL ECHOCARDIOGRAPHIC FINDINGS IN
HYPOPLASTIC LEFT HEART SYNDROME WITH CORO-
NARY FISTULA
Anna Lamberti
1
, Annabelle Azancot
1
, Maurice Guirgis
1
, Andre
Denjean
1
, Constance Beyler
1
, Damien Bonnet
2
1
Robert Debre Hospital, Paris, France
2
Universite Paris Descartes Sorbonne Paris Cite, France
Background:
Prenatal diagnosis of hypoplastic left heart is common-
ly performed during foetal life. Identifying risk factors to better
predict outcome is still challenging.
Case report:
We describe here the prenatal echocardiographic
features of a rare association of hypoplastic left ventricle with coro-
nary fistula. Foetal echocardiography at 33 weeks’ gestation showed a
small left ventricle (LV) of 6 mm with mitral hypoplasia. The LV had
a globular appearance with filled apex and a poor systolic function.
A small 1.5 mm aorta arising from the LV and a biphasic Doppler
flow recorded in the aortic root suggested aortic regurgitation. The
ductus arteriosus perfused the horisontal and ascending aorta. The
