CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
78
AFRICA
pulmonary artery diameter was 8 mm. The delivery was planned in a
tertiary centre. In the delivery room, Apgar was 5/8 and evidence for
low cardiac output was already noted. Prostaglandin perfusion was
started. Echocardiography showed a large left coronary fistula filling
the LV. This was confirmed by computed tomography (CT) angiog-
raphy. Subsequently, compassionate care was planned and the child
died. In prenatal echo, the LV cavity size was overestimated because
the LV was filled by the coronary fistula. In addition, this fistula was
responsible for a steal phenomenon that further compromised LV
function while no endocardial fibrosis could be evidenced.
Conclusion:
Coronary fistula is a rare associated lesion in hypoplas-
tic left ventricle. Awareness on this association might be useful to
better predict postnatal outcome and to improve prenatal counselling.
695: INTRACARDIAC ECHOCARDIOGRAPHIC GUIDANCE
FOR TRANSCATHETER CLOSURE OF ATRIAL SEPTAL
DEFECT IN AN UNSELECTED ADULT PATIENT POPULA-
TION
Alain Fraisse, Marion Sumian, Anass Assaidi, Julien Mancini, Issam
Kammache, Caroline Ovaert, Gilbert Habib
La Timone Hospital, Marsaille, France
Background
: Intracardiac echocardiography (ICE) is an alterna-
tive to transoesophageal echocardiography (TEE) for transcatheter
closure of ostium secundum atrial septal defect (ASD). However,
studies on ICE guidance generally include a majority of patent fora-
men ovale and only few ASDs. Our aim was to assess transcatheter
closure of ASDs under ICE guidance in an unselected patient popu-
lation, paying particular attention to complex cases with large (
>
38
mm) ASDs and/or deficient rims other than the anterior-superior.
Materials and method
: From January 2006 to January 2012 in our
centre, all ASDs in the adult population were closed percutaneously
under ICE guidance, except for 3 patients with Down syndrome who
underwent closure under general anaesthesia and TEE guidance.
During this period, 93 patients (59 females) underwent transcatheter
ASD closure at a median age of 48 (21–90) years with Amplatzer
devices under local anaesthesia and ICE guidance. All patients had
routine TEE before catheterisation.
Results
: Complex cases comprised 17 patients (18%) including 13
with one or more deficient rims other than the anterior-superior and
8 with an ASD size
>
38 mm. The median ASD diameter by TEE
and ICE was 20 (6–40) mm and 25(10–40) mm, respectively. Ninety
cases (97%) were successfully closed. Three cases failed because
of insufficient rims and/ or defect size superior to 40 mm. Minor
and transient complications (atrial arrhythmia, groin haematoma)
occurred in 10 patients (9.6%). Three patients experienced a major
complication with favourable outcome: one arterial tear (laceration
of a branch of hypogastric artery) during venous puncture attempt
successfully treated by percutaneous embolisation, one blood trans-
fusion for a groin haematoma and one retroperitoneal haematoma.
The only risk factor for failure to close the ASD was deficient rims
(
p
=
0.05).
Conclusion
: In an unselected adult population, ICE provides safe
and efficient guidance for device closure of ASD, even for large
defects with deficient rims.
706: TRANSCATHETER CLOSURE OF SECUNDUMATRIAL
SEPTAL DEFECT ASSOCIATED WITH DEFICIENT RIMS
OTHER THAN THE ANTERO SUPERIOR
Alain Fraisse, Issam Kammache, Anass Assaidi, Julien Mancini,
Deborah Luciano, Caroline Ovaert
La Timone Hospital, Marsaille, France
Background
: We aimed to assess the feasibility of transcatheter
closure for secundum atrial septal defects (ASDs) with deficient rims
(
<
5 mm), other than the antero-superior because it is well demon-
strated that deficiency in the anterior rim toward the aorta does not
influence the success rate for transcatheter ASD closure.
Materials and method
: Between 1 January 2008 and 31 December
2011, 192 patients underwent percutaneous closure of ASDs in our
institution, under transoesophagal echocardiography (TEE) guidance
in children and intracardiac echocardiography guidance in adults.
Amplatzer devices (Amplatzer Septal Occluder or Cribriform) were
used in 191 whereas 1 case without deficient rim was closed with
intrasept ASD occluder. We retrospectively analysed the outcomes of
the 43 patients (22.4%, 26 children) with one or more deficient rim.
Results
: The median age and weight was 16 (1.1–85) years and 56
(8.8– 99) kg, respectively. Deficiency of the inferior (11), inferior-
posterior (15), or of the superior-posterior rim (17) was confirmed by
TEE in all the cases. Transcatheter closure was successfully accom-
plished in 37 (86%) of the cases with a median Amplatzer septal
occluder size of 28 (10–40) mm. A modified method of implanta-
tion (sizing balloon technique) was used in 30 patients (70%).In 6
patients (5 children) the ASD could not be closed. Four other chil-
dren experienced device embolisation a few hours after successful
transcatheter closure and underwent surgical ASD closure without
further complication. With use of Fisher’s exact test, deficiency of
the inferior-posterior rim was associated with failure or embolization
(
p
=
0.05) and there was a trend for adult age to be associated with a
low risk of embolisation or failure (
p
=
0.06).
Conclusion:
Transcatheter closure of secundum ASD is feasible in
patients with deficient rims. However, embolisation may occur, espe-
cially in the paediatric population with deficient inferior-posterior
rim.
712: EARLY RESULTS FROM THE UNITED STATES
MELODY
s
TRANSCATHETER PULMONARY VALVE POST-
APPROVAL STUDY
Jonathan Rome
1
, Jacqueline Kreutzer
2
, Allison Cabalka
3
, John
Moore
4
, Alex Javois
5
, Daniel Turner
6
, Aimee Armstrong
7
, David
Balzer
8
, Collin Cowley
9
, Thomas Zellers
10
1
Children’s Hospital of Philadelphia, University of Pennsylvania,
Philadelphia, USA
2
Children’s Hospital of Pittsburgh, Pittsburgh, USA
3
Mayo Clinic, Rochester, Minnesota , USA
4
Rady Children’s Hospital, San Diego, USA
5
Advocate Hope Children’s Hospital, Illinois, USA
6
Children’s Hospital of Michigan, Michigan, USA
7
University of Michigan Congenital Heart Center, CS Mott Children’s
Hospital, Michigan, USA
8
St. Louis Children’s Hospital, St Louis, USA
9
Primary Children’s Medical Center, University of Utah, Salt Lake
City, USA
10
University of Texas Southwestern Center, Dallas, USA
Background:
This study was undertaken to evaluate short-term
outcome after percutaneous transcatheter pulmonary valve (TPV)
implantation in the ‘real-world’ clinical setting. The primary outcome
is TPV function and freedom from reintervention at 6 months. We
present procedural and early results.
Methods:
Implantation procedures were based on IFU guidelines.
Data were collected prospectively on all consecutive subjects enrolled.
Procedural success was defined as TPV appropriately fixed in posi-
tion; catheter gradient
<
35 mmHg; and
<
trivial pulmonary regurgita-
tion by angiography. Successful TPV function at endpoint was mean
echocardiographic gradient
<
30 mmHg and mild or less regurgitation.
Results:
Between 29 July 2010 and 23 May 2012, 127 patients were
enrolled at 10 USA centres for possible TPV implantation at a mean
age of 20.0
±
9.7 y. The primary indication was conduit stenosis in
19.8%, regurgitation in 42.9%, both in 30.2%. Most (78%) patients
were NYHA I or II. Most conduits were homografts (65.9%); 12.7%
were bioprosthetic. TPV implant was attempted in 98 patients, 97
(99%) were successful. Procedural success rate was 93% (90/97)
with no mortality. Serious procedure-related events included conduit
rupture (6 – all treated with covered stents; 5 underwent TPV, 1
surgery), pulmonary artery perforation (1), and coronary compres-
sion requiring emergent surgery (1). At discharge, the average mean
