CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
79
gradient was 16.9
±
7.6 mmHg; 97% had no or trace pulmonary
regurgitation. At mean follow-up of 7.7
±
6 mo 2 TPV were explant-
ed, 1 for endocarditis and 1 during aortic root replacement. Another
patient was treated for presumed endocarditis.
Conclusion:
These early data suggest TPV in standard clinical prac-
tice yields procedural results equivalent to those in the IDE study.
The procedure appears an acceptable alternative to surgical conduit
replacement. Endocarditis risk warrants further study.
735: ATRIAL LEVEL RESTRICTION INFLUENCES CERE-
BROVASCULAR IMPEDANCE IN THE FOETUS WITH
TRANSPOSITION OF THE GREAT ARTERIES
Jack Rychik, Hilea Su, Zhiyun Tian
The Children’s Hospital of Philadelphia, USA
Background:
In transposition of the great arteries (TGA) the aorta
arises from the right ventricle, which leads to alteration in cerebral
blood flow and oxygen delivery
in utero
. Restriction at the atrial
septum requires balloon atrial septostomy (BAS) after birth, but may
also influence patterns of cerebral blood flow before birth.
Objective:
To characterise cerebrovascular impedance in the foetus
with TGA and investigate the relationship to atrial septal restriction.
Methods:
Foetuses with TGA, intact ventricular septum, 2 good-size
ventricles and no outflow tract obstruction had middle cerebral artery
pulsatility indices (MCA-PI) measured and compared to normal
gestational age-matched controls. TGA group was divided into BAS
and no-BAS after birth, reflecting degree of prenatal atrial restriction.
Results:
Thirty-six foetuses with TGA (17 no-BAS; 19 BAS)
were compared to 126 controls. Overall there was no difference in
MCA-PI between TGA and normal. Comparing cohorts of similar
gestational age, at the end of gestation (36–39 w) BAS group had
MCA-PI similar to normal, which was significantly lower than no
BAS group (BAS 1.52 + 0.07 vs no BAS 2.02 + 0.15,
p
<
0.01).
Conclusions:
MCA-PI normally decreases at the end of gesta-
tion (36–39 w). MCA-PI is normal in the foetus with TGA and a
restrictive atrial septum, but is abnormally elevated near the end of
gestation when there is an open atrial septum. We speculate that a
restrictive atrial septum leads to increased mixing in the right atrium,
with cerebral oxygen delivery that is closer to normal, while under
conditions of open atrial septum, streaming leads to severely deoxy-
genated blood delivery to the brain. Chronic cerebral hypoxia in TGA
with open atrial septum leads to cerebrovascular dysregulation, with
markedly elevated MCA-PI. Childhood neurocognitive deficits in
TGA may in part have their origins in prenatal life as a consequence
of variability in cerebral blood flow and oxygen delivery.
753: ARE COVERED STENTS PROTECTIVE AGAINST
ACUTE LOCAL COMPLICATIONS IN HIGH-RISK
PATIENTS WITH AORTIC COARCTATION?
Baher Hanna
1
, Sylvia Abadir
1
, Frederic Dallaire
3
, Josep Rodes-
Cabau
4
, Joaquim Miro
1
, Adrian Dancea
5
, Reda Ibrahim
2
, Nagib
Dahdah
1
, Christine Houde
3
1
Sainte-Justine Hospital, Montreal, Quebec, Canada
2
Montreal Heart Institute, Montreal, Quebec, Canada
3
Laval University Hospital, Quebec, Quebec, Canada
4
Heart Institute-Laval Hospital, Quebec, Quebec, Canada
5
Children’s Hospital, Montreal, Quebec, Canada
Background
: Percutaneous dilatation and stenting of aortic coarc-
tation (CoA) has proved to be an effective alternative to surgery.
Because of complications associated with bare metal stent (BMS)
such as local dissection, covered stent (CVS) were introduced.
Aim and hypothesis
: To compare the results and complication rate
between BMS and CVS in the treatment of CoA. We tested the
hypothesis that a 50% or more stenosis in relation to the
aorta
at the
diaphragm
level is a significant risk factor associated with BMS for
acute local complications including
aneurysm
formation and bleb
tears.
Materials and methods
: We did a retrospective chart review of
patients treated at the collaborating centres, comparing pre- and
post-procedural data and procedural details. Patients who received
BMS with stenosis
≥
50% were considered high-risk (HR-BMS).
The 2 BMS groups we compared to a group of patients who received
a CVS, all of whom had stenosis
≥
50%. Acute complications were
classified as ‘
in situ
’ (
stent migration, intimal tear, and aortic aneu-
rysm
) or major (death,
stroke, wall rupture, cardiac arrest, transfu-
sion
, and necessity of urgent reintervention). Early and mid-term
MRI studies were reviewed for potential
in situ
complications.
Results
: There were 25 BMS recipients (0.74–71.47 yo; 25.7
±
18.49), 9 were HR-BMS (0.74–49.46 yo; 20.63
±
15.97, and 18
CVS recipients (12.4–58.0 yo; 26.74
±
14.63). Early total complica-
tion rate was 9/25 (36%) in the BMS group, and 6/9 (66.6%) in the
HR-BMS compared to 4/18 (22.2%) in the CVS group (
p
=
0.503
& 0.108 respectively). Major complications occurred in 3/25 (12%)
BMS patients, and in 3/9 (33.3%) HR-BMS, compared to 1/18
(5.56%) CVS, (
p
=
0.628 & 0.093 respectively).
In situ
complica-
tions were encountered in 3/25 (12%) BMS patients, or 1/9 (11.1%)
HR-BMS, compared to 0/18 (0%) CVS patients; (
p
=
0.25 & 0.33
respectively). Finally, the recatheterisation rate was 6/25 (24%) for
BMS, and 4/9 (44.4%) in the HR-BMS compared to 3/18 (16.67%)
in CVS; (
p
=
0.71 & 0.175 respectively).
Conclusion
: Based on our limited series, the use of covered stent
did not significantly reduce the risk of early
in situ
complications.
Long-term follow-up imaging is needed for appropriate assessment
of the hypothetical risk of long-term aortic wall integrity following
CoA stent procedures.
774: PROFILEAND PREGNANCY OUTCOMES OF FETUSES
WITH CONOTRUNCAL ANOMALIES IN A NEWLY ESTAB-
LISHED FOETAL CARDIOLOGY UNIT IN SOUTH INDIA
Balu Vaidyanathan, Shine Kumar, RK Kumar
AIMS, Kochi, India
Objective:
To describe the profile and immediate pregnancy
outcomes of foetuses with conotruncal anomalies (CTAs) in a newly
established foetal cardiology unit in South India.
Methods:
Records of 68 women identified with diagnosis of CTA on
foetal echo (mean gestational age 26.75
±
5.93 weeks; range 17–38
weeks) during the period 2008–2011 were reviewed.
Results:
The most common indication for referral was suspect-
ed congenital heart disease (CHD) during routine antenatal scan
(89.7%). The various CTAs diagnosed included tetralogy of Fallot
(TOF, 44.1%), double outlet right ventricle (DORV, 27.9%), trans-
position of great vessels (TGA, 8.8%), TOF with pulmonary atresia
(TOF-PA, 8.8%), TOF with absent pulmonary valve (TOF-APV,
7.4%) and truncus arteriosus (2.9%). Extracardiac anomalies were
reported in 4 foetuses (7.1%). Pregnancy outcomes were reported
for 65 foetuses (95.6%), with 4 lost to follow-up. The most common
outcomes included termination of pregnancy (41%), planned delivery
and post-natal care (41%), intra-uterine death (13%) and neonatal
death (5%). Termination of pregnancy rates, based on individual diag-
nosis, were as follows: TOF (43.3%), DORV (42.1%), TGA (50%),
TOF-PA (16.7%), TOF-APV (40%) and truncus (50%). Overall post-
natal survival among patients with intention to treat was 86.9% with
5 patients undergoing surgery in the neonatal period. The accuracy of
foetal echo in identifying the primary diagnosis was 96.4%.
Conclusion:
Pre-natal diagnosis of CTA prompted post-natal care in
less than half of the diagnosed patients with a very high proportion
of even repairable CTAs undergoing termination of pregnancy. Post-
natal survival of those with intention to treat was excellent.
803:TRANSCATHETER CLOSURE OF PERIMEMBRANOUS
VENTRICULAR SEPTAL DEFECT USING AMPLATZER
DUCTAL OCCLUDER
Seong-Ho Kim
1
, Sang Mi Lee
2
, Jae Young Choi
2
, Jin Young Song
3
,
Sang Yoon Lee
1
, Jae Sook Paik
1
, So Ick Chang
1
, Woo Seop Shim
1
