CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
80
AFRICA
1
Sejong General Hospital, Bucheon City, Republic of Korea
2
Yonsei University Hospital, Sinchon-dong, Seodaemun District,
South Korea
3
Samsung Medical Center, Seoul, Republic of Korea
Background:
Transcatheter closure of perimembranous ventricu-
lar septal defect (PMVSD) is a challenging procedure. Recently,
the Amplatzer PMVSD occluder (AGA Medical Corp, Plymouth,
Minnesota) has been shown to be effective in closing haemodynami-
cally significant PMVSDs. However, the high incidence of complete
atrioventricular block (CAVB) after device occlusion of a PMVSD
using it has been a controversial issue, too. Among several devices
tried to close PMVSD percutaneously, we prefer to use the Amplatzer
ductal occluder (ADO, AGA Medical Corp, Plymouth, Minnesota)
because of the anatomic resemblance between PMVSD with aneu-
rysm and patent ductus arteriosus.
Materials and methods
: Between August 2009 and June 2012, 21
patients underwent percutaneous PMVSD closure using ADO. There
were 5 males and 16 females; median age was 6 (6–42) years, and
median weight was 23 (18–60) kg.
Results:
All patients showed echocardiographic signs of left ventric-
ular volume overload and trivial to small mitral regurgitation (Qp/Qs
=
1.7
±
0.4). The mean defect size of the right ventricular side was 4.7
±
0.8 mm. Devices 2 mm larger than the measured narrowest VSD
diameter were selected in most patients. The ADOs were success-
fully implanted in all patients without any significant complications
except one transient CAVB and one case of delivery wire fracture.
Small residual shunts were observed immediately after device
implantation, but have been disappeared during follow-up in 20 of
21 patients. Mean follow-up period was 18
±
8 months, and CAVB
or aortic regurgitation was not observed in any patients.
Conclusions
: Transcatheter closure of PM VSD with the ADO is a
safe and promising treatment option, but long-term follow-up in a
large number of patients would be warranted.
808: UTILITY OF FOETAL ECHOCARDIOGRAPHY IN THE
EVALUATION AND TREATMENT OF FOETAL ANAEMIA
Darren Hutchinson
1
, Lisa Hornberger
1
, Venu Jain
2
, Sue Chandra
2
,
Yuka Yamamoto
1
, Akiko Hirose
1
1
Stollery Childrens Hospital, Edmonton, Alberta, Canada
2
Lois Hole Hospital for Women, Edmonton, Alberta, Canada
Background:
Significant foetal anaemia can cause foetal compro-
mise as a result of high foetal cardiac output (CO), with intrauterine
transfusion (IUT) being the treatment of choice. IUT carries risks
including preterm delivery and foetal demise. Peak middle cerebral
artery (MCA) Doppler velocity of
>
1.5 multiples of the mean
(MoM) is sensitive for moderate-severe foetal anaemia with false-
positive rates of
≥
12%. We sought to explore the additive value of
foetal echocardiography (FE) and calculated foetal combined CO
(CCO) in assessing foetal anaemia.
Methods
: We identified pregnancies that underwent FE prior to IUT
for suspected foetal anaemia from June 2009 to June 2012 in our
programme. FE was used to calculate foetal CO. Prenatal records
were reviewed for peak MCA velocity at IUT, pre-transfusion haemo-
globin (Hb) and hydrops. Anaemia was graded as moderate if foetal
Hb was
<
0.65 MoM and severe if
<
0.55 MoM.
Results:
Eleven pregnancies complicated by foetal anaemia had
20 IUTs. Nine of the 11 pregnancies had FE within the preceding
30 days. One case was excluded because of no pre-transfusion Hb
measurement. Median gestation at FE was 24 wks (range 19–29wks).
Peak MCA Doppler was
>
1.5 MoM (range 1.5–2.5) in all. Of the
nine foetuses with measured Hb, 44% had severe (
n
=
4, 3 of whom
with hydrops), 22% moderate (
n
=
2) and 33% (
n
=
3) mild anaemia.
Foetal CO was above the 90
th
centile in all foetuses with moderate or
severe anaemia. In 3 with mild anaemia, 2 had normal CO and 1 had
CO at the 90
th
centile.
Conclusions:
FE-derived CO may be a useful additional tool in the
evaluation of foetal anaemia severity. A normal foetal CO, even with
elevated peak MCA Doppler, may allow the clinician to predict mild
anaemia at foetal blood sampling. Surveillance using FE may avoid
or delay the need for invasive management and the associated foetal
morbidity and mortality.
811: EASE OF RETRIEVABILITY OF ADO II - AN ADDED
ADVANTAGE
Premsekar Rajasekaran, Anuradha Sridhar, Saileela Rajan, Raghavan
Subramaniam
Frontier Lifeline Hospital & Dr KM Cherian Heart Foundation,
Chennai, India
Background
: Amplatzer Duct Occluder II (ADO II - AGA Medical
Corporation, Plymouth, USA) has found wide favour in transcatheter
closure of large ductal shunts as well as in retrograde transcatheter
closure of perimembranous and muscular vertricular septal defects
(VSDs). This is attributable to the fabric-free design and thinner
nitinol wire mesh rendering device delivery through smaller cath-
eters feasible. However, this design also enhances the flexibility of
the device, making it prone for deformation and migration when
deployed across large (
>
5.5 mm) high pressure shunt lesions, despite
optimum placement of the device.
Materials and method
: We report our institutional experience
of ADO II from August 2011 to date; 27 devices were implanted
(perimembranous VSD 19, patent ductus arteriosus (PDA) 6, muscu-
lar VSD 1, aortopulmonary window 1) in 27 patients aged 4 months
to 12 years (mean age 4.7 years) with 3 devices migrating to the
pulmonary artery. One was in an infant with a 5.5 mm Type A PDA
closed with 6-4 ADO II and the other two were children with 5 mm
perimembranous VSDs where a 5-4 ADO II was deployed. The
retrieval was done by first positioning a 7 Fr Mullins sheath in the
distal main pulmonary artery through which a 5 Fr snare catheter
and 5 mm gooseneck snare (Cook incorporated, Bloomington, USA)
is advanced to the embolised device. The proximal screw of ADO II
was snared and the device withdrawn into the 7 Fr Mullins sheath.
Results
: In all three cases, the devices were retrieved successfully
and subsequent transcatheter closure performed with a nitinol duct
occluder.
Conclusion
: ADO II is not ideal for use in high pressure shunt
lesions measuring
>
5.5 mm. However, the fabric-free design and the
thinner nitinol wire mesh renders it easily retrievable even after being
completely deployed.
832: TEN YEARS’ EXPERIENCE OF TRANSCATHETER
CLOSURE OF VENTRICULAR SEPTAL DEFECT IN CIPTO
MANGUNKUSUMO HOSPITAL, JAKARTA, INDONESIA
Mulyadi Djer
1
, Sukman Putra
1
, Hasri Samion
2
1
Department of Child Health, University of Indonesia, Jakarta,
Indonesia
2
Institut Jantung Negara, Kuala Lumpur, Malaysia
Background
: Recently transcatheter closure of ventricular septal
defect (VSD) is more popular compared to surgery because of shorter
hospitalisation, eliminated need for thoracotomy, and better cosmetic
results without scar.
Objective
: To evaluate the efficacy and safety of transcatheter
closure of VSD.
Methods
: A case series of patients who underwent transcath-
eter closure of VSD in Dr. Cipto Mangunkusumo Hospital, Jakarta,
Indonesia.
Results
: In our hospital since February 2002, transcatheter closure
of VSD has been done in 43 patients. For perimembranous VSD, 38
were closed using membranous VSD occluders and 3 were closed
using ADO II; the 2 muscular VSDs were closed using Amplatzer
muscular VSD occluder and Amplatzer septal occluder, respectively.
There were 24 males. Age ranged from 5 to 46 years (median 6 years)
and the median body weight was 19 (range 8–68) kg. The size of VSD
was 3.5 (2.0–11.0) mm. Systolic pulmonary artery (PA) pressure was
