CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
82
AFRICA
1
The Queens Silvia Children’s Hospital, Göteborg, Sweden
2
Astrid Lindgren Children’s Hospital, Stockholm, Sweden
Background:
Foetal tachycardia represents a risk for morbidity and
mortality and there is no consensus concerning medical treatment.
Aim.
To evaluate the treatment of foetal tachycardia with emphasis
on choice of first-line agent.
Materials and methods:
Eighty of 128 referrals with foetal tachy-
cardia received transplacental antiarrhythmic treatment and were
reviewed.
Results:
Fifty-one foetuses were diagnosed with atrioventricular
re-entry tachycardia (AVRT), 23 had atrial flutter (AF), 5 permanent
junctional reciprocating tachycardia (PJRT), one junctional ectopic
tachycardia (JET) and one atrial ectopic tachycardia (AET). Drugs
used included sotalol, digoxin, flekainide and amiodarone.
Conclusions:
In this small series sotalol was more effective than
digoxin in terminating tachycardia without hydrops. In hydropic
foetuses neither sotalol nor digoxin was effective in terminating the
tachycardia as first-line agent.
993: TRANSCATHETER CLOSURE OF RIGHT DUCT IN
INFANT WITH ISOLATED RIGHT SUBCLAVIAN ARTERY
FROM MAIN PULMONARY ARTERY WITH PULMONARY
AND SUBCLAVIAN STEAL SYNDROME: AN EXTREMELY
RARE CASE REPORT
Ratthapon Wongwandee, Boonchu Sirichongkolthong,
Utairat
Chaumrattanakul
Faculty of Medicine, Thammasat University, Thailand
Background:
Isolated subclavian artery without associated congeni-
tal cardiac defect is an extremely rare. This anomaly can cause
pulmonary and subclavian steal with perfusion of the arm and lung
via the vertebrobasilar system. Reimplantation of subclavian artery
into the ascending aorta is considered a conventional management.
However, transcatheter embolisation may be a proper alternative for
small infants with this condition.
Methods and results:
We report an infant girl diagnosed with
22q11.2 deletion syndrome who presented with continuous murmur,
heart failure and poor perfusion of right arm. The MDCT angiography
demonstrated isolated right subclavian artery from main pulmonary
artery via right duct with retrograde flow of right vertebral artery.
Moreover, collateral branches of prominent right intercostal arteries
supplied the right subclavian artery. The right duct was completely
occluded with vascular plug II for stopping pulmonary overcircula-
tion. The angiogram showed that subclavian steal phenomenon was
diminished as a result of closure of the duct. Right subclavian artery
was supplied by right vertebral artery and right intercostal arteries.
Consequently, her perfusion of right arm and heart failure were clini-
cally improved.
Conclusions:
Transcatheter occlusion of isolated right subclavian
artery from main pulmonary artery with steal phenomenon is an
effective and alternative treatment for small infants.
995: HYBRID MANAGEMENT OF A PRENATALLY DIAG-
NOSED PULMONARYARTERYTO LEFTATRIUMCOMMU-
NICATION
Nestor Sandoval, Juan Araque, Gino Bresciani, Carlos Obando,
Alberto Garcia, Miguel Ronderos
Fundacion Cardioinfantil, Bogotá C/marca, Colombia
Background/hypothesis
: Symptoms of a pulmonary artery (PA)
to left atrium (LA) fistula appear at different stages of childhood
depending on the severity of the shunt. In newborns, central cyano-
sis and severe heart failure are signs that an emergency manage-
ment must be done. Open heart surgery is the gold standard for the
management of PA to LA fistula but with the arrival of new technol-
ogy, transcatheter interventions are becoming the elective choice in
some cases.
Materials and methods
: We report a case of a female newborn with
a prenatal diagnosis of right pulmonary artery (RPA) to LA commu-
nication managed with a hybrid technique. Pulmonary aneurysm was
diagnosed in the last trimester.
Results
: After caesarean section, because of severe heart fail-
ure, central cyanosis and hypoxaemia, urgent catheterisation was
performed and a RPA to LA fistula with a large pulmonary cavity is
found. She was taken to emergency surgery. Intraoperative findings
included type III PA to LA fistula and 4 mm patent ductus arteriosus
(PDA). On extracorporeal circulation without aortic clamping the
fistula and the PDA were ligated. Because of a persistent image of
an upper right pulmonary lobe cavity, catheterisation was done and a
6 mm plug was implanted in the efferent branch of the fistula, creat-
ing a successful embolisation. The patient was discharged a few days
later with normal development seen on follow-up. Hybrid manage-
ment of this rare entity was successful.
Conclusions:
Prenatal diagnosis is important for planning and
performing emergency operations, and in the presence of anomalies
in the PA, a fistula between the PA to LA must be suspected. Team
work on the hybrid procedure is a useful tool to manage this rare
entity.
1012: FOETALAND POSTNATAL OUTCOME OF CONGENI-
TAL HEART DISEASE DIAGNOSED IN UTERO - A SINGLE
CENTRE EXPERIENCE
Pallavi Mahindrakar, Shweta Nathani, Nageswararao Koneti
Care Hospitals, Hyderabad, India
Background
: Foetal echocardiogram (FE) is an established proce-
dure to diagnose foetal heart disease; however foetal and postnatal
outcomes are variable depending on social, financial and cultural
factors. We report our experience of FE and their outcome.
Materials and methods
: A total of 1 390 FE for suspected abnor-
malities were performed from January 2004 to June 2012 at our
centre; 430 (31%) foetuses had a significant finding in FE. The
maternal risk factors, indications, diagnosis and outcome of the
foetal heart disease were analysed.
Results
: The mean maternal and foetal age was 25.9
±
4.1 years and
25.6
±
4.6 weeks respectively. The indications for FE were high-risk
pregnancy (45%), suspected congenital heart disease (CHD) (22%),
previous sibling with CHD (18%), arrhythmia (7%) and intracar-
diac echogenic focus (8%). Among the abnormal FE of 374
,
CHD
accounted for 83.4%, arrhythmias 13.6% and cardiac tumours 2.9%.
Heterotaxy syndrome was the commonest diagnosis contributing
20%, followed by hypoplastic left heart syndrome (HLHS) 11.6%,
isolated ventricular septal defect (VSD) 9%, double outlet right
ventricle (DORV), dextro-transposition of the great arteries (d-TGA),
single ventricle and tetralogy of Fallot (TOF) contributed 6–7% each.
Other defects contributed 21.4%.
One foetus with severe aortic stenosis underwent balloon valvot-
omy at 24 weeks. Two hundred and eight women opted for medical
termination of pregnancy, a few beyond the legal gestational age
limit. Foetal SVT was seen in 11, of which 10 were successfully
controlled by transplacental pharmacotherapy. One foetus with sinus
bradycardia was diagnosed as LQTS after birth. Twenty babies
underwent emergency intervention after birth, 5 babies underwent
definitive cardiac surgery as a single stage. The remaining babies
were followed up medically.
Conclusions
: Late referral FE is commonly seen in our geographical
location. Good outcome is predicted in a subset of CHD with defini-
tive treatment, arrhythmias and tumours. Late terminations beyond
the legal limit are noticed in complex foetal CHD.
1013: CHANGES IN HEALTH-RELATED QUALITY OF LIFE
OVER 3YEARS FOLLOWINGTRANSCATHETER PULMON-
IC VALVE IMPLANTATION: RESULTS OF A CONTROLLED
INTERNATIONAL MULTICENTRE TRIAL
