CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
84
AFRICA
artery access in young children is associated with an increased proba-
bility of its closure or obstruction. Long-term administration of hepa-
rin is associated, in most cases, with a total arterial recanalisation.
1086: PERCUTANEOUS CLOSURE OF SHUNT FISTULAS
WITHTHEAMPLATZERVASCULAR PLUG IV IN PATIENTS
WITH CONGENITAL HEART DISEASE
Gesa Wiegand
1
, Ludger Sieverding
1
, Wolfgang Bocksch
2
, Michael
Hofbeck
1
1
University Children´s Hospital, Tuebingen, Germany
2
University Hospital of Tuebingen
Background:
Vascular plugs allow the interventional closure of large
to medium-sized abnormal vessels, but their application is limited by
the need for long sheaths or large guiding catheters. We report our
experiences with the newAmplatzer Vascular Plug IV (AVP IV). This
self- expanding spindle-shaped occluder is made of a nitinol wire
mash and it is possible to place it through a 4 to 5 French catheter
with a lumen of 0.038’.
Method and results:
From October 2009 until June 2012, 14 AVP
IV devices were deployed in 12 patients (age range 3 months to 48.8
years, weight 6.3–60.6 kg). Nine patients had venovenous or arterio-
venous collaterals in functional univentricular hearts. One patient had
pulmonary atresia with ventricular septal defect and major aortopul-
monary collateral arteries, one patient had a pulmonary arteriovenous
fistula and one child had a large coronary artery fistula. We used AVP
IV devices with diameters of 4–6 mm and 8 mm. In all 12 patients the
AVP IV was implanted successfully, in 2 patients 2 different vessels
were occluded with AVP IV devices and there was no occluder dislo-
cation. In 2/14 vessels it was necessary to place additional devices
in the presence of a residual shunt. Complete vessel occlusion was
achieved in 7 cases; in a further 7 patients a residual shunt was present
at the end of the procedure while patients were still fully heparinised.
There were no complications related to the procedure.
Conclusion:
Based on our experience, the AVP IV allows safe and
effective occlusion of medium-sized and large abnormal vessels. It
is also well suited for tortuous high-flow vessels such as coronary or
pulmonary arteriovenous fistulas. In case of suboptimal positions it is
possible to reposition the occluder with ease. The AVP IV represents
a valuable new device in the interventional treatment of complex
congenital vessel malformations.
1092: PRENATAL DIAGNOSIS OF MAJOR CONGENITAL
HEART DISEASE: COMBINING UK CENTRAL CARDIAC
AUDIT DATABASE AND MATERNITY AUDIT TO OBTAIN
CENTRE-SPECIFIC DETECTION RATES IN 120 198
SCREENEDWOMEN
Helena Gardiner
1, 2
, Alexander Kovacevic
1
, Laila van der Heijden
1
,
Joan Larovere
1
, Rodney Franklin
1
1
Royal Brompton NHS Foundation Trust, London, UK
2
Imperial College, London, UK
Background/hypothesis:
Foetal cardiac screening standards intro-
duced by NHS Foetal Anomaly Screening Programme for English
maternity units, 2010, have no current baseline data. In contrast,
prenatal diagnosis for infants undergoing transcatheter or surgical
treatment is routinely collected and validated by Central Cardiac
Audit Database (CCAD) (
). A national system is
vital to measure prenatal detection of major congenital heart disease
(CHD).
Material and methods
: A total of 120 198 unselected pregnant
women were screened in three maternity units referring to one surgi-
cal centre:
A: co-located with foetal medicine unit; ready access to second opin-
ion; training in major cardiac malformations
B: received on-site training and telemedicine support by perinatal
cardiologist;
C: supported by local obstetricians with scanning expertise
We cross-referenced maternity records and CCAD to include cases
unreported by obstetric screening.
Results
: Of 120 198 screened women, 388 cases of CHD were
documented; detection by unit (A,B,C): simple transposition of great
arteries (TGA) (78%, 50%, 0%) and coarctation (82%, 20%, 13%).
Conclusions:
Combining prenatal diagnosis (PD) with CCAD
produced maternity hospital and lesion-specific detection rates and
confirms that continued improvement in CHD detection depends on
integration of health information systems to enable tracking between
maternal and infant records.
1095: FOETAL LATERALITY DISTURBANCE: DO ATRIAL
APPENDAGES MATTER?
Caroline Jones, John Simpson, Shane Tibby, Owen Miller, Gurleen
Sharland
Evelina Children’s Hospital, London, UK
Background
: Laterality disturbance in the foetus is associated with
a wide spectrum of cardiac abnormalities. Many present prenatally
with complex morphology where single ventricle palliation is the
only management option after birth. The cumulative effect of associ-
ated lesions means many do not achieve Fontan completion long-
term. We report a large prenatal series describing their associated
malformations and review factors that influence their outcome.
Materials and methods:
We performed a retrospective search of our
foetal cardiology database from 1985 to 2010 for cases of laterality
disturbance. Pre- and postnatal management and long-term outcomes
were documented.
Results:
A total of 255 cases of laterality disturbance were identified.
Three cases were excluded as outcome data was not available. Of the
252 cases, 120 resulted in termination of pregnancy (TOP) and 16
intra-uterine death (IUD). Fifty-four patients remain alive, 20 with a
Fontan circulation; 2 patients have undergone cardiac transplantation.
In those receiving active treatment after birth, univentricular physiol-
ogy, complete heart block, total anomalous pulmonary venous drain-
age and right heart outlet obstruction were independent risk factors
for death or transplantation (
p
<
0.05).
Conclusions:
Prognosis remains poor for those with univentricular
physiology with an ongoing high risk of mortality throughout child-
hood. Survival in this group has not significantly changed across
the study period. Detailed prenatal assessment to identify specific
morphological features associated with poor prognosis may help
guide foetal counselling. In addition reduced quality of life remains
a serious concern for the few survivors.
1124: OUTCOMES OF AMPLATZER DUCT OCCLUDER II
(ADO II) DEVICE OCCLUSION OF PATENT DUCTUSARTE-
RIOSUS (PDA) – THE NORTHWEST EXPERIENCE
Atul Kalantre, Arul Narayanan, Arjamand Shauq, Gordon Gladman,
Ian Peart, Prem Venugopal, Edmund Ladusans
Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
Background
: The Amplatzer Duct Occluder II (ADOII) is a self-
expanding nitinol device for closure of patent ductus arteriosus
(PDA). This device is designed to produce high rates of occlusion
but there has been recent concern as to device deformability and
embolisation.
Objective
: To evaluate our experience of using the ADOII device and
document the closure rate and incidence of complications.
Method
: A retrospective analysis of data of patients on whom we
attempted closure of PDA using the new device from July 2008 to
June 2012 were included (
n
=
67).
Results
: Median (range) age was 20 (5–130) months and weight 10
(5.2–39) kg. The narrowest ductal diameter was 2.6 (1.5–4.9) mm,
length of duct 7 (3.3–17) mm, and diameter of aortic ampulla 7.7
(3–13) mm. Procedure time was 48 (22–114) min and fluoroscopy
time 7 (2.8–23.3) min. Krichenko classification of PDA morphol-
ogy: A
=
28 (42%), B
=
12 (18%), C
=
18 (27%), D
=
2 (03%), E
=
