CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
85
7 (10%). Devices used were 3/4 (12), 4/4 (30), 5/4 (15), 6/4 (3), 4/6
(3), 5/6 (2) and 6/6 (2). The venous approach was employed in all.
Echocardiography was done on D1 and 4-6 weeks post implantation.
One device was not deployed successfully. Complete angiographic
closure occurred in 55, trivial contrast flow in 10 and mild flow in
one patient. In 65 patients, echocardiography the next day and on
follow-up scan at 6 weeks showed no residual shunts. In one patient
mild flow was noted which resolved at 4 weeks. Three devices embo-
lised, 1 occurring within 6 hours and 2 the next day. There were no
procedure-related complications.
Conclusion
: ADOII is a safe and effective device for PDA occlusion
and has a high early closure rate and low embolisation rate.
1133: IMPROVED LONG TERM OUTCOME IN PATIENTS
UNDERGOING PERCUTANEOUS PULMONARY VALVE
IMPLANTATION AT AYOUNGER AGE
Sharon Borik
1
, Rajiv Chaturvedi
1
, Kyong Jin Lee
1
, Mark K Friedberg
1
,
Brian W McCrindle
1
, Andrew Crean
2
, Marc Osten
2
, Eric M Horlick
2
,
Lee N Benson
1,2
1
Hospital for Sick Children, Labatt Family Heart Centre, Toronto,
Canada
2
Toronto General Hospital, Peter Munk Cardiac Centre, Toronto,
Canada
Background/hypothesis:
Percutaneous pulmonary valve implanta-
tion (PPVI) has become increasingly accepted as a safe, less invasive
alternative to surgical pulmonary valve replacement for congenital
heart disease patients with right ventricular outflow tract dysfunction.
Several series have demonstrated favourable short-term outcome
after PPVI. The aim of this study was to determine if reverse right
ventricle (RV) remodelling following PPVI is persistent in the long
term and whether earlier timing of PPVI may be favourable.
Methods:
PPVI patients from Hospital for Sick Children (HSC) and
Toronto General Hospital (TGH) were studied. Cardiac magnetic
resonance imaging (MRI), echocardiography, metabolic exercise
testing, and haemodynamics prior to intervention were compared to
repeat measures on follow-up, using paired
t
tests and linear regres-
sion models assessing changes over time.
Results:
Fifty-one patients were followed for up to 6.6 (4.2
±
1.9)
years after PPVI, including 35 HSC patients, averaging 14.8
±
8.9
years of age at intervention and 16 TGH patients, 32.0
±
2.1 years
old at implantation. Freedom from re-intervention was 87% and
68% at 3 and 5 years, respectively, and 92% from re-operation at 5
years. Younger age at implantation was associated with an increase of
4.17
±
1.29%/10 years of age in echo left ventricle ejection fraction
(LVEF) (
p
=
0.001), 0.23
±
0.10 points (on a 3-point scale) per 10
years in qualitative RV function (
p
=
0.03), 2.68
±
0.90 ml/kg/min per
10 years in max VO2 (
p
=
0.003) and a decrease of 0.81
±
0.19 cm
per decade in RVED (
p
<
0.001). Preparing the conduit for implanta-
tion (prestenting) yielded an increase of 5.32
±
1.95% in LVEF (
p
=
0.006) and 0.63
±
0.18 points in RV function (
p
<
0.001) as well as
a decrease of 0.80
±
0.30 cm in RVED (
p
=
0.007) and 8.77
±
3.39
mmHg in RV systolic pressure (
p
=
0.01).
Conclusions:
This is the largest series to show that PPVI at a young-
er age has improved long-term outcomes. Strategies to preserve right
ventricular function should be considered in management planning
for this population.
1154: TRANSCATHETER CLOSURE OF PERSISTENT
DUCTUS ARTERIOSUS AT CIPTO MANGUNKUSUMO
HOSPITAL JAKARTA: CLINICAL CHARACTERISTIC AND
OUTCOME
Suprohaita Budiyarso, Mulyadi Djer, Sukman Putra
University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
Background:
Transcatheter closure of persistent ductus arteriosus
(PDA), as alternative to PDA ligation, has shorter hospital stays,
fewer major complications, and comparable success rates. Studies
suggest a success rate of 90% to 99% for transcatheter closure of
PDA, with the higher success rates being associated with newer
devices.
Methods:
A descriptive analysis was done in 285 consecutive
patients with diagnosis of small to moderate PDA (279 patients) and
residual PDA after PDA ligation (6 patients) from January 2002 to
July 2012 who underwent transcatheter closure of PDA. Data were
collected from medical records and analysed by descriptive statistics.
Results:
From January 2002 to July 2012, 285 patients had transcath-
eter closure of PDA. The median of age was 3.5 years (40 days to 37
years). One hundred and ninety-seven of the patients were female
(69.1%) and median weight was 12 (3.6–59) kg. Median size of PDA
was 3.6 (1–15.6) mm. Amplatzer Ductal Occluder I (ADO I) was
used in 259 (90.9%) patients; median size of ADO I device was 6/8
(4/6–14/16) mm. Other devices were Gianturco coil (5.6%), ADO II
(1.8%), pfm nit coil (1.1%), and Amplatzer septal occluder (0.4%).
The median of flow ratio was 1.8 (0.6–14.5), fluoroscopy time was
15.4 (2.3–80) minutes, and procedure time was 76 (30–198) minutes.
Median length of hospital stay was 3 (3–4) days. Overall success
rate was 99.3% and 98.2% of patients had no major complications.
Transient bradycardia occurred in 3 patients and migration of device
in 2 patients. Evaluation of echocardiography showed most patients
had complete closure of PDA. Almost all of them were discharged
one day after procedure.
Conclusions:
Transcatheter closure of PDA is a safe and effective
alternative to surgery. This procedure has a high success rate, short
length of stay in hospital, and minimal complications.
1181: FOETAL CARDIAC DISEASE AND FOETAL LUNG
VOLUME: AN IN UTERO MRI INVESTIGATION
Elisabeth Mlczoch
1
, Lisa Schmidt
1
, Maximilian Schmid
2
, Gregor
Kasprian
3
, Daniela Prayer
3
, Ina Michel-Behnke
1
, Ulrike Salzer-
Muhar
1
1
Pediatric Heart Center, Department of Pediatrics and Adolescent
Medicine, Vienna, Austria
2
Department of Obstetrics and Gynecology, Division of Obstetrics
and Fetomaternal, Vienna, Austria
3
Department of Radiology, Division of Neuroradiology and
Musculosceletal, Vienna, Austria
Background:
Foetal magnetic resonance imaging (MRI) has become
a good non-invasive tool to study foetal lung volumes after 18 gesta-
tional weeks
in vivo
. In foetuses with congenital heart disease (CHD)
proper lung function is essential for postnatal survival. Pulmonary
hypoplasia is associated with high morbidity and mortality. Antenatal
detection of abnormal pulmonary development may help to optimise
pre- and perinatal management of the foetuses at risk. The aim of our
study was to investigate foetal lung volume in foetuses with prena-
tally diagnosed heart disease.
Material and methods:
A cross-sectional retrospective study of
105 consecutive singleton pregnancies that underwent MRI was
performed. The heart defects were divided into 4 groups and
compared within the groups, and also with a normal collective. To
compare the lung volumes we calculated z-scores (normal range:
z-score -2 to +2). Our focus of interest was the lung volume of
foetuses with heart disease, compared to healthy foetuses and to
calculate z-scores for these foetuses.
Results:
Foetuses with CHD have significantly smaller lung volumes
compared to healthy foetuses corrected by gestational age (
p
=
0.049). No difference was found within the specific groups. Z-scores:
18/105 foetuses had lung volumes with a z-score
<
-2.
Conclusion:
Foetuses with CHD show similar lung volume within
different types. Our data might indicate that postpartum pulmonary
symptoms in neonates with CHD may have contributed more to the
lower lung volume than to the cardiac disease itself.
