CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
86
AFRICA
1184: PRIMARY STENT THERAPY FOR SHUNT MALFUNC-
TION IN INFANTS
Nancy Dobrolet
1
, Robert Hannan
1
, Redmond Burke
1
, Michael Lopez
1
,
Evan Zahn
2
1
Congenital Heart Institute at Miami Children’s Hospital, Miami,
USA
2
Cedars-Sinai Medical Center, Los Angeles, USA
Background:
Stent therapy (ST) for BT shunt malfunction (SM) is a
viable alternative to surgical shunt revision. In our institution, ST is
the preferred method of treatment for SM.
Methods:
A retrospective analysis of all infants with suspected SM
was performed including demographics, catheterisation findings,
intervention type, survival to second operation and evidence of
bacteraemia.
Results:
Seventeen patients (pts) presented with SM (s/p Norwood
(5), Damus-Kaye-Stansel/shunt (12)) with a median age and weight
of 31 days (7d - 2 yrs) and 3.2 kgs (2.6 - 14.2) kg. Five pts presented
to the lab requiring mechanical cardiopulmonary support. Primary
ST was attempted in 15/17 pts with technical success in all 15 pts.
One pt underwent primary angioplasty and one patient arrested
during the diagnostic part of the case and underwent emergent surgi-
cal revision. Both of these patients survived to second operation. Of
15 stented pts, 4 (26%) died prior to discharge; 2 arrived at the lab
requiring mechanical support, and 2 had pre-existing bacteraemia.
All remaining ST patients (11/15 (73%)) survived to second opera-
tion, resulting in overall survival to second operation of 77% (13/17).
Aetiology of SM included discrete stenosis (12), thrombus (3), or a
diffusely small shunt (2). Stenosis at the distal shunt anastomosis
occurred in 10/12 patients, 3 of whom also had evidence of thrombus
within the shunt. Two patients with diffusely small shunts underwent
successful primary stenting with enlargement of overall shunt diam-
eter, both surviving to second operation.
Conclusions:
A programmatic approach of primary stent therapy
for SM in infants has a high technical success rate and acceptable
survival to second planned operation. Discrete stenosis most often
occurs at the distal anastomosis and may be associated with throm-
bosis. Pre-existing bacteraemia and/or requirement for mechanical
circulatory support prior to ST were associated with high mortality
in this small series.
1187: FOETAL SUPRAVENTRICULAR TACHYCAR-
DIA (SVT): COMPARISON OF TWO DRUG TREATMENT
PROTOCOLS
S Sridharan
1
, I Sullivan
1
, V Tomek
2
, J Wolfenden
1
, J Škovránek
2
, R
Yates
1
, J Marek
1, 2
1
Great Ormond Street Hospital, London, UK
2
University Hospital Motol, Prague, Czech Republic
Background
: The best treatment for sustained foetal SVT with 1:1
atrioventricular relationship is not known. We compared 2 treatment
protocols.
Methods
: A total of 155 consecutive foetuses with supraventricular
tachyarrhythmia presented from 2000 to 2012; 127 had SVT with 1:1
atrioventricular conduction, and 86 received drug treatment accord-
ing to one of two protocols: first-line maternal intravenous digoxin
(
n
=
52, centre 2), or maternal oral flecainide (
n
=
34, centre 1).
Treatment success was defined as live birth after conversion to sinus
rhythm, or rate reduction by
>
15%.
Results
: Short ventriculo-atrial (VA) interval occurred in 69 and long
VA in 17. Median age at start of treatment start was 31 weeks’ gesta-
tion in each centre. Hydrops was present in 30/86 (35%). Digoxin
was successful in 23/28 (82%) and flecainide in 26/27 (96%,
p
=
0.19) of non-hydropic fetuses, compared to 8/21 (38%) and 6/7
(86%,
p
=
0.07) respectively when hydrops was present. For short VA
SVT, conversion to sinus rhythm and rate control was 31/44 (70%)
and 0/44 for digoxin, and 23/25 (92%) and 1/25 (cumulative 96%,
p
=
0.01) for flecainide. For long VA SVT, conversion to sinus rhythm
and rate control was 4/8 (50%) and 0/8 for digoxin, and 5/9 (55%)
and 2/9 (cumulative 78%,
p
=
0.3) for flecainide. Second-line drug
treatment was added to digoxin in 19/52 (37%), and to flecainide in
2/34 (6%,
p
=
0.002).
Intrauterine or neonatal death occurred in 9/21 (43%, including 1
termination) hydropic foetuses treated with digoxin compared to 0/9
(
p
=
0.03) of those treated with flecainide.
Conclusions
: Flecainide was more effective than digoxin in short VA
SVT, especially when hydrops was present. Additional treatment was
used more often in the digoxin protocol. No adverse foetal outcomes
were attributed to flecainide.
1188: FOETALATRIAL FLUTTER: COMPARISON OF DRUG
TREATMENT PROTOCOLS
S Sridharan
1
, V Tomek
2
, J Marek
1,2
, J Wolfenden
1
, J Škovránek
2
, R
Yates
1
, I Sullivan
1
1
Great Ormond Street Hospital, London, UK
2
University Hospital Motol, Prague, Czech Republic
Background
: The best treatment for sustained foetal AFl, defined as
regular atrial rate
>
200 bpm and faster than the simultaneous ventric-
ular rate, is not known. We compared drug treatment protocols.
Methods
: Of 155 consecutive foetuses with supraventricular arrhyth-
mia, presenting from 2000 to 2012, 28 had AFl; 25 received drug
treatment according to one of two drug protocols: digoxin
±
sotalol/
other drug (n
=
16, centre 2), or digoxin
±
flecainide (n
=
9, centre
1). Treatment success was defined as conversion to sinus rhythm.
Results
: Hydrops was present in 7/16 (44%) in centre 2, and in 1/9
(11%, p 0.18) in centre 1. Median age at treatment was 32 weeks’
gestation in centre 2 and 31.4 weeks’ gestation in centre 1 (
p
=
0.96).
In non-hydropic fetuses, sinus rhythm occurred with digoxin mono-
therapy in 7/17 (41%), with digoxin + flecainide in 1/17 (cumula-
tive 47%), and with digoxin + sotalol in 1/17 (cumulative 53%). In
hydropic foetuses, sinus rhythm occurred with digoxin monotherapy
in 3/8 (38%), with digoxin + sotalol in 2/8 (cumulative 63%), digoxin
+ sotalol + amiodarone in 1/8 (cumulative 75%), and with digoxin
+ propranolol in 1/8 (cumulative 88%). Hydrops was present in 1/9
(11%) of foetuses with sustained AFl compared to 7/16 (44) of those
converting to sinus rhythm (
p
=
0.18). Intrauterine death did not
occur (0/8 hydropic foetuses, 95% confidence interval (CI) 0–0.37).
Gestation at delivery was median 38 (range 31–39) weeks’ gestation.
Conclusions
: Surprisingly, hydrops did not reduce the likelihood of
conversion to sinus rhythm, raising the possibility that the natural
history of foetal AFl may be more important than a drug effect.
Hydrops was also well tolerated
in utero
in comparison to foetal
supraventricular tachycardia with 1:1 atrioventricular relationship,
possibly because of later onset of AFl and more favourable atrioven-
tricular coupling.
1196: TRANSCATHETER CLOSURE WITH USE OF THE
CARDIO-O-FIX OCCLUDERS IN 153 PATIENTS WITH
CONGENITAL AND STRUCTURAL HEART DEFECTS.
Jacek Bialkowski, Malgorzata Szkutnik, Roland Fiszer
Medical University of Silesia, SCCS Zabrze, Poland
Introduction
:
Transcatheter closure of different congenital heart
disease (CHD) with the use of nitinol wire mesh occluders has been
widely accepted as preferred treatment; however, the high cost of
these devices limits their clinical application in many countries. Few
clinical data are available regarding lower-cost products.
Aim
.
We evaluated the efficacy and safety of CARDIO-O-FIX
occluders (COF) type: patent ductus arteriosus (PDA), atrial septal
defect (ASD),and patent foramen ovale (PFO).
Materials and method
:
From September 2009 to August 2012
a total of 153 patients (pts) with congenital and structural heart
defects (ages 0.5–72 years) underwent transcatheter closure with use
of different COF occluders: 63 pts - PFO, 36 - ASD, 47 - PDA ,6 -
ruptured sinus of Valsalva aneurysm (SOVA) and one coronary artery
fistula to right ventricle (CAF). Patients with PFO had cryptogenic
