CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
87
stoke in anamnesis and confirmed right-to-left shunt through PFO.
Mean diameter of ASD was 21 mm, PDA 4.1 mm, SOVA 10.0 mm
and CAF 6 mm.
Results
:
All procedures were successful. In one PFO case COF was
withdrawn because of the unusual position of the device caused by
long tunnel (27 mm) of PFO; application of ASD COF was efficient
in this case. In all cases complete closure of undesirable connections
was achieved without any complications at follow-up (1–35 months).
In ASD mean diameter of applied devices was 20 (10–28 mm), for
PFO mostly 25/18 mm devices were used, for PDA devices 4/6 to
10/12, for SOVA PDA COF 10/12 to 16/18 and for CAF PDA COF
8/10 mm
Conclusions
:
These results suggest that the COF are safe and effec-
tive devices for the transcatheter closure of CHD. For confirmation a
randomised controlled trial with more patients and longer follow-up
is warranted.
1205: MID-TERM FOLLOW-UP RESULTS OF TRANSCATH-
ETER TREATMENT IN PATIENTS WITH UNROOFED
CORONARY SINUS
Jou-Kou Wang, Shy-Jye Chen, Jui-Yu Hsu, Su-Man Lin, Ming-Tai
Lin, Shuenn-Nan Chiu, Chun-An Chen, Mei-Hwan Wu
National Taiwan University Hospital, Taipei, Taiwan
Objectives
: We present the mid-term results of transcatheter treat-
ment of unroofed coronary sinus (CS) using the Amplatzer septal
occluder.
Background
: The unroofed CS is a rare atrial septal defect connect-
ing the left atrium and CS. Surgery has been the mainstay of treat-
ment.
Methods
: In a 4.5-year period, 9 patients (5 males) with ages ranging
from 26 to 69 years (median 39 years) diagnosed with an unroofed
CS but without a persistent left superior vena cava (PLSVC) under-
went transcatheter treatment. Computed tomography (CT) was
performed in 8 patients. Transoesophageal echocardiography (TEE)
was used to monitor the procedure.
Results
: The mean Qp/Qs ratio was 2.4
±
1 and mean systolic
pulmonary artery pressure was 35
±
19 mmHg. An Amplatzer septal
occluder was deployed in all 9 patients. The device was implanted in
the defect in 1 patient and at the CS ostium in the other 8 patients.
The median device size used was 22 mm (16–28 mm). The left
disc herniated into the CS in the single patient in whom the device
was implanted within the defect. All patients were available for
the 3-month follow-up. None had a residual shunt on the 3-month
follow-up echocardiography. One patient died of a stroke 4.5 months
after the procedure. At mean follow-up 42.6
±
18.3 months, sympto-
matic improvement was documented in the remaining 8 patients. All
8 patients had an O
2
saturation above 96 %.
Conclusions
: Transcatheter treatment for unroofed CS without
PLSVC using the Amplatzer septal occluder is safe and feasible.
1213: ASSESSMENT OF THE DUCTUS ARTERIOSUS IN
FOETUSES WITH RIGHT VENTRICULAR OUTFLOW
TRACT OBSTRUCTION AND VENTRICULAR SEPTAL
DEFECT
Giulia Tuo, Davide Buzzi, Maurizio Marasini
Cardiology Unit, G Gaslini Institute, and University of Genoa,
Genoa, Italy
Objectives:
To describe the ductus arteriosus (DA) in foetuses with
right ventricular outflow tract obstruction (RVOTO) and anteriorly
malaligned ventricular septal defect (VSD).
Background:
Foetuses with RVOTO may develop significant cyano-
sis after birth.
Prenatal diagnosis may improve the early postnatal
management approach. Although prenatal detection of RVOTO
has already been reported, there is lack of information on ductal
morphology and ductal blood flow pattern, during pregnancy and
after birth.
Patients and methods:
The department registry was retrospectively
searched
for all patients born between January 2006 and June 2012
with a prenatal diagnosis of RVOTO and VSD. RVOTO was consid-
ered severe if pulmonary artery/aortic diameter ratio was
≤
0.5 and
pulmonary circulation was ductus dependent. Foetuses with pulmo-
nary atresia or absent pulmonary valve syndrome were excluded.
Results:
Out of 50 foetuses,
33 had tetralogy of Fallot (TOF) (66%)
and 17 (34%) had double outlet right ventricle with subaortic VSD.
Five (10%) foetuses had severe RVOTO with reverse flow across
the DA; parents opted for termination of pregnancy (TOP) in 2
cases and the other 3 liveborn infants underwent modified Blalock
Taussing (mBT) shunt. Thirty-three (66%) foetuses had mild RVOTO
with normal ductal morphology and flow pattern; there were 9 TOP
and 2 neonatal deaths for extracardiac reasons. Twelve (24%) more
foetuses had mild to moderate RVOTO but very small ductus with
changeable flow pattern, spontaneously closed immediately after
birth. Two of them developed severe hypoxic spells respectively at
birth and during the first month of life and both had mBT shunt.
Conclusion:
In less severe degrees of RVOTO, flow across the DA
would be reduced and ductus diameter would be decreased even up
to prenatal closure. Ductal morphology assessment may be useful for
improving management of neonates with prenatal mild to moderate
RVOTO and small DA who may become cyanotic at birth.
1221:THEAMPLATZER DUCT OCCLUDER IIADDITIONAL
SIZES DEVICE FOR TRANSCATHETER PATENT DUCTUS
ARTERIOSUS CLOSURE: INITIAL EXPERIENCE
Elchanan Bruckheimer, Max Godfrey, Tamir Dagan, Gabriel Amir,
Georgy Frenkel, Einat Birk
Schneider Children’s Medical Center Israel, Petach Tikva, Israel
Background
: Effective and safe patent ductus arteriosus (PDA)
transcatheter closure requires a device suited to the specific ductal
anatomy which is appropriate for the patient size. The newAmplatzer
Duct Occluder II Additional Sizes (ADOIIAS) device is designed
with a range of diameters (3–5mm) and lengths (2–6mm) and small
disks to avoid flow disturbance in the aorta and pulmonary artery.
Materials and methods
: Population: All patients who underwent
attempted closure with an ADOIIAS device. Following aortography
the PDA was closed using a 4-5 Fr delivery system from the pulmo-
nary or aortic approach with an ADOIIAS of waist
≥
1.5 times the
narrowest part of the PDA. Aortography to confirm position and leak
was performed before and after device release. Echocardiography
was performed the following day.
Results
: Between June 2011 and August 2012, 45 consecutive patients
(25 female), median age 3.3 years (0.6–15.8) and weight 14.5kg (4–79),
underwent PDA closure with an ADOIIAS device. In 42/45 (93.3%) a
device was successfully deployed (38 aortic). At echocardiography the
next day 41/42 (97.6%) of PDA were closed; in 1 case there was a tiny
residual leak. In 3 patients the ADOIIAS was unstable and an alterna-
tive device was implanted. The mean ratio of ADOIIAS:PDA diameter
was 2.4 (
±
0.52):1. There were no complications.
Conclusions
: We present a large initial clinical experience with the
new ADOIIAS device which is easily implanted from the aortic side
and is safe and effective for PDA closure. The variety of sizes affords
intuitive suiting of the device to the specific PDA anatomy.
1224: IDENTIFYINGPREDICTORSOFMITRALVALVE (MV)
TEARS RESULTING FROM PERCUTANEOUS BALLOON
MITRAL VALVULOPLASTY (PBMV): A DESCRIPTIVE
STUDY BASED AT TYGERBERG ACADEMIC HOSPITAL
Jonas Bovijn, Anton (A F) Doubell, Phillip (P G) Herbst
1
Division of Cardiology, Department of Medicine,TygerbergAcademic
Hospital and Stellenbosch University, Cape Town, South Africa
Background/hypothesis:
Despite selection and procedural refine-
ment for PBMV, the rate of catastrophic mitral regurgitation (MR)
from mitral valve (MV) tears remains fixed at
±
5%, reflecting our
