CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
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AFRICA
inability to predict this complication. Valve tears not related to cata-
strophic MR are incompletely studied. The mechanisms underlying
MV tears are presumably common to both these scenarios, creating
an opportunity to study predictors of MV tears in this cohort.
Materials and methods:
Forty-five consecutive patients undergoing
PBMV (Inoue-technique) with pre- and post-PBMV digital echocar-
diographic images available were assessed. Patients with a clearly
identifiable tear of the mitral leaflets or apparatus (MVA) were
identified. The mechanism and severity of MR pre- and post PBMV
were evaluated. We recorded detailed morphological descriptions of
each case; including Massachusetts General Hospital score (MGHS),
parameters quantifying subvalvular involvement, detailed leaflet
edge and commissural assessment and tear location.
Results:
Twelve patients (26.7%) developed clearly identifiable tears
of the MVA; 3 patients (6.7%) had catastrophic tears necessitating
early surgery. All patients developed moderate or greater MR from
their tears. The mean MGHS was 9.5 with subvalvular thickening
(3.5) and calcification (2.33) contributing most. Tear location: ante-
rior leaflet 6; posterior leaflet 5; subvalvular 1. Nine of 11 leaflet
tears were located in a thin, calcium-free area of the leaflet adjacent
to an area of significant calcification. Six of 7 tears that occurred
laterally (not centrally) were located on the side of the most severe
subvalvular involvement.
Conclusions:
Non-catastrophic MVA tears related to PBMV are
more common than previously thought. Longitudinal follow-up of
this cohort is required to evaluate outcomes in patients who develop
non-catastrophic tears post-PBMV. An interesting interplay appears
to exist between the morphology at the edge of the MV leaflets,
where tears presumably start, and factors that restrict free movement
of leaflet segments. This is being assessed in an ongoing study.
1229: FOETAL BRADYCARDIA AND SINUS NODE
DYSFUNCTION
Nathalie Jeanne M Bravo-Valenzuela
Taubate University, Brazil
Introduction
: Sinus node dysfunction is a common condition in
elderly patients or those with postoperative congenital heart disease.
It is characterised by an abnormality of cardiac impulse formation.
In this report I present a rare case of foetal bradycardia and sinus
node dysfunction.
Case description
: A 26-year-old pregnant patient was referred
because of persistent foetal bradycardia after obstetric ultrasonogra-
phy. The 23 weeks’ gestation echocardiogram showed sinus brady-
cardia (heart rate (HR) 80–87 bpm) with normal conduction time
from the atria to the ventricles (1:1) and normal anatomy. Follow-up
echocardiograms performed at 29, 32, 35 and 38 weeks’ gestation
showed profound bradycardia (HR 53–62 bpm) with no hydropsy
or blocked atrial extrasystoles. Maternal antibody titres for SS-A/
SS-B and the screen for QT long syndrome were negative. A female
infant was born by caesarean section at 39 weeks’ gestation and had
Apgar scores of 8/8. After birth, the baby developed profound brady-
cardia (HR 50 bpm), poor perfusion, and signs of shock. Atropine
and isoproterenol were administered intravenously to the patient
with no significant improvement in HR (55–60 bpm). The initial
ECG showed junctional rhythm at 55 bpm, normal QTc (0.42 s),
atrial extrasystoles, and variable second-degree atrioventricular (AV)
block. A 24-hour ECG and oesophageal ECG allowed the diagnosis
of sinus node dysfunction to be confirmed. The echocardiogram
demonstrated two small ostium secundum atrial septal defects.
Possible sinus bradycardia causes were dismissed, thus confirming
the above diagnosis. The baby developed oliguria and heart failure
at which time the implantation of a pacemaker was indicated. The
surgery was successful, and the patient is currently growing and
thriving at 24 months of age.
Conclusion:
The author reports the importance of foetal echocardi-
ography for the diagnosis and appropriate therapy approach to avoid
complications.
1233: SUCCESSFUL CONSERVATIVE TREATMENT FOR
HAEMOLYSIS AFTER TRANSCATHETER CLOSURE OF
VENTRICULAR SEPTAL DEFECT (VSD) USING NIT-
OCCLUD
®
LÊ VSD OCCLUDE
Supaporn Roymanee
1
, Worakan Promphan
2
, Nakharin Tonklang
1
,
Kanjarut Wongwaitaweewong
1
1
Prince of Songkla University, Hat Yai, Thailand
2
Queen Sirikit National Institute of Child Health College of Medicine,
Rangsti University, Bangkok, Thailand
Background:
We report a haemolysis-associated transcatheter VSD
closure using Nit-Occlud
®
Lê VSD occluder (LVO) that led to tran-
sient renal failure and recovery by conservative treatment.
Case:
A 1-year-old (8 kg) boy with an underlying disease of cri
du chat syndrome underwent transcatheter VSD closure. An LV
angiogram revealed a large perimembranous VSD with a tricuspid
pouch (11 mm). Initially, a Cocoon Duct Occluder (CDO) (12/14)
was placed, resulting in mild aortic regurgitation. A CDO (6/8) was
placed instead but resulted in a residual moderate shunt. When an
LVO coil (12/6) was used instead of the CDO it showed another RV
exit (5 mm). We placed a second LVO coil (8/6) into that exit. A
repeat LV angiogram revealed a trivial residual shunt. Unfortunately
the LVO coil (12/6) became stuck during deployment, but it was
retrieved and another LVO coil (10/6) was placed instead. After the
4-hour procedure, the result was a mild residual shunt. Unfortunately,
the patient did not gain full consciousness when weaned off anaes-
thesia. An emergency craniotomy and clot removal was done after
a competd tomography (CT) brain scan showed a large subdural
haematoma. In the intensive care unit (ICU) his dark brown urine
suggested haemolysis, which was confirmed by urinalysis. Because
of the complicated procedure, we avoided unnecessary intervention.
Our strategy for the haemolysis was aspirin cessation, IV hydration,
alkalinisation of urine and to maintain the haemoglobin
>
12 g%.
His baseline blood, urea, nitrogen (BUN)/creatinine was 14.1/0.32
mg%, which increased slowly in the first 10 days then rose rapidly
to 31.2/0.57 mg% within 1 day after the IV fluid was unintentionally
withdrawn. We re-administered our strategy plus dexamethasone.
The next day his BUN/Cr dramatically declined to 17/0.35 mg%.
Gradually his renal functions resolved within 4 days.
Conclusion:
In some circumstances, haemolysis can be overcome
by conservative treatment to avoid redoing percutaneous or surgical
closure.
1255: NORMAL GROWTH OF FOETAL CARDIOTHORACIC
STRUCTURES DURINGTHE LATE FIRST/ EARLY SECOND
TRIMESTERS
Angela McBrien
1
, Lisa Howley
1
, Yuka Yamamoto
1
, Akiko Hirose
1
,
Priya Sekar
1
, Venu Jain
2
, Tarek Motan
2
, Jean Trines
1
, Winnie Savard
1
,
Lisa Hornberger
1
1
Fetal & Neonatal Cardiology Program, Division of Cardiology,
Department of Pediatrics, University of Alberta, Edmonton, Alberta,
Canada
2
University of Alberta, Edmonton, Alberta, Canada
Background/hypothesis:
Foetal echocardiography is used increas-
ingly early in pregnancy to screen for congenital heart disease
(CHD). Data are lacking for normal growth of the foetal heart in
the late first/early second trimester. Foetal weight increases in a
non-linear fashion and we hypothesise that growth of cardiothoracic
structures is also non-linear.
Materials and methods:
A total of 197 healthy pregnant women
were prospectively recruited to have detailed echocardiography
between 8 and 14 + 6 weeks’ gestation. Atrial, ventricular, heart,
chest, pulmonary artery and ascending aorta dimensions were meas-
ured. Statistical analysis included ANOVA.
Results:
There was non-linear growth of all measured structures,
with faster growth after 12 weeks’ gestation. From 8 to 10 + 6 weeks’
gestation, 95% (20/21) had a pericardial effusion. Heart and atrial
size relative to chest size decreases significantly over time. There is
