CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
92
AFRICA
and outcomes were recorded.
Results:
From June 2011 to July 2012; 22 patients (11 females and
11 males) were assigned to percutaneous closure using Amplatzer
Duct Occluder II Additional Sizes (ADO II AS). Mean patients’
age was 9 months (range 1–60 months), and weight was 5.4 kg
(1.1–12.9). The QP:Qs ratio mean was 2.2 (1.1–4.89) and pulmonary
vascular resistance mean was 1.88 WU (0.12–7.12 WU). The ductal
size mean was 1.9 mm (0.6–3.2). Ten patients had Krichenko Type A
duct, 2 type B, 4 type C, 1 type D and 5 type E. The screening dura-
tion mean was 21.1 minutes (9–45.3). Nine patients were occluded
with ADO II AS 4 x 6 mm device; 8 with 5 x 6 mm; 2 with 3 x 6 mm;
1 with 3 x 4 mm; 1 with 4 x 2 mm and 1 with 5 x 2 mm. In 19 patients
the device was deployed via the pulmonary side and in 3 patients via
the aortic side. In one patient, the device dislodged to the pulmonary
arteries immediately following deployment, with successful retrieval.
Complete ductal occlusion was achieved in all (100%) other patients
(n
=
21) before discharge (day one).
Conclusion:
The ADO II AS is a safe and effective device for closure
of small ducts even in smaller infants. There is minimal risk for aortic
and pulmonary artery obstruction with the device.
1386:TRANSCUTANEOUSAORTICVALVE REPLACEMENT:
INITIAL EXPERIENCE IN A DEVELOPING COUNTRY
Stephen Brown, Hennie Theron, Edwin Turton, Coert De Vries,
Francis Smit, Johan Jordaan, Ruan Botha, Jacques van Rensburg
University of the Free State, Bloemfontein, South Africa
Aim
: Critical aortic stenosis is a common structural heart disease
in the elderly and symptomatic stenosis has a mortality of 50%
over 24 months. Surgery for this group carries 3–15% mortal-
ity. Transcutaneous aortic valve insertion (TAVI) is a non-invasive
alternative to surgery. The aim of this study was to assess the initial
experience of TAVI in a high risk aortic stenosis population of central
South Africa.
Methods
: Prospective study of all patients undergoing a TAVI proce-
dure over a 12-month period. Seventeen patients with a median age
of 79.6 yr (range 62.8–87.9) were included. Median aortic valve area
and gradient were 0.6 cm² (range: 0.5–1.5) and 70 mmHg (46–120),
respectively. Co-morbidities were present in all with a median
Euroscore of 15 and predicted Society of Thoracic Surgeons (STS)
mortality of 21.4%.
Results
: Vascular access was percutaneously gained in 16 and surgi-
cally in1 patient. All valves were successfully implanted: 26 mm
(6), 29 mm (7) and 31 mm (4). Procedure time ranged from 45 to
160 min. No procedural or peri-procedural deaths occurred. Aortic
valve peak gradient decreased significantly to a median of 0 mmHg
(range: 0–31) (
p
<
0.0001). Mean hospital stay was 3.9
±
1.3days.
Four patients (23%) required permanent pacemaker insertion. NYHA
class symptomatology improved significantly (
p
<
0.001) during
follow-up. There were 2 late deaths, not related to the procedure (78
& 93 days, respectively).
Conclusion
: Our results show that TAVI is feasible in our popula-
tion. The procedure is successful and follow-up shows that stable
device position is maintained in all patients. Clinical and haemody-
namic improvement could be demonstrated in all patients. Short-term
mortality and morbidity show that TAVI is an acceptable alternative
to conventional surgical valve replacement in this high-risk group of
patients.
1407: RADIOFREQUENCY ABLATION OF MULTIFOCAL
RIGHT ATRIAL TACHYCARDIA FACILITATED BY 3D
MAPPING AND ROBOTIC ASSISTANCE IN A PATIENT
WITH REPAIRED TETRALOGY OF FALLOT
Faizel Lorgat, Evan Pudney, Helena Van Deventer
Chris Barnard Memorial Hospital, Cape Town, South Africa
Background
: Patients with congenital heart disease often have
complex cardiac arrhythmias with extensive underlying substrate.
Significant structural variations in the underlying anatomy provide
further challenges to the success of ablation therapy. Cumulative
radiation exposure of the operator is an added concern.
Materials and methods
: A 50-year-old male patient with repaired
tetralogy of Fallot presented with incessant tachycardia and heart fail-
ure. The cardiac ejection fraction (EF) was reduced at 43%. A cardiac
electrophysiological study was performed and a multifocal right
atrial tachycardia was identified. A detailed 3D map of an enlarged
right atrium was generated using an integrated robotic sheath and RF
Ablation catheter (LYNX, Hansen Medical) and Ensite Velocity (St
Jude Medical). Arrhythmogenic foci were identified along the crista
terminalis and around the sinus node. The sinus node was carefully
tagged on the 3D map. Radiofrequency (RF) ablation was remotely
performed with precision guidance of the LYNX RF ablation catheter.
Results:
The arrhythmogenic foci were successfully ablated and
tachycardia was rendered non-inducible. Sinus node function was
unchanged post ablation. At 2-months follow-up the patient remains
in stable sinus rhythm and left ventricle (LV) function has recovered
completely with the EF now 60%.
Conclusion
: Ablation of complex and challenging cardiac arrhyth-
mias is greatly facilitated by 3D mapping and robotic assistance.
These technologies also improve safety and reduce operator fatigue
and radaition exposure.
1408: RADIOFREQENCY ABLATION OF SYMPTOMATIC
PREMATURE VENTRICULAR COMPLEXES (PVCS) IN
THE YOUNG PATIENT
Faizel Lorgat, Evan Pudney, Helena Van Deventer
Chris Barnard Memorial Hospital, Cape Town, South Africa
Background:
Although often benign, premature ventricular
complexes (PVCs) can cause severe symptoms in some patients and
may induce ventricular dysfunction. Drugs are frequently not effica-
cious in this condition and have major side-effects and toxicity which
is particularly relevant in the young patient.
Materials and methods:
Two young patients presented with symp-
tomatic high-grade PVCs. The first, a 21-year-old male patient was
almost permanently in a bigeminal rhythm with bizarre atypical
left bundle branch block (LBBB) morphology ectopics. The ensu-
ing compensatory pauses produced sinus bradycardia. The second,
a 10-year-old girl had 1233 PVCs per hour on Holter monitoring.
These had positive inferior axis and morphology consistent with a
right ventricular outflow tract (RVOT) source. Aside from mildly
dilated RVOTs on the echocardiogram, both had otherwise structur-
ally and histologically normal hearts as determined by right ventricle
(RV) angiography, cardiac magnetic resonance imaging (MRI) and
RV biopsy. Both patients underwent cardiac electro-physiology (EP)
studies. In the first patient, a 3D map was constructed and an activa-
tion map identified an arrhythmogenic focus on the free wall of the
RV adjacent to the tricuspid annulus. This was ablated with robotic
assistance. An arrhythmogenic focus was identified in the second
patient in the RVOT and manually ablated.
Results:
Both patients were rendered completely
asymptomatic off
all drug therapy. Follow-up ECG and Holter studies confirmed elimi-
nation of the PVCs.
Conclusion:
Radiofrequency ablation is an effective and safe treat-
ment of symptomatic PVCs in the young patient.
1428: ANGIOPLASTY PROCEDURE IN AORTIC COARCTA-
TION
Maria Fernanda Biancolini, Julio Cesar Biancolini, Victorio Lucini,
Adelia Marques, Ines Martinez, Judith Ackerman, Adriana Olive,
Jesus Damsky Barbosa, De Dios Ana
Hospital de Niños Pedro de Elizalde/Buenos Aires, Argentina
Background
: Follow up of patients (p) with aortic coarctation
(AoCo) post angioplasty (BCA) procedure.
Methods
: We performed retrospective analysis of 47 p post angio-
