CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
93
plasty procedure, grouped by severity as mild
<
20 mmHg, moder-
ate 20–40 mmHg, and severe
>
40 mmHg. Topics reviewed: age
at diagnosis, clinical manifestations (cardiac insufficiency (CI),
arterial hypertension (AH)), defect extension (localised, extensive,
isthmus hypoplasia), associations, initial treatment (catheterisation or
surgery), and long-term evolution. Multivariable statistical analysis t
test
p
<
:0.05.
Results
: Forty-seven p with AoCo post BCA were followed up.
Age at diagnosis was
<
1 month (11 p), 1-2 years (17 p) and
>
2
years (13 p); the median age at BCAwas 8
±
8 months. On clini-
cal examination 19 p had CI and 8 p AH; 1 p had AH without CI.
Electrocardiography revealed right ventricular hypertrophy in 13 p,
and left in 11 p. Associations included ventricular septal defect in 13
p (5 perimembranous, 7 muscular, 1 subaortic), ductus in 8, mitral
stenosis in 1, mitral insufficiency in 3, aortic insufficiency in 3, and
right aberrant subclavian artery in 1. Anatomic types: 41 p localised:
6 p membranous, 35 p fibromuscular; 1 p extensive; 7/47 p had hypo-
plasia of the transverse aortic arch. Severity was judged as moderate
in 18 p and severe in 29. BCA involved 52 procedures on 47 p; 44 p
had one BCA, 4 p had two BCA (2 p had native AoCo), 1 p had four
BCA, and 1 p needed a stent. The procedure was efficient in 38/47
p (80.8%), but not efficient in 8 p; 1 p died of cardiogenic shock
during the procedure. Pressure gradient post procedure: dropped
from 50
±
18 mmHg to 14
±
10 mmHg (
p
=
0.00). Recoarctation
(RC): Seventeen of 30 p with native AoCo, all
<
1 year old with CI,
had early RC X: 12
±
10 month; 2 p had small saccular aneurysms.
Four of 17 p had postoperative RC (23%); 1 p required a stent and 3
p another BCA.
Conclusion:
Angioplasty is an efficient recourse to solve complicat-
ed types of AoCo in infants (localised, without isthmus hypoplasia).
This procedure in infants has a high risk of recoarctation (57%) and
saccular aneurysms (4.2%). Therefore, except in those special situa-
tions, it is not recommended as the first therapeutic choice.
1437: A META-ANALYSIS ON THE EFFICACYAND SAFETY
OF TRANSCATHETER DEVICE CLOSURE OF VENTRICU-
LAR SEPTAL DEFECTS (VSD)
Swee Chye Quek, Bee Choo Tai, Lin Qi Yang
National University of Singapore
Background
: Advances in interventional techniques now allow for
transcatheter treatment of some VSDs. Widespread use of this option
is limited, unlike atrial septal defects (ASDs), to several factors, one
being concerns about adverse events. We performed a systematic
analysis to look at outcomes and complications associated with use.
Method
: A PubMed search for series in English on device closure
of VSD from 2003 to June 2012 was performed. We excluded small
series which were included in multicentre studies so as not to double
count, and also patients who had acquired VSD following myocardial
infarction. The random effect model was used to obtain pooled esti-
mates of success and complications.
Results
: A total of 37 publications comprising 4 406 patients with
VSDs (perimembranous 3 758 , muscular 419, intracristal 47, doubly
commited subarterial 36, multiple 16, post-surgical 123, unclassified
7) were included in this analysis. The age of patients ranged from 3
days to 84 years with the mean age ranging from 0.4 to 37.9 years
at the time of surgery. The pooled estimate of success of device
implantation was 96.6% (95% confidence interval (CI):95.7–97.5;
heterogeneity test
p
<
0.001). Complications included residual shunt,
rhythm abnormalities, valvular defects and others.
Discussion
: Our analysis suggests that transcatheter device closure
of VSD is safe and yields good results. However, this study does not
analyse different devices individually, and it does not segregate age
range and different VSD types.
Conclusion
: Transcatheter closure of VSD appears a feasible alterna-
tive to surgery (with very high success and low complication rates).
However, there are several complications which require attention.
Further data stratifying type of VSD, age range of patients and
prevention of complications would be useful before this can be
recommended for routine treatment of haemodynamically significant
VSD.
1441: FOETAL AORTIC VALVULOPLASTY TECHNICAL
ASPECTS AND FACTORS INFLUENCING POSTNATAL
OUTCOME
Joanna Dangel
1
, Marzena Debska
2
, Adam Kolesnik
1,3,
, Romuald
Debski
2
, Monika Kowalczyk
3
, Grazyna Brzezinska-Rajszys
3
, Andrzej
Kansy
3
1
Medical University of Warsaw, Poland
2
The Center of Postgraduate Medical Education
3
Children’s Memorial Health Institute
Objectives
: There are still many queries concerning foetal aortic
balloon valvuloplasty. The aim of this study was to evaluate early
experience and find the main factors influencing the postnatal
outcome.
Material and methods:
Between June
2011 and July 2012 foetal
aortic valvuloplasty was performed in 10 fetuses. Evolving hypo-
plastic left heart syndrome (HLHS) was diagnosed in 8, severe heart
failure with foetal hydrops in 2. The mean age of treatment was 24
weeks. Maverick2 catheters were used, with balloon size slightly
bigger than the aortic valve. Six procedures were performed under
general anaesthesia, 4 under mothers’ intravenous and foetal analge-
sia with fentanyl.
Results:
All aortic valves were successfully dilated, without major
complications during and just after the procedure. Pericardial punc-
ture was necessary in 2, and adrenaline injection in 2. One emergency
caesarean section was performed because of placental abruption on
the 2
nd
day after the procedure, 1 foetus died at the end of pregnancy
from obstetric causes. Two fetuses are still
in utero
. Aortic diameter
was within lower limits of normal in all children. Three neonates
with big left ventricles (LVs) and poor function had balloon valvu-
loplasty just after birth. Conversion to univentricular circulation was
attempted in two of them, the third is still a neonate. All three of them
had severe heart failure. Three Norwood operations were performed
without complications.
Conclusions.
Foetal aortic valvuloplasty is technically possible and
can be performed by an experienced team without major complica-
tions. Good aortic development was observed in all children, which-
made the Norwood procedure easier in neonates with HLHS ventri-
cles. Neonates with borderline left ventricles with high gradients
across the aortic valve were the most difficult group of patients. After
our early experience, we think that early aortic valve replacement,
i.e. neonatal Ross-Konno operation, should be considered to improve
long-term outcome after prenatal aortic valvuloplasty.
1467: FERP (FOETAL ECHOCARDIOGRAPHY REFERRAL
PROJECT): THE DISSEMINATION OF GUIDELINESAIMED
TO IMPROVE PROVIDER KNOWLEDGE
Sarah Heinonen
1,2,3
, Neda Mulla
2
, Jennifer Newcombe
2
, Sarah (Jodi)
Shaefer
3
1
University of Kansas Medical Center, Kansas, USA
2
Loma Linda University Medical Center-Children’s Hospital,
California, USA
3
Johns Hopkins University, Baltimore, Maryland, USA
Although clinical practice guidelines do exist regarding foetal
echocardiography referrals, these guidelines are often not utilised in
practice, partly because of lack of provider knowledge. The primary
purpose of this 6-week Quality Improvement (QI) Research Project
was to increase the knowledge of obstetrical providers on the guide-
lines for foetal echocardiography referrals. A 3-phase intervention
project using a non-experimental descriptive design methodology
was implemented, employing both pre- and post-project surveys to a
convenience sample of obstetrical providers within a 50-mile radius
of a specified Southern California zip code.
A paired-samples t test was used to evaluate the statistical signifi-
