CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
94
AFRICA
cance of pre- and post-project obstetrical provider scores. Study
findings indicated a positive correlation between the use of an educa-
tion intervention, implemented by an advanced practice nurse and
her team, utilising a multi-modal approach and increased provider
knowledge on foetal echocardiography guidelines.
1482: STENTING THE PATENT DUCTUS ARTERIOSUS IN
NEONATES WITH CRITICAL CONGENITAL CYANOTIC
HEART DISEASE IN A DEVELOPING COUNTRY
Stephen Brown, Carri-Lee Greig, Daniel Buys, Francis Smit
University of the Free State, Bloemfontein, South Africa
Background
: Critical cyanotic heart disease in newborns is life-
threatening and difficult to manage. Systemic to pulmonary artery
shunts are used as temporary palliative interventions. This is associ-
ated with increased morbidity and mortality. Patent ductus arteriosus
(PDA) stenting has been introduced as a non-surgical alternative.
The aim of this study was to determine the short- and medium-term
outcomes of PDA stenting in neonates with duct-dependent pulmo-
nary circulations in central South Africa.
Materials and methods
: Sixteen neonates with duct-dependent
pulmonary circulation requiring PDA stenting were included in a
retrospective review from September 2005 to March 2012. In 3 cases
stenting was not performed because of inability to obtain vascular
access. Stenting was performed via the femoral artery and/or vein.
Standard balloon expandable coronary bare metal stents were used off-
label. Follow-up included clinical assessment and echocardiography.
Results
: Thirteen cases were successfully stented at first attempt.
Five underwent concomitant Rashkind septostomy. Diagnoses
consisted of pulmonary atresia (
n
=
9) and tricuspid atresia (
n
=
4). Median age at procedure was 2 days (range 0–23) and median
weight 3.0 kg (1.5–4.3). Number of stents used were 1 (
n
=
3), 2 (
n
=
9) and 3(
n
=
1). Implanted stent diameters were 3.5 mm (
n
=
4), 4
mm (
n
=
7), 4.5 mm (
n
=
1) and 5 mm (
n
=
1). Median saturations
were 80% (52–92) pre-procedure and 90% (64–97) post-procedure
(
p
=
0.07). Periprocedural complications included stent migration
into pulmonary artery (
n
=
1), femoral artery compromise (
n
=
1)
and temporary dysrhythmia (
n
=
3). There was no periprocedural
mortality. All patients received low-dose acetylsalicylic acid follow-
ing the procedure. At last follow-up (median 136 days; range 7–334),
balloon angioplasty (
n
=
1) and restenting (
n
=
1) of stenotic stents
had been performed. Three cases had proceeded to palliative surgery.
Four cases had demised at a median of 9.5 days (7–14) post-proce-
dure, secondary to septicaemia (
n
=
1), airway obstruction(
n
=
1),
pneumonia(
n
=
1) and severe hypertrophic cardiomyopathy (HOCM)
(
n
=
1). All deaths were unrelated to the procedure.
Conclusions
: PDA stenting is a safe and effective alternative to
surgical shunts as a palliative procedure for neonates with duct-
dependent pulmonary circulation.
1489: GIANT INTRACARDIAC HAEMANGIOMA DIAG-
NOSED IN UTERO
Claudeen Scott, Gurur Biliciler-Denktas, Kenneth Moise, Anthony
Johnson, Michael Bebbington, Mousumi Moulik, Ashish Banker,
Michael Hines
UT Medical School at Houston, Texas, USA
We describe a case of a foetus diagnosed at gestational age (GA) 31
weeks with a large right atrial cavernous capillary haemangioma who
had elective delivery by caesarean section and successful elective
resection of tumour at 1 week of life. A 36-year-old G3P2001 mother
was referred for a foetal echocardiogram when a mass was visualised
on routine anatomy scan at 31 weeks’ gestation. Foetal echocardio-
gram was significant for a large loculated visualised mass occupying
the majority of the right atrial cavity with sparing of the posterior
third of the right atrium. There was no obstruction to the tricuspid
valve inflow, systemic venous return or coronary sinus. There was
a small pericardial effusion of no haemodynamic significance. The
foetus was in sinus rhythm. The patient was followed weekly with
echocardiograms. The night prior to delivery, the foetus was in atrial
flutter in 2:1 at a ventricular rate of 300/minute without hydrops
fetalis. Rhythm had spontaneously converted to sinus before delivery.
Delivery was uneventful with Apgar scores 8 and 9. Echocardiogram
post-delivery revealed a wide-based large mass (19.9 x 21.3 mm) in
the lateral wall of the right atrium, attached to the right atrial append-
age extending anteriorly to the aortic root. The mass had irregular
borders with cystic formation inside in addition to echogenicity with
blood flow with connection to the right coronary artery. Elective
resection of the tumour was done at 1 week of age. Pathologic evalu-
ation also confirmed the diagnosis. Patient was discharged home a
few days after surgery.
Compared to the most frequently seen rhabdomyomas and less
common teratomas and fibromas, cardiac haemangioma is one of
the rarest types of benign cardiac tumours found in neonates. Foetal
echocardiogram is an essential diagnostic tool for early detection,
close monitoring and appropriate and early treatment.
1506: COVERED STENTS IN THE MANAGEMENT OF
NATIVE COARCTATION OF THE AORTA: INTERMEDIATE
AND LONG-TERM FOLLOW-UP
Masood Sadiq
1
, Asif-ur Rehman
1
, Ahmad Usaid Qureshi
1
, Shakeel
Ahmed Qureshi
2
1
Punjab Institute of Cardiology and The Children’s Hospital, Lahore,
Pakistan
2
Evelina Children’s Hospital, London, UK
Objectives:
To evaluate the results of the use of covered Cheatham-
Platinum (CP) stents in the management of native coarctation of the
aorta (CoA) and report intermediate and long-term follow-up.
Background:
Covered stents are being used increasingly in CoA to
reduce risk of aortic wall complications; however, there are limited
data on the intermediate and long-term outcome.
Patients and methods:
Fifty-nine covered CP stents were implanted
in 56 patients. In 54 patients these were as primary treatment for
severe CoA with near atresia and complex CoA, and in 2 as rescue
for complications related to bare stent implantation. The follow-up
was based on echocardiography and computed tomography (CT).
Results:
Mean patient age was 22.25
±
1.2 (11–56) years and weight
was 58.6
±
2.1 (32–99) kg. The systolic gradient across the CoA
decreased from mean of 51.4
±
3.4 to 4.6
±
0.7 mmHg (
p
<
0.0001).
The diameter of the CoA segment increased from 4.69
±
0.20 to 15.1
±
3.2 mm (
p
<
0.0001). There was one death 3 days post procedure
due to cerebral anoxia. There was one dissection diagnosed 24 hours
post procedure. At a mean follow-up of 45.9
±
3.9 (3–120) months,
all stents were patent and in good position on CT. Four (7.1%)
patients underwent successful redilation. Antihypertensive medica-
tion was decreased or stopped in 37 (66%) patients.
Conclusions:
Covered CP stents may be used effectively as the
therapy of choice in selected patients with severe CoA. Aortic wall
complications can occur even with covered stents. The stents can be
redilated safely to keep pace with somatic growth. Covered stents
provide a safe alternative to conventional stenting in the intermediate
and long term.
1512: THE DEVELOPMENT OF THE LEFT VENTRICLE IN
PRENATALLY DIAGNOSED LEFT SIDED OBSTRUCTION
Hana Jicinska
1,2
, Pavel Vlasin
2
, Jiri Navratil
1
1
University Children’s Hospital, Brno, Czech Republic
2
Centre for Foetal Care, Brno, Czech Republic
Background:
The asymmetry in four chamber view with small left
ventricle (LV) in the foetal heart could be caused by the obstruction
in different levels of the left heart, by the presence of left superior
vena cava draining coronary sinus (LSVC-CS), aortic stenosis (AS),
coarctation of aorta (COA) or hypoplastic left heart syndrome
(HLHS). The aim of the study was to follow up the development of
