CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
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the LV in foetuses with left sided obstruction.
Materials and methods:
The length of the LV was measured at the
time of diagnosis prenatally and after birth in echocardiographic
evaluation in 131 foetuses with left-sided obstruction and small LV.
Results:
Of these 131 foetuses detected at 11–37 weeks gestation, 42
were diagnosed with LSVC-CS, 30 with AS, 24 with COA, 21 with
HLHS and 14 without final diagnosis (non-specified disproportion)
as a result of early stage of gestation. There were extracardiac abnor-
malities in 24 foetuses and chromosomal abnormalities in 20. The
pregnancy was terminated in 51 (39%) cases: for HLHS 100%, for
non-specified disproportion 93%, for AS 43%, for COA 8% and for
LSVC-CS 4%. Eighty (61%) children were born; 6 of them died. The
size of LV was normal postnatally in 100% of foetuses with LSVC-
CS, in 95% of foetuses with COA and in 68% of foetuses with AS.
Conclusion:
There was normal development of the LV in foetuses
with prenatally diagnosed LSVC-CS and COA (small number of
terminations of pregnancy and low mortality after birth). In AS there
was good development of LV after birth in the majority, but there was
a high number of terminations of pregnancy (43%). There were asso-
ciated abnormalities in the majority of foetuses with non-specified
disproportion and none of them survived.
1515: TRANSCATHETER CLOSURE OF AN AORTO-
CAMERAL FISTULA WITH A VASCULAR PLUG USING A
RETROGRADE APPROACH: A CASE REPORT
Amitabha Chattopadhyay
1
, Prashant Thakur
1
, Navdeep Singh
1
,
Mahua Roy
1
, Debasree Gangopadhyay
1
, Hemant Nayak
1
, Biswajit
Bandyopadhyay
1
, Rhitajyoti Sengupta
1
, Bimlendu Kumar Das
2
,
Sanjay Tanti
2
1
Rabindranath Tagore International Institute of Cardiac Sciences,
Kolkata, India
2
Bramhanand Narayana Hrudayalaya, Tatanagar, India
Background
: Aorto-cameral fistula is a rare cardiac anomaly. Few
reports in the medical literature discuss the use of a vascular plug
using a retrograde approach to close these fistulae.
Materials and method
: We describe the case of an 8-year-old
girl who presented with complaints of frequent respiratory infec-
tions since early infancy, shortness of breath (NYHA class II) and
palpitations for the last 2 years. She had a 3/6 continuous murmur
at the left lower parasternal area. Echocardiography revealed a huge
aorto-cameral fistula originating from the
right sinus of Valsalva
emptying into the right ventricular (RV) inlet just below the anterior
leaflet of the tricuspid valve (TV).The right coronary artery (RCA)
was faintly visualised. As the child was symptomatic, a cardiac cath-
eterisation was planned with a goal of possible transcatheter closure
of the defect. Aortogram confirmed the echo findings. The RCA was
faintly visualised originating 8 mm away from the aortic sinus with
decreased flow. The narrowest segment of the fistula measured 6.1
mm.There was retrograde filling of the RCA from the left coronary
artery (LCA) branches. On temporary balloon occlusion beyond the
origin of the RCA with a 6F SwanGanz catheter, no electrocardio-
graph (ECG) changes were seen. A 10 mm vascular plug (166% of
the narrowest diameter of the fistula) was placed into the narrow-
est part of the fistula through a retrograde approach, through a
patent ductus arteriosus (PDA) device delivery system, resulting in
complete occlusion of the fistula. Post procedure RCA angiogram
showed normal flow through the RCA with visualisation of the
marginal branches which were hitherto not seen as a result of steal
through the fistula. The retrograde approach obviated the need for an
arteriovenous loop. No procedural complications occurred with the
patient showing better exercise tolerance on follow-up.
Result
: Complete occlusion of fistula with improvement in symp-
toms was achieved.
Conclusion
: Coronary artery fistula closure by vascular plug
through a retrograde approach is safe and should be considered as
the standard approach
.
1559: VARIABLE APPROACH AND OUTCOME OF STENT-
ING OF ARTERIAL DUCT IN DUCT-DEPENDENT PULMO-
NARY CIRCULATION
Nageswara Koneti, Sudeep Verma, Karunakar V, Shweta Bakhru,
Pallavi Kathare, Jagannath BR, Tapan Kumar Dash, Sunil Swain,
Raghavaraju Penumatsa, Sreenivas Kumar Arramraju
Care Hospital, Hyderabad, India
Background:
Stenting of arterial duct has emerged as an alterna-
tive for systemic to pulmonary shunt in young infants with duct-
dependent pulmonary circulation (DDPC). However, the approach of
stenting is determined by the anatomy and orientation of the arterial
duct. We report our experience of stenting of arterial duct by various
approaches and their outcomes.
Materials and methods:
Data of 45 (31 male) young children
with DDPC were included for the procedure. Seven children were
excluded after angiogram because of unfavourable anatomy in 4 and
inability to negotiate wire in 3. Various parameters and outcomes
were analysed.
Results:
The anatomical diagnosis includes 24 cases of ventricular
septal defect (VSD) pulmonary atresia, 12 of pulmonary atresia with
intact septum and 9 with single ventricle physiology and pulmonary
atresia. The median weight was 3 kg (range 1.7–6.5) and age 20 days
(range 2–370 days). Successful deployment of stent was done in 37
(82%) children. The approach for stent deployment was determined
by the anatomy of the arterial duct and physician experience; femoral
artery approach in 19, axillary 8, carotid (hybrid) 15 and femoral vein
in 3 cases. There were two deaths; rupture of the ductus in one and
the other was due to sepsis. There were three major procedure-related
complications: spasm, dissection and acute thrombosis, which were
managed. Six children died at various hospitals during follow-up – as
a result of pneumonia (1) , gastroenteritis with dehydration (1), and
awaiting surgery (2); the cause could not be detected in 2. Successful
second-stage procedures (systemic to pulmonary shunt in 4, bidirec-
tional Glenn in 4 and biventricular repair in 4) were done.
Conclusion:
Stenting of the arterial duct in DDPC is an alternative
palliation using various approaches as a result of variable anatomy
of tortuous vertical arterial ductus. The outcome is determined by
the presentation, associated co-morbid condition and underlying
complex anatomy.
1599: MANAGEMENT OF DEXTROCARDIA, SITUS INVER-
SUS TOTALIS, MIXED TYPE TAPVC, COMPLETE AV
CANAL DEFECT, COMMON ATRIUM, BILATERAL SVC,
PDA, SEVERE PAH’
Sivasubramanian Muthukumar, Jebaraj, Ranjith Karthekayan,
Dheeraj Reddy, Periyasamy Thangavelu
Sri Ramachandra University, Chennai, India
Objective:
To present the management of dextrocardia, situs inversus
totalis, TAPVC – mixed, complete atrioventricular (AV) canal defect,
common atrium, bilateral SVC, patent ductus arteriosus (PDA),
severe pulmonary arterial hypertension (PAH).
Diagnosis:
This 9-month-old girl baby girl was admitted with failure
to thrive and respiratory distress. Echo evaluation revealed the above-
mentioned diagnosis. After preoperative evaluation, surgery was
performed. Operative finding included mixed type TAPVC – right
superior and middle pulmonary veins and left inferior pulmonary
vein were draining into common venous chamber. A vertical vein
from the common chamber was joining RSVC, and a left supe-
rior vein to LSVC. The right upper lobe vein joined the RSVC.
Morphologic right atrium (RA) was on right side receiving RSVC
and hepatic vein. Morphologic left atrium (LA) was on the left side
receiving LSVC and IVC. Other findings were: unroofed coronary
sinus; complete AV canal defect – Rastelli Type A with large inlet
ventricular septal defect (VSD); severe mitral regurgitation (MR) –
anterior mitral leaflet (AML) cleft; common atrium.
Results:
The procedure included TAPVC repair & AV canal repair.
Rerouting of pulmonary veins was done with wide anastomosis
