CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
96
AFRICA
between the common venous chamber and mLA. Vertical vessel was
ligated. Since innominate vein was present, LSVC was interrupted,
hence diverting left superior vein to mLA. Regarding AV canal repair,
a double patch technique was used. VSD closure, MV repair withAML
cleft repair, tricuspid valve repair, atrial septal defect (ASD) closure
with Pericardia patch created an atrial baffle, diverting IVC, RSVC and
hepatic vein to mRA. Core cooling was done to 28C. Total CPB time
was 325 min and aortic cross clamp time 235 min. Total ventilatory
support was given for 86 hours and inotropes for 6 days. Intensive care
unit (ICU) stay was until the 8
th
post-operative day (POD).
Conclusion:
Baby was discharged on 16
th
POD with stable haemody-
namics and on normal oral feeds.
1570: USEFULNESS OF JOINT FOETAL ECHOCARDIOG-
RAPHY AND COUNSELLING SERVICE - EXPERIENCE IN
HONG KONG
Shuk Han Lee, Kwok Yin Leung, Teresa Ma, Betty Lau
Queen Elizabeth Hospital, Hong Kong, China
Aim:
We collaborated with our obstetricians to run a Joint Foetal
Echo and Counselling service. This study aims to review the useful-
ness of this service.
Methodology:
We reviewed our results from 1993 to 2012. Medical
records were retrieved and analysed retrospectively.
Results:
A total of 150 pregnant women underwent foetal echocar-
diography in our department; 56 foetuses were found to have cardiac
abnormalities and prenatal counselling was offered to their families.
Detailed anatomy, expected management, prognosis and our life
experience of similar cases were explained to the expectant parents.
Psychological support was offered as well. Out of the 56 foetuses,
45 had major congenital cardiac abnormalities; only 13 (29%) of the
pregnancies were electively terminated, 1 aborted spontaneously and
the rest were born at or near full term.
Follow-up:
After birth, these babies were reassessed, stabilised and
referred to our neonatal cardiac centre for surgery. The prenatal diag-
noses were accurate in 98.7% of cases. The transfer and preoperative
course was smooth as appropriate stabilisation was instituted soon
after birth. The survival rate after surgery is best in the right ventricu-
lar outflow tract obstruction and transposition of great artery groups,
amounting to 100%. The oldest child is 13 years of age. However, all
died after surgery for truncus arteriosus, pulmonary artery sling and
hypoplastic left heart syndrome, though the number was very small.
Of those with complex heart lesions including heterotaxy syndrome,
60% survived with or without surgery. The only foetus diagnosed
with premature closure of ductus survived after prompt delivery and
neonatal intensive care.
Conclusions:
In our experience, the Joint Foetal Echocardiography
and Counselling service is invaluable for the management of foetuses
with cardiac abnormalities. It does result in a low elective abortion
rate but also improves babies’ survival and parents’ acceptance after
birth.
1591: EXPERIENCE WITH THE COOK FORMULA STENT
IN PAEDIATRIC CARDIAC INTERVENTIONS
Oliver Stumper, Bharat Ramchandhani, Patrick Noonan, Vinay
Bhole, Chetan Mehta, Rami Dhillon
Birmingham Children’s Hospital, Birmingham, UK
Introduction:
Balloon-expandable stents are an integral part in the
catheter treatment of congenital heart disease (CHD). In the grow-
ing child, stents have to be dilatable to greater diameters over time.
All current stent designs have limitations. The pre-mounted Cook
Formula stent is a recent 316 stainless steel open-cell design licensed
for peripheral vascular work.
Methods:
Extensive
ex vivo
studies were carried out to better under-
stand the stent behaviour regarding shortening and ability to overdi-
late the stent. Subsequently 30 stents were implanted in 29 children
(median age 0.96 (0.03–9.8) years; median weight 7.7 (3.8–43)kg).
Results:
Stents were implanted in the right ventricle (RV) outflow
tract in 11 patients with Fallot-type lesions, in 9 for branch pulmo-
nary artery stenosis (3 post Fontan), 4 conduit stenosis, 2 Fontan
fenestrations, and 1 each for SVC, coarctation of the aorta (CoA)
and patent ductus arteriosus (PDA). Stent delivery up to 7 mm was
over a 0.014’ wire via a 4F sheath or 6F guide catheter. 8 or 10
mm stents (from 3/2012) were placed over a 0.035’ wire using a 7F
Mullins sheath. Stent tracking and delivery was excellent. There was
no stent shortening for dilatation to nominal diameter and beyond.
This allowed for precise placement, avoiding protrusion into adjacent
vessels. Sixteen stents were primarily or subsequently overdilated
without any shortening. The 5 mm stent could be dilated to 10 mm,
and the 10 mm stent could be dilated to 17 mm without shortening.
There was one circumferential balloon fracture requiring retrieval,
and one stent slipped and was removed.
Conclusion:
The Cook Formula stent is a versatile pre-mounted
balloon-expandable stent that can be significantly overdilated with
virtually no shortening. It is a great addition to the range of stents for
use in the catheter treatment of complex CHD in children.
1601: STENTING OF BILATERAL ARTERIAL DUCTS IN
COMPLEX CONGENITAL HEART DISEASE
Nawal AlAbdulkarim, Khalaf AlKhalaf, Atif AlSahari
Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
Background:
Maintaining ductal patency in duct-dependent congen-
ital heart lesions by implantation of coronary stents is an alternative
to systemic pulmonary shunt in selected cases and lesions with
suitable anatomy. Bilateral arterial ducts are a very rare pattern of
pulmonary blood flow in congenital heart disease with pulmonary
atresia with non-confluent pulmonary arteries. Ductal closure leads
to severe systemic hypoxia indicating emergent surgical palliation or
repair; percutaneous arterial duct stenting might be an alternative to
surgery, in such high-risk patients.
Methods:
We describe two critically ill neonates (both male) with
complex heart disease and discontinuous pulmonary arteries surviv-
ing on bilateral arterial ducts who successfully underwent transcath-
eter ductal stenting as first-step palliation toward lower-risk surgery.
Results:
Patient #1 (weight 3.8 kg) was referred at 4 weeks with single
double inlet left ventricle, atretic right atrioventricular valve, restric-
tive atrial septal defect (ASD), pulmonary atresia, disconnected BPAs
supplied by bilateral ducts. The procedure entailed atrial septostomy/
bilateral coronary stent placement in each ductus. Patient #2 was diag-
nosed antenatally then delayed to complete fungal sepsis treatment.
At 8 weeks (weight 4.3 kg) bilateral coronary stent placement in each
ductus was performed for single ventricle, atretic left atrioventricular
valve, pulmonary atresia, right arch disconnected BPAs supplied
by bilateral ducts. Ductal stabilisation was achieved with coronary
stents, patient #1 is awaiting first palliative surgical procedure, patient
#2 underwent a successful first palliative surgical procedure, and he
continues to do well at clinical follow-up at 14 months of age.
Conclusions:
Stent implantation is a technically feasible, safe and
effective palliative option in high-risk surgical patients with bilateral
arterial ducts with pulmonary atresia with non-confluent pulmonary
arteries.
1630: TEMPORARY USE OF SMALL STENTS IN CRITICAL
CONGENITAL HEART DISEASE
Stephen Brown, Carri-Lee Greig, Daniel Buys, Michael Long
Department Paediatric Cardiology, University of the Free State,
Bloemfontein, South Africa
Background
: Surgery in children with critical congenital heart
disease is associated with a high morbidity and mortality. The aim
of this study was to look at the short and medium-term outcomes of
stent implantation in these patients and to determine whether surgery
could be delayed in a developing country.
