CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
97
Materials and methods
: Eighteen children were included in a retro-
spective review from October 2005 to May 2012. Vascular access
was obtained via the femoral artery and/or vein. Balloon-expandable
coronary bare metal stents were used. Follow-up included clinical
assessment and echocardiography.
Results
: Eighteen cases were successfully stented. Indications were
aortic arch obstruction (9), right ventricular outflow tract obstruction
(4), systemic-to-pulmonary artery shunt stenosis (3), pulmonary
venous chamber stenosis (1) and patent ductus arteriosus (PDA)
stenting to preserve a discontinous left pulmonary artery (1). Eight
patients had residual problems following prior surgery. Median age
was 4.8 months (range 0.1–65.1) and median weight 4.6 kg (1.7–17).
Number of stents used: 1 (
n
=
12), 2 (
n
=
5) and 4 (
n
=
1). Implanted
stent diameters: 2.5 mm (
n
=
2); 3.5 mm (
n
=
2); 4.0 mm (
n
=
4);
4.5 mm (
n
=
3); 5.0 mm (
n
=
9); 5.5 mm (
n
=
1); 6.0 mm (
n
=
3) and
8.0 mm (
n
=
2). Paired pressures were not obtainable in all cases as
most patients were critically ill. Saturations improved from a median
83.5% to 90% in patients with obstructive pulmonary blood flow
(
n
=
4). Periprocerdural complications included temporary rhythm
disturbances (
n
=
3). There was no periprocedural mortality. Last
follow-up was at a median 200 days (range: 10–1406). A second stent
procedure was performed in 6 patients ranging between 3.8 and 17.8
months post initial stent placement. Five cases proceeded to surgery.
Five cases demised at a median of 73 days (range: 20–422), all at
home secondary to unknown causes. Three patients have been lost to
follow-up. Five patients remain in follow-up.
Conclusions
: Mortality in this high-risk group remains high.
Stenting is feasible and may delay surgery in some; however, prob-
lems in developing countries present unique challenges to patient
follow-up.
1695: ANEURYSM OF THE FORAMEN OVALE FLAP AND
VENTRICULAR SIZE DISCREPANCY IN PRENATAL ECHO-
CARDIOGRAPHY
Anna Lamberti, Mauricio Guirgis, Carine Vastel, Ronan Bonnefoy,
Isabelle Denjoy, Jean Marc Lupoglazoff, Constance Beyler
Robert Debré Hospital, Paris, France
Background:
Ventricular size discrepancy
(VD) is easily detected
in routine general foetal echography; echocardiography is therefore
performed, the aim being to detect prenatally left ventricle inflow
or outflow obstructive lesions and aortic arch anomalies. However
VD can be a physiological aspect late in pregnancy or associated to
anomalies such as left vena cava or aneurysm of the foramen ovalis
flap (AFOF).
Materials:
Among 3 500 prenatal echocardiographies performed in
our unit from January 2008 to July 2012, 45 AFOF were detected
with variable degree of VD late in pregnancy: mean term was 33.5
±
0.7 weeks of gestation (w). In all patients ventricular and arterial
ratio, right/left ventricular diameter (VR), aorta/pulmonary artery
diameter (AR) and aortic isthmus diameter (AID) were measured.
Colour Doppler images and velocities were recorded. In most cases
analysis of the aortic arch showed a complete aortic arch with normal
flow velocity and direction; AID was considered as normal when
>
3
mm after the 30th w or 0.1 mm x w when earlier in gestation.
Results:
In group 1 (G1), 33 patients with VR
<
1.5 had 31 normal
AIDs and 2 small AIDs. In group 2 (G2), 12 patients with VR
≥
1.5
had 8 normal AIDs and 4 small AIDs. Only 15% of 45 patients with
AFOF and VD had AID suspicious of postnatal coarctation. In these
few cases birth was planned in our hospital in conjunction with the
intensive care and paediatric cardiology units.
Conclusion:
AFOF is frequently associated with VD in prenatal
echocardiography. If the AID is normal with forward flow and
normal velocity, AFOF can be considered as the main factor respon-
sible for VD and there is low risk of postnatal coarctation. This
screening is useful to plan
in utero
transfers from peripheral hospitals
and avoid unnecessary ones.
1697: SCREENING OF FOETAL CARDIAC DISEASE IN
SAUDI ARABIA: A TERTIARY CARDIAC CARE CENTRE
EXPERIENCE
Nawal AlAbdulkarim
Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
Introduction:
Antenatal detection of cardiac malformations remain
suboptimal in most areas of the world with a gap in diagnosing seri-
ous cases of congenital heart disease (CHD).
Method:
To describe the current status and factors affecting detec-
tion of CHD antenatally in Saudi Arabia.
Results:
Foetal echocardiography/cardiology started in the 1980s at
our institution; however rates of detection of foetal CHD remain low
with almost half the cases referred with serious CHD not picked up
by antenatal screening. Contributing factors include high incidence
of CHD in low-risk pregnancies, suboptimal referral system, lack of
regional/national foetal cardiac screening programmes and the need
for more countrywide training for cardiac screening at obstetric units.
Conclusions:
The overall rate of detection of major congenital heart
disease before birth remains low. Cases will only be detected by
screening of the low-risk population at the time of routine obstetric
scanning. A common effective practice standard for antenatal detec-
tion of CHD needs to be established nationally/regionally and glob-
ally, with enhanced training and education in the screening of the
foetal heart with appropriate referral/networking.
1770: PRENATAL DIAGNOSIS OF EBSTEIN’S ANOMALY:
REPORT OF FOUR CASES
Ana Flavia Torbey
1,2
, Maria de Fåtima Leite
2,3
, Alan Silva
2
, Aurea
Grippa
1,2
, Sandra Pereira
4
, Luciana Duarte
1
, Jefferson Magalhães
5
,
José Pedro Silva
6
, Fåbio Bergman
1
1
Universidade Federal Fluminense, Brazil
2
Baby Cor Cardiologia Pediatrica e Foetal, Rio de Janeiro, Brazil
3
Instituto Fernandes Figueira, Brazil
4
Hospital Servidores do Estado, Rio de Janeiro, Brazil
5
Perinatal Hospital, Rio de Janeiro, Brazil
6
Beneficencia Portuguesa de Sao Paulo, Brazil
Ebstein’s anomaly (EA) is a rare malformation of tricuspid valve
leaflets and can be detected in foetal life by important cardiomegaly
during obstetric ultrasonographic examination, the most common
indication of foetal echocardiogram. We describe the evolution of
four cases of foetal diagnosis of EA, from 3 units of the Fetal and
Pediatric Cardiology Centre of Rio de Janeiro are reported. Patients
were referred for foetal echocardiogram because of cardiomegaly
observed during obstetric assessment, between 25 and 37 weeks’
gestation age. All foetuses had significant tricuspid regurgitation, and
significantly enlarged right atrium. Ventricular septal tricuspid leaf-
let was attached to ventricular septum, obstructing right ventricular
outflow tract with functional pulmonary atresia (PA) in two cases,
and true PA, associated with pulmonary branches hypoplasia, in the
other two foetuses. One foetus had heart failure with periods of atrial
tachycardia treated with oral maternal digitalis. Two patients died,
one in the 38
th
gestational week due to corioaminionitis confirmed by
anatomo-pathologic study after birth, and another due to pulmonary
hypoplasia. Another case of PA needed a systemic-pulmonary shunt
during the neonatal period and had a tricuspid valve repair one month
after birth with good postoperative evolution, although he developed
tachyarrhythmia that was controlled with amiodarone. The last one
had functional PA but pulmonary blood flow became normal, after
measures to lower pulmonary vascular resistance.
Foetal echocardiogram is an important tool of diagnosis of
congenital heart disease with severe manifestations and complica-
tions during the perinatal period. It permits the medical team to
create strategies to prevent the dangers of metabolic acidosis and
hypoxaemia in the first hours after birth. The presence of intrauterine
pulmonary hypoplasia, severe tricuspid regurgitation and pericardial
effusion are signs of poor prognosis.
