Cardiovascular Journal of Africa: Vol 24 No 1 (February 2013) - page 100

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013 98 AFRICA
1775: PERCUTANEOUS TRANSMITRAL COMMISSUROTO-
MY IN CHILDREN: INTERMEDIATETERMRESULTSWITH
SPECIAL REFERENCE TO PULMONARY HYPERTENSION
Najma Patel
National Institute of Cardiovascular Disease, Karachi. Pakistan
Objective: To know the long-term results of percutaneous transmitral
commissurotomy (PTMC) and fate of pulmonary hypertension in
children who have undergone PTMC.
Material: During the last 11 years 138 children, aged 10.48 ± 2.24
years (range 3.5 -16) had PTMC. Indications were echocardiographic
evidence of moderate to severe mitral stenosis (MS) plus pulmonary
arterial hypertension (PAH) more than 50 mmHg and/or FC III-IV
Result: Pre PTMC, mitral pressure gradient (MPG) across the mitral
valve (MV) was 18.6 mmHg ± 3.4 which decreased to 7.6 mmHg ±
2.21 .MVA was 0.62 cm2 ± 0.12 which increased to 1.6 cm2 ± 0.3.
Pulmonary artery pressure (PAP) was 83 mmHg ± 13 decreased to
50 mmHg ± 14.5. Three procedures were unsuccessful: there were 2
deaths, one within half an hour in patient (pt) with PAP of 100 mmHg
and left ventricle (LV) dysfunction, had no mitral regurgitation (MR)
or tamponade. Another died after 24 hours, after thromboembolism
of LAD, he revived and had successful PTMC but died after 24
hours. One had tamponade drained and had a successful PTMC after
1 week. There was no change in MR in 50 pts.
After a mean follow-up period of 44.3 yrs ± 30.6 of 110 pts (10
months to 10 years), 8 needed repeat PTMC after 5.37 ± 2.3yrs
(0.5–8 yrs), and 2 had mitral valve regurgitation (MVR) after 1 and
7 years.
Systolic PAP was 83 mmHg ± 13 pre procedure which decreased
to 50 mm Hg ± 14.5 immediately after and to 42 mmHg ± 13 after
6 months . Immediately after PTMC 54 pts had PAP more than 50
mmHg, after 6 months 24pts .Out of these 2 died: one had severe
PAH despite adequate relief of MV, died after 3 yrs; another had mild
MS and +2 MR with persistent severe PAH, had MVR after 1 year.
PAP did not decline after surgery and he died two years after PTMC.
Both had initial PAP of more than 100 mmHg.
Conclusion: PTMC is effective in reliving stenosis, however initial
high PAP is predictor of persistent pulmonary hypertension.
1783: CONGENITAL LEFT VENTRICULAR ANEURYSM:
FOETAL DIAGNOSIS
Ana Flavia Torbey 1,2, Aurea Souza1,2, Tatiana Berg 3, Sandra Pereira3,
Luciana Duarte1 , Sandra Possato2, Maria de Fátima Leite4, Alan
Silva2, Fábio Bergman2
1Universidade Federal Fluminense, Brazil
2Baby Cor Cardiologia Pediatrica e Foetal, Rio de Janeiro, Brazil
3Hospital Servidores do Estado, Brazil
4Instituto Fernandes Figueira, Brazil
Background: Congenital left ventricular aneurysm (CLVA) is a rare
cardiac malformation occurring in 0.5:100 000 births, regardless of
gender and presents as a single lesion in 75% of cases. Most patients
are asymptomatic, although some complications such as congestive
heart failure, arrhythmias, thromboembolism and ventricular wall
rupture may occur.
Case report: A 29-year-old primigravida, without risk factors was
referred for foetal echocardiography at 33 weeks gestational age
with diagnosis of cardiomegaly during obstetric ultrasound. Foetal
echocardiogram showed a 1.9 cm expansive rounded area in left
ventricle apex, consistent with a CLVA with slow velocity flow
inside. Doppler analysis detected supraventricular extrasystoles and
bigeminism periods. No other structural changes, thrombi or signs of
heart failure were observed during subsequent evaluations. Delivery
occurred at termwithout complications and postnatal echocardiogram
confirmed the diagnosis. During the first weeks of life, the newborn
developed supraventricular tachycardia, successfully controlled with
betablockers; since then she has remained asymptomatic
Discussion: Aetiology of CLVA is unknown and may occur by local-
ised weakening of the ventricular wall during embryogenesis, infec-
tion or ischaemia of the ventricular myocardium. It can be produced
by stenosis, hypoplasia or abnormal development of coronary arter-
ies. Foetal echocardiogram is essential for early diagnosis, as well as
allowing monitoring during pregnancy and birth to detect complica-
tions such as rupture of the wall, thromboembolism, arrhythmias and
heart failure, should intrauterine treatment be necessary. The natural
history of CLVA is not well studied so the approach must be individu-
alised for each case.
1789: TRENDS IN PRENATAL DIAGNOSIS OF TRANSPOSI-
TION OF THE GREATARTERIESWITH INTACTVENTRIC-
ULAR SEPTUMAND IMPACT ON OUTCOMES
Maria Clara Escobar1, Alejandra Bueno-Martinez1, Brian Kalish 2,
Ravi Thiagarajan1, David Brown 1, Sitaram Emani1, Pedro Del Nido3,
Wayne Tworetzky 1
1Boston Children’s Hospital, Boston, USA
2Harvard Medical School, Boston, USA
3Children’s Hospital, Boston, MA, USA
Background: In transposition of the great arteries with intact
ventricular septum (TGA/IVS), changes occur after birth that, if
untreated, lead to haemodynamic compromise and death. Prenatal
diagnosis (Dx) allows for delivery site planning and timely neonatal
management. Despite TGA being a major heart defect, detection is
challenging for obstetricians.
Objective: To evaluate temporal trends in prenatal Dx and its impact
on neonatal morbidity and mortality.
Methods: Patients with TGA/IVS referred for surgical management
between 1995 and 2012 were included. The study time was divided
into three 6-year periods. We compared variables pre-op and post-op
between those diagnosed pre or postnatally. Variables included gesta-
tional age and weight at birth, age at admission, mechanical ventila-
tion, ECMO, metabolic acidosis, timing of septostomy and surgery,
intensive care unit (ICU) and hospital stay, and mortality.
Results: Of the 295 patients, 78 (26%) had prenatal Dx. There was
an increase in the prenatal diagnosis over the years, from 10%, during
the first period, to 42% during the last period. Gestational age and
birth weight was similar between groups. Age at admission (1.4 vs
0), at septostomy (1.2 vs0.3) and surgery (4.7 vs 3.9) were greater in
the postnatal Dx group. The postnatal Dx group had more metabolic
acidosis (19% vs 7%), mechanical ventilation (71% vs 40%) and need
for ECMO (3.7% vs 1.3%) prior to surgery. The overall mortality was
2.7%. In the postnatal Dx group 7/217 patients died, 3 pre-op and 4
post-op. There was 1 death (pre-op) in the prenatal Dx group. Hospital
and ICU stay was not significantly different between groups.
Conclusions: Prenatal detection rate of TGA/IVS increased signifi-
cantly over the study period, but is still disappointingly low at <
50%. Although the mortality rate was not different between pre- and
postnatal Dx groups, patients with prenatal Dx had significantly less
metabolic acidosis, earlier admission and septostomy compared to
those diagnosed postnatally.
1798: FOETAL CARDIAC MASSESWITH LARGE PERICAR-
DIAL EFFUSION: A CASE REPORT
Ana Flavia Torbey1,2, Aurea Grippa1,2, Sandra Pereira3, Andrea Ãvilla3,
Martha Vilela3, Lilian Stwert4, Carla Kluft3, Fernanda Balzana3, Maria
de Fátima Leite 2,5
1Universidade Federal Fluminense, Brazil
2Baby Cor Cardiologia Pediatrica e Foetal, Rio de Janeiro, Brazil
3Hospital Servidores do Estado, Brazil
4Instituto de Cardiologia Aloisio de Castro, Brazil
5Instituto Fernandes Figueira, Brazil
Background: Primary tumours of the heart are rare with a preva-
lence rate that ranges from 1 per 1.000 to 1 per 100 000 of the general
population autopsy studies. Most of all primary cardiac tumours
are benign and rhabdomyoma is the most common in the paediatric
population.