CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
81
108 (87–164) mmHg and flow ratio was 1.3 (0.6–5.0). The size of
device used was 5 (4–12) mm. Fluoroscopy time was 42 (10–159)
minutes and procedure time was 147 (38–305) minutes. Small
residual shunt was observed in 1 patient following VSD closure using
ADO II. All patients were discharged on day after procedure. Patients
were followed-up periodically clinically and by echocardiography
to monitor the presence of residual shunt or complications. During
procedure and follow-up no significant complications occurred and
no patient had complete atrioventricular block.
Conclusion
: Based on our experience we conclude that percutaneous
transcatheter closure of VSD is effective and save.
887: IMPROVED OUTCOME AFTER PERCUTANEOUS
ULTRASOUND-GUIDED STENTING OFTHE FOETALATRI-
AL SEPTUM IN LEFT ATRIAL HYPERTENSIVE CARDIAC
LESIONS
Edgar Jaeggi
1
, Greg Ryan
2
, Michael Seed
1
, Glen Van Arsdell
1
, Rajiv
Chaturvedi
1
1
The Hospital for Sick Children, University of Toronto, Toronto,
Canada
2
Mount Sinai Hospital, University of Toronto, Toronto, Canada
Background
: Hypoplastic left heart syndrome with a highly restric-
tive or intact atrial septum (HLHS-RAS) has a very high mortality.
Foetal left atrial (LA) hypertension results in abnormal lung develop-
ment with lymphangiectasia and severe pulmonary vascular disease.
We report our experience of
in utero
percutaneous ultrasound-guided
stenting of the foetal atrial septum to decompress the LA.
Methods
: Retrospective review of foetuses with HLHS-RAS or a
variant that underwent active perinatal management since 2000 at our
tertiary care centers.
Results
: Ten foetuses were identified. Of 6 cases without prena-
tal intervention, 2 died
in utero
(33, 29 weeks) from progressive
hydrops. The 4 foetal survivors required the urgent creation of an
atrial communication immediately after birth but died subsequently
(5-54 days). Percutaneous ultrasound-guided catheter interventions
were performed in 4 more recent foetuses at 28-36 weeks. A 20 cm
non-bevelled 18 G needle was advanced via the maternal uterus,
amniotic fluid, the foetal chest and right atrium across the muscu-
larised thickened inter-atrial septum to stent the atrial septum with a
coronary stent expandable to about 3.5 mm. Elevated LA pressure,
dilatation and Doppler flow pattern of the pulmonary veins, and
magnetic resonance imaging (MRI)-estimated lung perfusion all
immediately improved after the procedure. Three of the 4 stented
foetuses were born by vaginal delivery. Atrial septectomy and addi-
tional surgical procedures were performed within 72 hours of birth.
Intraoperative lung biopsy demonstrated muscularised pulmonary
veins and lymphangiectasia in all 4. Two of the 4 foetuses developed
severe or moderate stent stenosis
in utero
and both died after birth
from pulmonary hypertension and sepsis, respectively. The other
2 remain alive
>
12 months of life, a significant improvement in
survival compared with non-stented cases (
p
=
0.03).
Conclusion
: Foetal LA decompression by atrial septal stenting may
decrease lung injury and has the potential to improve survival in
HLHS-RAS.
925: SUCCESSFUL PALLIATIVE BALLOON DILATION OF
NATIVE COARCTATION OF THE AORTA IN A PRETERM
VERY LOW BIRTHWEIGHT INFANT
Chanatip Luevisadpaibul
1
, Anant Khositseth
2
1
Faculty of Medicine, Srinak
2
Faculty of Medicine, Ramath
Balloon dilation of coarctation of aorta may provide adequate pallia-
tion in preterm infants, by relieving symptoms and allowing growth
until definitive surgical repair can be performed. We report success-
ful balloon angioplasty in a preterm very low birth weight (VLBW)
infant with coarctation of the aorta.
Case report:
The patient was a 30-week gestation preterm female
infant with birth weight of 1 050 g. She had respiratory distress
syndrome and required mechanical ventilation. The echocardio-
gram revealed moderate size of ventricular septal defect and patent
ductus arteriosus at 13 days. The aortic arch could not be identified
because of poor echo window. She was treatmed with a diuretic. At
1.5 months, she developed hypertension with 50 mmHg blood pres-
sure differential in upper and lower extremities. The echocardiogram
revealed coarctation diameter of 1.6 mm. with maximum pressure
gradient (PG) 60 mmHg and mean PG 17 mmHg. The balloon dila-
tion was done at 2 months of age (body weight 1 000 g) via 4 Fr
sheath at right femoral artery. The aortogram revealed hypoplastic
transverse arch 3.2 mm, aortic isthmus 2.2 mm, coarctation 1.8
mm. and descending aorta 4.3 mm. Balloon dilation was done with
coronary balloon (Hirye) 4
×
20 mm, requiring 2 attempts. The peak
to peak PG across coarctation after balloon insertion was reduced
from 70 to 12 mmHg. She was successfully extubated after 2 days of
intervention. The echocardiogram revealed residual coarctation 2.5
mm. with mean PG 9 mmHg after 12 days of intervention. Two weeks
later, she was weaned off oxygen. She was discharged from hospital
3 months after intervention with body weight 2 090 g.
Conclusion:
We were successful in palliative balloon dilation of
coarctation of the aorta in a preterm VLBW infant.
926: ROUTINE ULTRASOUND-GUIDED VENOUS ACCESS
FOR ELECTRO-PHYSIOLOGY PROCEDURES REDUCES
INADVERTENT ARTERIAL PUNCTURE AND THE RISK OF
ARTERIOVENOUS FISTULA FORMATION
Trinette Steenhuis, Antigoni Deri, Michael Blackbur, Dominic Hares
Yorkshire Heart Centre, Paediatric Cardiology, Leeds General
Infirmary, Leeds, UK
Background:
Electro-physiology (EP) studies are commonly
performed in children and require the insertion of multiple electrodes
into the heart. This requires multiple points of venous access, includ-
ing femoral, subclavian or brachial venous access. There is evidence
to suggest that percutaneous femoral venous access carries a risk
of inadvertent arterial puncture (IAP) with development of arterio-
venous (AV) fistulae. In the United Kingdom, National Institute of
Clinical Excellence (NICE) guidance suggests that ultrasound guid-
ance should be used for central venous access.
Objective:
To assess whether the routine use of a vascular ultrasound
machine (SONOSITE M-TURBO) reduces the risk of arterial punc-
ture and thereby the causation of AV fistulae.
Methods
: We utilised a departmental database (Oscar 4D) to perform
a retrospective review of the procedural notes of patients who under-
went EP studies in our institution from June 2008 to June 2011. Our
database contains information on access methods and complications.
Results:
A total of 122 EP studies (87 radio frequency ablations)
were performed in 108 children under the age of 16 in the time
period reviewed, with between 3 and 5 sites of venous access per
study. Successful femoral venous puncture was performed in 100%
of patients, successful brachial venous puncture was performed in
97.5% (119/122) of patients under echo guidance, with IAP reported
in none. There were no reported cases of AV fistulae in over 500
episodes of access, with up to 3 years of post-procedural clinical
outpatient review.
Conclusion:
Our experience shows that ultrasound-guided venous
access is safe and achievable for children undergoing EP studies,
with a reduction of the expected risk of IAP from published data
and no episodes of post-procedural AV fistulae. We recommend
the routine use of ultrasound to reduce these potentially significant
complications.
964: RESULTS OF TREATMENT OF FOETAL TACHYCAR-
DIA IN 80 SUBJECTS IN SWEDEN
Britt-Marie Ekman-Joelsson
1
, Mats Mellander
1
, Linda Legnefeldt
2
,
Sven-Erik Sonesson
2
