CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
83
Peter Ewert
1
, Felix Berger
1
, Lars Søndergaard
2
, Maarten Witsenburg
3
,
Maria Giulia Gagliardi
4
, José Suárez de Lezo
5
, Lee Benson
6
, John
Hess
7
1
German Heart Institute Berlin, Berlin, Germany
2
Rigshospitalet Copenhagen, Copenhagen, Denmark
3
Erasmus Medical Center, Rotterdam, The Netherlands
4
Hospital Bambino Gesù, Rome, Italy
5
Hospital Reina Sofía de Córdoba, Spain
6
Hospital for Sick Children, Toronto, Canada
7
German Heart Institute Munich, Munich, Germany
Introduction:
Transcatheter pulmonic valve (TPV) implantation
has been shown to be an effective treatment for patients with right
ventricular conduit failure. In addition to improvements in ventricular
function, overall health-related quality of life (QOL) is an important
measure of patient satisfaction. The aim of this study is to evalu-
ate long-term clinical performance and whether TPV leads to QOL
improvement.
Methods:
TPV was implanted in 63 patients between October 2007
andApril 2009 at 7 centres throughout Europe and Canada. Procedural
outcomes, haemodynamic effects, and QOL (EQ-5D) measures were
evaluated during pre-implant, discharge, 6 month and annual visits.
Results:
Forty-two patients (age
≥
15 years) who completed the
EQ-5D assessments at pre and post-implant were included for
analysis: 30 were male; mean age 26
±
11 years (range 15–59).
The underlying congenital heart diseases included tetralogy of
Fallot (45%) and truncus arteriosus (17%). Eighty-three per cent of
conduits were homografts. Compared to pre-implant (81%), patients
in NYHA class I/II increased at 1 year (93%) and sustained through
3 years. Mean pressure gradient pre-implant was 37
±
12 and 1 year
post-implant 17
±
6 mmHg which remained similar through 3 years.
None of the patients experienced moderate/severe pulmonary regur-
gitation at discharge and throughout 3 year follow-up. EQ-5D index
and health state significantly improved at 6 months and remained
improved through 3 annual visits (
p
<
0.05). Pain/discomfort and
anxiety/depression components of the EQ-5D index improved
significantly at 6 months and 1 year (anxiety/depression through 3
years,
p
<
0.05).
Conclusion:
In addition to the positive haemodynamic effects, TPV
leads to QOL improvement. Whether these results support indication
of TPV at an earlier stage of valve dysfunction needs to be discussed.
1059: TRANSCATHETER CLOSURE OF PDA USING
AMPLATZER DUCT OCCLUDERS: A SINGLE CENTRE
EXPERIENCE
Nazan Ozbarlas, Sevcan Erdem, Osman Kucukosmanoglu, Alev
Kiziltas, Abdi Bozkurt
Faculty of Medicine, Cukurova University, Adana, Turkey
In this report we review initial and 4-year results following transcath-
eter occlusion of patent ductus arteriosus (PDA) using Amplatzer
duct occluders (ADO). Between November 2004 and May 2012,
91 patients, ages 3.5 months to 66 years, underwent transcatheter
closure using the ADO and ADO II. Mean pulmonary artery pressure
was 25.4
±
8.6 mmHg (median 23 mmHg, 12–60 mmHg); 51 were
greater than 25 mmHg. The mean PDA diameter (at the pulmonary
end) was 3.2
±
1.2 mm (range 1.6–7.5 mm), the PDA length was 6.9
±
3 mm (median 6, range 3–16 mm) and the mean ampulla diameter
(at the aortic end) was 10
±
3.9 mm (median 9, range 4–23 mm).
For closure of PDA, 130 ADO and 41 ADO II and 14 ADO AS were
used. Occlusion of femoral artery developed in only one patient and
there were no other complications in early period. Complete closure
was observed in 56/57 (98.2%) in ADO patients, 19/20 (95%) in
ADO II patients and 14/14 (100%) in ADO II AS patients at the end
of the 6th month after closure.
Conclusion:
All ADO types can be used safely and effectively in
treatment of PDA. ADO II and ADO II AS have many advantages
in small infants and short ductus. These devices can be deployed
completely in the ductal body without any obstruction because of
their special configuration. They have smaller sheath sizes and a
flexible, user-friendly delivery system.
1066: EXTRACARDIAC FINDINGS IN FOETAL LATERAL-
ITY DISTURBANCE - THE UNUSUAL SUSPECTS
Caroline Jones, John Simpson, Owen Miller, Gurleen Sharland
Evelina Children’s Hospital, London, UK
Background
: In prenatal congenital heart disease, the group with
laterality disturbance are most likely to have an associated extracar-
diac abnormality (ECA). ECAs are multi-system, vary in severity
and may be difficult to detect prenatally. We report a large series of
prenatal cases with laterality disturbance and describe their associ-
ated extracardiac malformations.
Materials and methods:
We performed a retrospective search of our
foetal cardiology database from 1985 to 2010 for cases of laterality
disturbance. Post-mortem (PM) and postnatal notes were reviewed to
document ECA.
Results:
A total of 255 cases of laterality disturbance were identified.
Three cases were excluded as outcome data was not available. Of the
252 cases, 120 resulted in termination of pregnancy (TOP), 16 intra-
uterine deaths occurred and 54 patients were still alive. PM reports
were available in 86 (72%) cases following TOP. Common findings
were bowel malrotation (84 cases, 33%), polysplenia (62 cases, 25%)
and asplenia (60 cases, 24%). An additional 43 patients had other
ECAs. Of those live born, 23 (20%) patients underwent 29 non-
cardiac surgical procedures including 17 Ladd procedures, 2 Kasai
procedures for biliary atresia and 2 congenital diaphragmatic hernia
(CDH) repairs. Four patients died as a direct result of ECA. Three
had significant respiratory compromise as a result of CDH or major
airway abnormality. One patient died following surgery for volvulus.
Conclusions:
Intra-cardiac pathology is the predominant cause of
death in the foetus diagnosed with laterality disturbance.
The ECAs
influence survival in a minority of cases, though they may have a
significant impact on the quality of life of survivors. Particular atten-
tion should be made to discussing potential ECA when laterality
disturbance is diagnosed.
1077: USEFULNESS OF LONG-TERM ADMINISTRATION
OF HEPARIN IN THE RECANALISATION OF FEMORAL
ARTERIES IN YOUNG CHILDREN AFTER PERCUTANE-
OUS PROCEDURES
Jacek Kusa
1
, Leslaw Szydlowski
1
, Agnieszka Skierska
1
, Zbigniew
Olczak
2
, Ewa Nowakowska
1
1
Medical University of Silesia, Katowice, Poland
2
Department of Pediatric Radiology, Medical University of Silesia,
Katowice, Poland
Introduction
: As a result of interventional and diagnostic procedures
performed in young children because of congenital heart defects
some vascular complications can appear. The obstruction of the
femoral artery is the most common problem.
Material and methods:
Between March 2010 and July 2012 we
performed 176 heart catheterisations. Among these were 95 chil-
dren under 3 years of age who underwent catheterisation through
the femoral artery access. The presence of arterial pulse on lower
extremities was examined by palpation in all patients. In cases of
doubt, or lack of pulse, ultrasound vascular flow was performed. In
6 patients, aged 20.5
±
9.7 months (0.2–30) weighing 9.2
±
4.0 kg
(33–15), there was no flow through the punctured artery. The consult-
ing vascular surgeon found no need for surgical treatment in all cases.
Results:
All 6 patients received continuous infusion of heparin.
When the absence of flow was still observed we started the treat-
ment with low molecular weight heparin. As a result, after 19.7
±
10.5 days (6–40) of intake of heparin, in 5 patients complete vessel
patency returned. We have no data about the last patient because he
was transferred to another department.
Conclusions:
Performing heart catheterisation through the femoral
