CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
91
was then retrieved into the sheath and redeployed with a good result.
The child did well post catheterisation with the liver functions recov-
ering to within normal limits shortly after closure.
1360: LONG-TERM OUTCOME OF BALLOON DILATATION
OF VALVULAR AORTIC STENOSIS AS PRIMARY TREAT-
MENT: THE NEED FOR REINTERVENTION
Jaana Pihkala, Talvikki Boldt
Children’s Hospital, University of Helsinki, Helsinki, Finland
Background
: Although balloon dilation of congenital aortic stenosis
has become a primary therapeutic strategy, few data are available
regarding long-term outcomes.
Objectives
: We evaluated the long-term (median 6.0, range 1.6–11.6
years) results of balloon dilation of severe or critical aortic valve
stenosis in children in our institution where all invasive paediatric
cardiology in our country is centralised.
Methods:
Retrospective long-term follow-up study comprised 47
children who underwent balloon aortic valvuloplasty (BAV) between
1/2000 and 12/2010. There were 20 neonates, 16 children aged 1–12
months, and eleven aged
>
12 months. We assessed clinical, catheteri-
sation and echocardiographic outcome and need for reintervention.
Results
: The median (range) age at dilatation was 0.11 (0–16.8)
years and weight 4.4 (2.2–84) kg. Fourteen children received prosta-
glandins, 66% had bicuspid aortic valve and 47% had other cardiac
abnormalities. At catheterisation, median peak gradient before dila-
tation measured 60 (35–113) mmHg and after dilatation, 17 (3–48)
mmHg (
p
<
0.0001). Valve regurgitation before dilatation was graded
as none or mild in all children, and after dilatation as moderate in 7
(15%) and as none or mild in others. Mean balloon to annulus ratio
measured 0.91. Complications in 15% of patients included transient
pulse loss in 4, transient haematuria in 1, transient hypotension in 1,
and pericardial tamponade and resuscitation in 1, leading to neuro-
logical damage and death. One child died 2.5 months after BAV, after
operation for CoA. Acute and long-term mortality rates were 2% and
4%, respectively. During median follow-up of 6 years, survival was
96% and freedom from reintervention 57%. Twenty children had
undergone reintervention: repeat balloon valvuloplasty in 6 (13%),
and surgery in 14 (30%) including valvotomy (5), Ross operation (6),
and aortic valve replacement (3).
Conclusions
: In our centre, balloon dilatation of aortic stenosis
has been effective with low complication and mortality rates.
Reintervention is frequently needed.
1368:ACUTE DISSECTIONAND PSEUDOANEURYSMWITH
TRANSCATHETER PATENT ARTERIAL DUCT DEVICE
OCCLUSION
Supratim Sen, Philip Roberts
Heart Centre for Children, The Children’s Hospital at Westmead,
Sydney, Australia
Background:
Transcatheter device occlusion of patent ductus arte-
riosus (PDA) is a well-established and safe procedure with a
high success rate. Previous reports describing pseudoaneurysms as
complications with PDA devices have alluded to femoral artery pseu-
doaneurysms at the vascular access site. A literature review did not
identify reports of acute dissection and pseudoaneurysm formation
during transcatheter PDA occlusion.
Case report:
A 3.1 kg 74-day-old infant with a moderate atrial septal
defect (ASD), PDA and pulmonary valve stenosis was planned for
transcatheter balloon pulmonary valvotomy (BPV) and PDA device
closure. Pulmonary valve annulus measured 8 mm. An aortogram
with a 4F vessel sizing pigtail with the end cut off showed a long and
tubular PDA with a slight constriction at the pulmonary end. BPV
was performed with a 9 mm X 3 cm Tyshak II balloon. A 4-4 ADO II
AS device was deployed from the aortic side. The device was howev-
er freely mobile on stability testing and pushed through the duct into
the main pulmonary artery (MPA) with easy retrieval of the fully
deployed device back into the aorta. The delivery system and unre-
leased device were removed. Repeat angiography into the PDA with
a cut pigtail catheter demonstrated dissection and pseudoaneurysm
of the duct with 2 exit points into the MPA. Transthoracic echocar-
diography confirmed a tissue flap at the proximal pulmonary end of
the duct and a pseudoaneurysm which prolapsed into the MPA. The
infant was referred for surgical PDA ligation. Post ligation, there was
no residual PDA with resolution of the pseudoaneurysm.
Conclusions:
The dissection could have occurred during BPV, during
retrieval of the occlusion device or with positioning the cut vessel
sizing pigtail during the second aortogram. We feel the injury most
likely occurred with the cut pigtail catheter. This highlights the risks
associated with the sharp edges of a cut catheter.
1372: FEASIBILITY AND SAFETY OF TRANSCATHETER
CLOSURE OF ATRIAL SEPTAL DEFECT IN SMALL CHIL-
DRENWEIGHING 10 KG OR LESS
Nam Kyun Kim
1
, Su-Jin Park
1
, Jo Won Jung
1
, Lucy Youngmin Eun
2
,
Jae Young Choi
1
1
Congenital Heart Disease Center, Severance Cardiovascular
Hospital, Department of Pediatrics, Yonsei University College of
Medicine, Seoul, Korea
2
Department of Pediatrics, Gangnam Severance Hospital, Yonsei
University College of Medicine
Background:
Transcatheter closure of atrial septal defects (ASD)
has been accepted as a standard treatment for patients with haemody-
namic significance in children and adults. Little is known about very
small children and infants with poor weight gain and symptoms with
congestive heart failure.
Materials and methods:
From April 2004 to March 2008, 316
patients underwent transcatheter closure of ASD using Amplatzer
septal occluder (ASO, Golden Valley, MN) in our institute. Among
them 94 patients weighed 10 kg or less. The indication of early treat-
ment in each group was symptoms of congestive heart failure with
volume overload of the right side of the heart. We analysed the demo-
graphic data, clinical characteristics and outcome of the patients.
Results:
There were 28 males and 66 females. Median age was 15
months (7–15months) and average weight was 9.1 kg (5–10 kg).
Median ASD size was 15 mm (10–24 mm). Four patients were sent to
surgery because of the encroaching mitral valve by left atrium (LA)
disk after device placement. The procedure was successful in the
rest of the patients. There was no mortality. Complete closure rates
at discharge were 81.8%. Only one minor complication was noted
during the procedure (transient arrhythmia). The mean hospital stay
was 4.7 days.
Conclusions:
Transcatheter closure of secundum ASD with the ASO
is technically feasible, safe and effective even in very small children
and infants of less than 10 kg. Meticulous patient selection is of
critical importance to avoid undue invasive procedures in this unique
group of patients.
1376: DUCTAL CLOSURE USING AMPLATZER DUCT
OCCLUDER TYPE II ADDITIONAL SIZES: EARLY EXPE-
RIENCE IN PORT ELIZABETH HOSPITAL COMPLEX,
SOUTH AFRICA
Lungile Pepeta, Adele Dippenaar
Port Elizabeth Hospital Complex, Walter Sisulu University, Port
Elizabeth, South Africa
Background:
Various devices have been developed for percutane-
ous closure of patent ductus arteriosus (PDAs) in all patients except
the small infant. Such devices lead to either pulmonary artery or
descending aorta obstruction.
Methods:
Records of patients undergoing ductal closure were
reviewed. Demographics; haemodynamic and angiographic charac-
teristics including size, shape, length and aortic diameter, device to
close the duct and closure approach, screening time, complications
