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Transcatheter closure of PDA can be accomplished in selected infants weighing <6 kg despite the manufacturer's recommended weight limit of 6 kg for most ductal occluders. The embolization rate is higher than previously reported in larger patients. Retrievability of the occluder and duct morphology needs careful consideration before deciding whether surgical ligation or transcatheter therapy is the better treatment option.

Congenital Heart Disease (CHD) is an enormous problem in Low Middle Income Countries and particularly in sub-Saharan Africa. There is an estimated 500,000 children born in Africa with CHD each year with a major proportion of this in sub-Saharan Africa. The vast majority of these children receive sub-optimal or no care at all. In East Africa: Kenya, Tanzania, and Uganda have all attempted to create a CHD service for the last 20 years with minimal success due to various factors. Visiting cardiac missions have made considerable contributions in the development of CHD services in these countries, however there remains a significant number of children with lack of care. We explore the positive aspects of the current projects, the various factors that hinder growth in this area, and what can be done to promote CHD service growth in these countries.

Interventricular septal haematoma is a rare postoperative complication in congenital heart surgery. We present one case of a 6-month-old after tetralogy of Fallot repair and 1 case of a 10-month-old after ventricular septal defect repair. Both were noted to have interventricular septal haematoma on intraoperative transoesophageal and postoperative echocardiogram. Although multiple previous reports, mainly in adults, have suggested aggressive intervention, both these cases were managed conservatively, highlighting the management and evolution of a rare postoperative complication in the paediatric population.

We describe percutaneous repair of severe pulmonary regurgitation and a right ventricular outflow tract pseudoaneurysm in a 19-year-old patient after repair of pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals. A 3D printed model of his heart was used to simulate percutaneous repair with a closure device in the aneurysm neck and a Venus P-valve in the right ventricular outflow tract. The encouraging findings from the simulation allowed us to plan the complex procedure effectively with a successful outcome and avoidance of surgery.

Percutaneous pulmonary valve implantation has gradually become the first line strategy for re-intervention for right ventricular outflow tract dysfunction during long-term follow-up after congenital cardiac surgery in many centers. We describe a case of a patient with double outlet right ventricle (Fallot's type) with a doubly committed subarterial ventricular septal defect, where the unique anatomy precluded percutaneous pulmonary valve implantation. © 2016 Wiley Periodicals, Inc.

BackgroundThe technique of transcatheter patent ductus arteriosus (PDA) closure has evolved in the past two decades and is increasingly used in smaller patients. We sought to report a multicentre experience of transcatheter PDA occlusion in infants weighing <6kg.MethodsA multicentre, retrospective analysis of children weighing <6 kg in whom transcatheter PDA occlusion was attempted between January 2004 and December 2014 from 10 tertiary paediatric cardiology units in the UK and Ireland.ResultsA total of 361 patients underwent attempted transcatheter PDA closure. The mean weight at catheterization was 4.8 ± 1.0 kg and mean age was 5.7 ± 2.7 months. Successful device closure was achieved in 321(89%) patients without major complication. Device placement was attempted but failed in in 13 cases. Device malposition or embolization post release occurred in the remaining 27 cases. Of these, 11 patients had surgical retrieval of the embolized device and PDA ligation; 6 patients were referred for surgery at a later date after transcatheter retrieval of device and 10 patients had ductal closure with a different device after transcatheter retrieval of the initial device. In the 331 patients who had transcatheter PDA occlusion, 34 had coils and 297 had occluders, including Amplatzer Duct Occluder (ADO) (n = 197); ADO II (n = 51); ADO II Additional Sizes (n = 42); Amplatzer Vascular Plug (n = 6); Occlutech Duct Occluder (n = 1). Complete occlusion was achieved in a 312(94%) patients at either catheterization or last available follow-up. Three of 19 patients had mild residual flow which persisted at less than a year post procedure; but follow up data was not complete in the rest. There were 17 cases of mild left pulmonary artery (LPA) stenosis related to device impingement with velocity >2m/s; 11 of which resolved with time, 5 had persistent mild LPA stenosis at last review with Doppler velocity of 2.5m/s or less; and 1 underwent LPA stenting. Mild aortic obstruction was recognised in 10 patients during catheterisation or on post procedure echocardiogram, 7 of which resolved; one had persistent increased velocity at the arch with no diastolic tail at last review and 2 had incomplete follow up data. Other complications include loss of pulse requiring TPA (n = 5) temporary reduction in pulse requiring heparin infusion (n = 16); bleeding requiring transfusion (n = 2); anaesthesia or airway related (n = 1); small pericardial effusion (n = 1); haemopericardium requiring percutaneous drainage (n = 1); tricuspid valve injury (n = 1); and cerebrovascular event (n = 1). There were 13 deaths in the cohort which were unrelated to the procedure. The causes of death were mainly related to underlying chronic lung disease and pulmonary hypertension.ConclusionsTranscatheteter closure of PDA can be safely accomplished in selected infants who are less than 6 kg despite the manufacturer’s recommended weight limit of 6 kg for most ductal occluders. The embolization rate (7%) in this group appeared to be higher than published series in infants >6kg,...

A 9-month-old male presented in heart failure with a 2-day history vomiting that followed a viral upper respiratory tract infection 10 days previously. Echocardiography demonstrated a normally connected heart with a severely dilated and poorly functioning left ventricle with bright mitral valve papillary muscles. It was difficult to demonstrate the origin of the left coronary artery and retrograde flow was seen in the vessel (Fig 1, Panel A). The right coronary artery appeared normal. A gated cardiac CT was performed and showed a normal right coronary origin and no clear connection of the LCA to Ao and there was suspicion of retrograde filling. Images of the left coronary origin did not show clear connection of the LCA to Ao (Fig 1, Panel B). As the case was extremely unusual coronary angiography was performed which confirmed the suspicion of a dominant right coronary system with collateral connection to the left coronary system and retrograde filling and no antegrade filling of the LCA from the Ao (Fig 1, Panel C). This was consistent with atresia of the left coronary ostium, which was confirmed at operation. The left coronary sinus was opened, as was the roof of the left coronary artery and an anastomosis was performed to aorta using an autologous patch. The post operative TOE showed good flow into the LCA (Fig 1, Panel D). There was good and quick post op clinical recovery but the left ventricular function remains still poor at the moment with slow recovery as expected. The cardiac function will be monitored echocardiographically and the reconstructed coronary artery with CT. Abstract P1486 Figure 1