COMPLEMENTARY TECHNIQUES OF PERCUTANEOUS CLOSURE OF DUCTUS ARTERIOSUS USING DETACHABLE COOK COILS AND AMPLATZER DEVICES.

BACKGROUND: Patent Ductus Arteriosus (PDA) is a commoncardiac malformation whose treatment locally has been surgical ligation via a lateral thoracotomy. Device closure of the ductus was first performed at the Mater hospital in 1999 in a ten year old male using a five millilitre detachable cook coil. In 2000 the Amplatzer device was introduced to close larger ducts. Subsequently these devices have been used interchangeably to close both small and large ducts. We report this single centre experience of percutaneous PDA closure in a resource-limited setting; utilising the two techniques. OBJECTIVE: To describe our experience of trans-catheter closure of small and large ducts using either the detachable Cook coils or the Amplatzer occluders at the Mater Hospital Nairobi. DESIGN: A descriptive retrospective cohort study. Setting: The Mater Hospital, Nairobi, Kenya. SUBJECTS: Patients with clinical and echo-cardiographic features of patent ductus arteriosus who underwent cardiac catheterisation and angiography followed by device embolisation of the ductus. RESULTS: From April 1999 to October 2009 a total of ninety eight subjects were recruited. into the study. Sixty nine (70%) of these subjects had the ducts closed using the Amplatzer devices, while twenty nine (30%) were embolised using the cook detachable coils. Three of the subjects in the coil group had the ducts embolised using the double technique while the rest were embolised using single coils. Various coil sizes four to eight millimetres were used in patients with small to medium ducts (two to seven millimetres) whereas the Amplatzer duct occluder was successfully used in all the duct sizes. The Amplatzer atrial septal occluder device was used to close very large ducts in two of the patients. The overall success rate was 93.1%, but the coil group had higher failure rate of 6.9% compared to the Amplatzer group of 3%. One patient in the Amplatzer group had a late embolisation requiring surgical retrieval at one month post occlusion. There were no mortalities. CONCLUSION: Transcatheter device occlusion of PDA is a safe and alternative to

Prevalence of iron deficiency in children with cyanotic heart disease seen at Kenyatta National Hospital and Mater Hospital Nairobi.

OBJECTIVE: To establish the prevalence of iron deficiency among children with cyanotic heart disease. DESIGN: Cross-sectional study. SETTING: The study was carried out at Kenyatta National Hospital and Mater Hospital from August to December of 2007. A total of 112 children meeting the eligibility criteria were recruited from the wards and the cardiac clinics. SUBJECTS: These were children less than 18 years of age, with cyanotic heart disease confirmed on ECHO, presenting at the paediatric cardiac clinic of the two hospitals or admitted in the wards at Kenyatta National Hospital. These were patients who had not undergone surgical correction. RESULTS: The prevalence of iron deficiency was found to be 16.9% (95% CI 9.8-24.1%). CONCLUSION: There is a high prevalence of iron deficiency among patients with congenital heart disease with cyanosis in the two institutions. Routine screening for iron deficiency is recommended for these children and those found to be deficient should be treated.

Percutaneous balloon mitral valvotomy: initial experience in Nairobi using a new multi-track catheter system.

OBJECTIVE: To determine efficacy and safety of the new multi-track catheter system for percutaneous baloon mitral valvotomy. DESIGN: Open, non-randomised intervention. SETTING: Cardiac catheterisation Laboratories of Mater Misericordiae Hospital (1997) and Kenyatta National Hospital, Nairobi(1994). PATIENTS: Twenty four consecutive patients with symptomatic severe pure mitral stenosis (less than 2+ mitral regurgitation) and suitable mitral valve apparatus(leaflets, chordae and papillary muscles) for successful commissurotomy. INTERVENTION: Percutaneous mitral baloon valvotomy under local anaesthesia. Standard left and right heart catheterisation for mitral valve disease. Transeptal left atrial entry using standard septal puncture technique and left ventricle position secured by single long-stiff guide-wire. Double-baloon mitral valvotomy on single guide-wire using multi-track baloon catheters. MAIN OUTCOME MEASURES: Mitral valve area, left atrial pressures, mitral regurgitation grade. RESULTS: Mitral valve area increased from 0.65 +/- 0.15cm2 to 1.98 +/- 0.34cm2 (P < 0.01), left atrial pressures from 30.5 +/- 9.1 to 11.9 +/- 5.1mmHg (P < 0.01). No significant change in mitral regurgitation grades. No complications related to multi-track technique. CONCLUSION: Percutaneous baloon mitral valvotomy using the multi track technique is effective and safe.

Effect of percutaneous balloon mitral valvotomy on pulmonary venous flow in severe mitral stenosis.

OBJECTIVE: To study the effect of percutaneous balloon mitral valvotomy (PBMV) on the deranged systolic and diastolic pulmonary venous flows in mitral stenosis. DESIGN: Open, non-randomised, case-control study. SETTING: Mater Misericordiae Cardiac Catheterisation Laboratory and Kenyatta National Hospital Cardiac Catheterisation Laboratory. PATIENTS: Twelve consecutive patients with severe symptomatic mitral stenosis with valve characteristics suitable for PBMV on echocardiographic evaluation. INTERVENTION: Percutaneous baloon mitral valvotomy. MAIN OUTCOME MEASURES: Peak systolic and diastolic pulmonary flow velocities and velocity time integrals (VTI). RESULTS: Peak sytolic pulmonary flow velocity increased from 29.8 +/- 9.6 to 46.1 +/- 8.5 cm/s p < 0.01) and systolic VTI from 2.6 +/- 1.0 to 5.5 +/- 0.9 cm (p < 0.01). Peak diastolic flow velocity increased from 39.3 +/- 5.7 to 43.0 +/- 6.9 cm/s (p < 0.05) and diastolic VTI from 3.9 +/- 1.5 to 4.8 +/- 1.6 cm (p < 0.05). Mean mitral valve area increased from 0.65 +/- 0.15 to 1.98 +/- 0.34 cm2 (p < 0.001) and mean left atrial pressures from 30.5 +/- 9.1 to 11.9 +/- 5.1 mmHg (p < 0.001). CONCLUSIONS: In patients with severe mitral stenosis and sinus rythm, left atrial filling is biphasic with diastolic preponderance. Successful PBMV causes predominant increase in atrial systolic filling.

Echocardiographic analysis of 266 patients with mitral valve disease: Results and interventional implications

Two hundred and sixty six patients (157 females and 109 males) aged nine to 58 years (mean: 29 years); with mitral valve disease of various aetiologies underwent clinical electrocardiographic; roentgenographic and detailed 2-D-colour-doppler echocardiographic evaluations. They were seen between June; 1993 and June; 1995 within an on-going mitral valve analysis project conducted in three major hosptials in Nairobi. As expected in this environment; majority (77 per cent ) of the valve lesions were of rheumatic aetiology; and of severe grades (41-48 per cent). Majority of patients with mitral stenosis were found to suitable for either mitral valvotomy (by baloon catheter or surgery) or mitral valve repair (72.3 per cent); the rest; 27.7 per cent; requiring mitral valve replacement. Nearly 42 per cent of mitral stenosis patients were suitalbe for percutaneous mitral baloon valvotomy. Mitral valve repair was found possible in 56.3 per cent of patients with predominant mitral regurgitation; while only 36.5 per cent were suitable for valve repair in those with mixed regurgitaion and stenosis. With the developments in echocardiography; inteventional catheterisation and valve repair techniques; many options for intervention are now available ot patients suffering from mitral valve disease