Follow up of late pulmonary valve replacements after repair of tetralogy of fallot

Heart,

Lung

and Circulation

2003;

Selected

12

haemostasis and reference articles on sheath removal and instructional video. Results Records of 79 (80% of all cases to October 2001) patients’ post PC1 were examined: mean age 61 years (37-82), 72% male, 14% diabetes. Complications - Bleeding occurred in 7.6% (N = 6), large haematoma (requiring further investigation or prolonged hospital stay) 3.8% (n = 3), one of these patients developed a pseudoaneurysm. No patients required vascular repair. Time the sheath was left in situ, time to haemostasis, length of procedure, blood pressure or personnel removing the sheath were not statistically significant predictors of complications. So far, 3 CCU nurses have undergone successful training. Complication rates were comparable to those in other institutions. Conclusion The learning package provides a successful tool to aid in the education of CCU nurses to safely remove arterial sheaths after the procedure of PCI/stent. Key words: Angioplasty, Health education, Patient care, Quality improvement Percutaneous Coronary Surgical Facilities Elizabeth M Hiegs, Denise Concord RGH, Austrulia

Interventions:

Without

On-Site

Cardiac

abstracts

from

the XIVth World Congress of Cardiology, May 5-9,2002

A21

right ventricular dilatation was present in 84% and 64% had right ventricular dysfunction. 95% were symptomatic with dyspnoea, arrhythmias and fatigue. Patients with arrhythmias had important right ventricular dilatation and dysfunction. Post-PVR follow up time was from two months to nine years. 63% had grade l/4 PI and 16% developed pulmonary stenosis. 64% had mild to moderate right ventricular dilatation with 54% having normal right ventricular function. Those with moderate to severe right ventricular dysfunction post-PVR had significant dysfunction preoperatively. 54% were now asymptomatic and those with continuing arrhythmias had significant right ventricular dilatation and dysfunction postoperatively. It is concluded that PVR is indicated before severe right ventricular dysfunction occurs. Arrhythmias relate to persistent right ventricular dysfunction and/or dilatation. Clinical symptoms are an indication for surgery but regular echocardiographic assessment of right ventricular size and function is necessary to determine time of intervention,which may be before symptoms develop. Key words: Antihypertensive therapy, Blood pressure, Echocardiography, transthoracic, Hypertension

J Lippiatt

Background Traditionally, Percutaneous Coronary Interventions (ICI) are performed at tertiary hospitals with on-site cardiac surgical facilities. Patients from other hospitals have been placed on waiting lists and transported to such a facility. The need for transfer may prolong length of stay and can decrease patient satisfaction. Our hospital has recently commenced providing PC1 to selected patients without on-site cardiac surgical facilities. The aim of this study was to assess the efficacy and safety of PC1 performed on in-patients without on-site cardiac surgery. Methods Efficacy was assessed by: (1) Angiographic success (residual stenosis < 20% lumen diameter); (2) Interval between diagnostic angiogram and PCI; (3) Patient satisfaction survey. All procedures were measured for rates of haematoma, need for surgical intervention or other complications. Results 199 in-patients underwent successful PC1 to 224 lesions from 1 September 2000 to October 12001. No patients required Coronary Artery Bypass Grafts (CABG’s) within 24 h of the procedure. 14 patients required repeat PC1 within 3 months because of restenosis. 11% developed significant haematomas requiring recompression but there were no haematomas requiring surgical intervention. The interval between diagnostic angiogram and therapeutic PC1 for in-patients decreased from a mean of 6.1 + 3.4 days before on-site PCI, to 1.1 f 0.25 days after on-site PCI. Patient satisfaction assessed by telephone questionnaire was 96.4%. Conclusion PC1 can be performed safely and efficiently in experienced laboratories without surgical backup. Most importantly, it improves patient access to resources, reduces hospital stay and improves patient satisfaction. Key words: Angioplasty, Cost-effectiveness Follow up of Late Pulmonary Valve Replacements After Repair Tetralogy of Fallot Belinda 1 Shearer, Dorothy J Radford, Darryl J Burstow The Prince Charles Hospital, Rode Road, Chermside, Australia, Australia

Unexpected Late Clinical Problems Associated Bipolar Pacing Lead Kave E Sutton’, William F Heddle2 ‘Flinders Medical Centre, Australia; 2Australia

a Ventricular

Background Pacing leads remain the ‘weak link in the pacing system and require constant surveillance to assess integrity, performance and reliability. Our observations of the performance of the Medtronic Capsure SP 4024 (SP4024) bipolar ventricular pacing lead (Medtronic Inc), a polyurethane, steroid eluting lead, did not correlate with the established knowledge that steroid eluting leads have reliable long-term pacing performance. Assessment of late clinical problems related to ventricular pacing leads (VP) was undertaken. Methods A retrospective study to detect the rate of late clinical lead problems (LCL) in SP4024 (n = 108) compared to all other* VP (n = 61) implanted at FMC between 1992 and 97. The number analysed excluded those lost to follow-up. A detailed audit and analysis of a clinical database and accompanying records for the presence of either/or a sustained increase in pacing threshold, decreased lead impedance or unplanned clinical intervention intrinsically associated with the lead performance. Minimum follow up 4 years. Results Results are presented in the table. SP4024 have significantly higher rates of unplanned clinical intervention than all other VP combined [12/108 vs. O/61 P = 0.0041. Gender M at Implant

Mean Age at Implant

Lost to Follow Up

132 n = 239 62 11= 115

72.3 f 14 years n = 239 70 + 14 years n = 115

131

Increased

Threshold

Decreased Impedance

Unplanned Clinical Intervention

SP4024

21 P = 0.102 rr = 1.97

11 P = 0.008 n = 108

VP

6 P=NS n = 61

0 P=NS n = 61

12 P = 0.004 n = 108 i, = 108 0 P=NS n = 61

SF’4024

VP

of

Pulmonary incompetence (PI) is initially well tolerated in young patients after repair of Tetralogy of Fallot. However, some require eventual pulmonary valve replacement surgery (PVR). Appropriate indications and timing of surgery have remained ill defined. We retrospectively reviewed clinical and echocardiographic data on such patients with a view to better defining the time for intervention. 55 patients (30 female, 25 male) were assessed. They had undergone initial total corrective surgery for Tetralogy and then had re-operation for PVR between 1972 and 2001. The average age at first corrective surgery was 6.5 years (range 4 months to 26 years). The average age at PVR surgery was 25 years (range 8-50 years) with average time between operations being 18.5 years. Prior to pulmonary valve replacement, 75% of patients had grade 3/4 to grade 4/4 PI and 23% had pulmonary stenosis. Moderate to severe

with

54

Conclusion The data suggest that the SP4024 has a statistically significant failure rate presenting as either increased pacing threshold or decreased impedance. ‘All leads were bipolar, passive fixation, silicon and steroid eluting. Key words: Cardiac pacing artificial, Electrophysiology, Implants, artificial, Pacemaker, artificial