Patient educational needs

Abstract for SHA22 only. We hypothesize that patients (pts) undergoing HRMV-PCI will have acceptable one year major adverse cerebral and cardiac event (MACCE) rates when compared with pts on MT only. Methods: Retrospective chart review was performed from 2005 till 2007. We included patients deemed high risk for CABG, underwent HRMV-PCI and compared data with patients who received MT only. Syntax and Logistic Euro-score were calculated in all pts. The groups were followed for one year and data on MACCE were also collected. Results: The cohort consisted of 86 pts. HRMV-PCI, and MT was performed in 67, and 19 pts respectively. Mean age was 65 years with males comprising 72% of the total cohort. Majority of pts (96%) had a recent acute coronary syndrome. Logistic Euro-score showed significant difference when HRMV-PCI was compared with MT (21.6 vs. 15.6; P = 0.04). There was no difference in syntax scores when HRM-VPCI was compared with MT (31.1 vs. 37.1; P = 0.07). One year MACCE rate in the HRM-VPCI and MT group was 22.4%, and 26.3% respectively (P = NS). MACCE rate was primarily driven by target lesion revascularization in the HRMV-PCI arm. Conclusions: PCI is a viable alternative for revascularization in patients with Multi-Vessel Disease not suitable for surgical revascularization. In our study, PCI was performed in a high risk subset of pts based on the calculated syntax and Euro-score. Both PCI and Medical Therapy showed similar outcome over one year follow-up. doi:10.1016/j.jsha.2011.02.069

SHA 069. One year clinical outcomes of patients undergoing multivessel PCI who are considered poor candidates for CABG: A single tertiary care center experience Samih Lawand a, Elie Saker a, M. Rizwan Khalid a, Abdullah Al Khodair a, Wael Alqarawi a, Mazin H. Fadl b, M.A. Assal b, Mohamad Ibrahim b a Department of Adult Cardiology, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia b Department of Cardiac Surgery, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia Objectives: Numerous clinical trials have established the feasibility of multi-vessel PCI in selected patients (pts). There is limited data, especially from the Middle East, on pts in which surgery was deemed too high risk and multi-vessel PCI was performed. We hypothesize that multi-vessel PCI can be performed in such pts with acceptable one year major adverse cerebral and cardiac event (MACCE) rates. Methods: Chart review was performed from October 2005 till December 2007. Pts that were considered poor surgical candidates and underwent multi-vessel PCI were included in this retrospective cohort analysis. Data was collected on demographic variables, clinical features, Logistic EuroSCORE and Syntax score. These pts were followed for one year and data on MACCE was also recorded. Statistical analysis was performed on SPSS 16.0 software. Results: Sixty seven pts were treated with multi-vessel PCI. Mean age was 64 years with males comprising 70% of the cohort. All pts had recent acute coronary syndrome. Previous history of DM, HTN, tobacco abuse and dyslipidemia was present in 76%, 76%, 28% and 61% of pts respectively. Seven patients were clinically in acute cardiogenic shock. Triple vessel disease was found in 90% of the pts. CABG was refused due to poor coronary targets secondary to diffuse CAD and significand co-morbidities in

191 36 (54%) and 21 (31%) pts respectively. Mean logistics EuroSCORE and Syntax score was 21.6 and 31.1 respectively. PCI was successfully performed in all pts. At one year follow-up there was one reported death (1.5%) and four non-fatal MI (5.9%). Overall one year MACCE rate was 22.4% primarily driven by target lesion revascularization in 10 pts (14.9%). Conclusions: This pilot study from the Middle East of Saudi patients who are not good candidates for surgical revascularization, demonstrates that multi-vessel PCI of patients with significant co-morbidities and high syntax scores can be a reasonable alternative to CABG with acceptable one year MACCE rates. doi:10.1016/j.jsha.2011.02.070

SHA 070. Coronary artery pattern in patients with transposition of great arteries and commissural malalignment Ahmed M. Alzahrani, Ali A. Al Akhfash, Fahad M. Al Habshan KACC, NGHA, Pediatric Cardiology, Riyadh, Saudi Arabia E-mail address: [email protected] (A.M. Alzahrani)

Introduction: In patients with transposition of great arteries (TGA) the anatomy of coronary arteries play a crucial rule in the surgical management as well as the outcome. The presence of commissural malalignment between the semi lunar valves (pulmonary and aortic valves) may be associated with abnormal coronary artery pattern in these patients. Objectives: To assess the coronray artery pattern in patients with TGA and commissural alignment or malalignment. Method: Retrospective data analysis of all patients who had a diagnosis of TGA during the period from July 2001 till June 2010. Patients with simple TGA as well as those with TGA and ventricular septal defect (VSD) were included. Patients who had no preoperative echocardiographic exams in our database as well as those with no clear echo images preoperatively were excluded. Complex TGA cases were also excluded. Results: 161 patients were identified to have TGA with or without VSD. Thirty-six patients did not fullfil the inclusion criteria. Seventy-nine patients (63%) had TGA with Intact ventricular septum, 43 (34.4%) had TGA with VSD, and 3 patients (2.4%) had TGA/VSD and left ventricular outflow tract obstruction. Nintyfive patients (76%) had usual coronary artery pattern. 67 patients (54%) had malaligned commeasures. Abnormal coronary artery pattern was found in 26 patients (39%) of those with malaligned commeasures compared to only 4 patients (7%) in the group who had aligned commeasures. The Sensitivity of having abnormal coronary artery pattern with malaligned commissures was 87%, specificity was 57. The likelihood ratio was 2. Conclusion: Malaligned commeasures in patients with TGA is a predictor of abnormal coronary artery pattern. doi:10.1016/j.jsha.2011.02.071

SHA 071. Adult congenital heart disease – ‘‘Do’s and Dont’s’’ – Patient educational needs Marinha Sofia Pires Macedo King Faisal Specialist Hospital and Research Centre, Cardiovascular, Riyadh, Saudi Arabia E-mail address: [email protected]

Abstract: Congenital Heart Disease – CHD – is a heart abnormality that is present at birth. Adult patients with CHD are the

192 beneficiaries of successful pediatric surgery and cardiology programs. Because of the pediatric cardiology and cardiac surgery advances, the number of children with CHD surviving into adulthood continues to increase. The complexity of these patients on the adulthood often exceeds the expertise of the health professionals that deal with them. Therefore, North American and European task forces have been developing recommendations for the management of these individuals. According to the World Health Organization (2006) the epidemiology of CHD in Saudi Arabia has not been determined. However, this group of patients has a peculiar anatomy and complications that will have a significant impact on their lives. As most early interventions have not been curative and approximately 50% of them might face further surgery and heart failure, as health professionals, we need to support the education of CHD patients; moreover we need to discuss lifestyle issues such as exercise, pregnancy, career planning, etc. These issues are often more important to patients and families than details about their disease. ACHD teams provide education to these patients and encourage them to create their own health files in order to make them proactive about their health. These teams have to establish a life-long partnership, particularly with young adults who are highly motivated and have excellent survival profile. Only through educated professionals and educated patients we will enable every CHD patient to enjoy their full potential life. doi:10.1016/j.jsha.2011.02.072

SHA 072. Features and concepts: Saudi congenital heart defects registry Nadia Dessouky, Futwan Al-Mohanna, Ahmed Al-Omrani, Mamdouh Al-Ahmadi, Mansour Al-Joufan, Zohair Al-Halees King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia E-mail address: [email protected] (N. Dessouky)

Objectives: Providing leadership in establishing and maintaining comprehensive congenital heart defects registration with other organizations. Supporting scientific and clinical research impacting on prevention, intervention and overall management care of CHDs. Methods: All patients having congenital heart defects are eligible for inclusion in the registry. Events recorded include; Demographics, diagnostics, catheter-based interventions, cardiac surgery and follow up visits. European Pediatric Cardiology Coding System is utilized for coding. Results: Around 20,000 patients are registered. The registry evolved to multi-institutional collaboration. An on line up to date counts and statistics can be obtained. Many projects based on the registry data have been published. Conclusion: Congenital Heart Defects Registry is now wellestablished. Available data will help in understanding the burden of Congenital Heart Disease in our area and hence better planning by health authorities to improve provided care. doi:10.1016/j.jsha.2011.02.073

SHA 073. Incidence of severe congenital heart disease in Qassim Province, Saudia Arabia Abdul Rahman Al Mesned, MD Dr., , Dr.Maha Al Sayed Pediatric Cardiology Department, Ministry of Health, Maternity and Children Hospital of Buraidah, Saudi Arabia

Abstract for SHA22 Objectives: Assess the incidence of sever congenital heart disease. Methods: All Patients born between 01-01-1429 and 01-01-1431 (10-01-2008 to 18-12-2009) in Qassim province, Saudia Arabia diagnosed to have severe congenital heart disease were included in the study. categorization of severity was according to those published by Hoffman (will be presented in details in the presentation). Results: Among 39309 live birth 207 patient diagnosed to have severe congenital heart disease given incidence of 5.3 per 1000 live birth. Conclusion: Severe congenital heart disease is a major health problem in Pediatric population in Saudia and deserve establishment of advanced cardiac center in major provinces in the country. doi:10.1016/j.jsha.2011.02.074

SHA 074. Indications, safety and efficacy of interventional cardiac catherterisation in children during early post-operative period Muhammed Amin Rasul, Al-Ata Jameel, Arfi Muhammed Amin, Hussain Arif, Kouatli Amjad, Ghasan Basslaim, Ahmad Jamjoom King Faisal Specialist Hospital and Research Centre General Organization, Peds Cardiology, Jeddah, Saudi Arabia E-mail address: [email protected] (M.A. Rasul)

Objectives: To review indications, efficacy, and safety of interventional cardiac catheterization performed in children during early post-operative period after cardiac surgery for congenital heart defects. Methods: Medical records including operative, post-operative and catheterization data of patients who could not be weaned off mechanical ventilation, isotropic, and/or ECMO support because of residual cardiac lesions necessitating catheter based intervention during January 2006 to December 2008 were reviewed. Risk factors including age, weight, pump time, aortic cross clamp time, the time interval between cardiac surgery and trans-catheter intervention, and total length of stay in ICU were compared among survivors and non-survivors. Chi square test and student t-test were used respectively to compare the categorical and numerical data to identify risk factors for procedure related and over all morbidity and mortality. Results: Forty-three procedures done on 35 patients: sent angioplasty 19, balloon dilation and angioplasty 13, coil occlusion 8, device occlusion 2, atrial septostomy 1. Five patients underwent procedure on ECMO support. No procedure related morbidity or mortality recorded. Pre-procedure: mean duration of mechanical ventilation or ECMO support was 12.5 ± days (2–59). Post-procedure, 14/35 (40%) patients were extubated within 48 hours (0–2 d) and 26/35 (74%) within 7 days. Of 5 mortalities (11.5%), four died in stent angioplasty and one after coil occlusion group. All mortalities were related to severe cardiopulmonary dysfunction and none of the risk factors examined were found significant for mortality. Conclusion: Interventional cardiac catheterization can be safely and effectively performed during early post-operative period in critically ill patients left with residual cardiac lesions after cardiac surgery. Skilled operator, well trained team, adequately equipped catheterization laboratory and emergent surgical back up are prerequisite for embarking on this treatment option. doi:10.1016/j.jsha.2011.02.075