Percutaneous closure of interatrial defects: the Free State experience

OBJECTIVE

Atrial septal defects and patent foramen ovale can now be closed percutaneously. This report describes our initial and follow-up experience, especially in relation to efficacy and complications.

METHODS

During a 2-year period, seven atrial septal defects and one patent foramen ovale were closed. The Amplatzer artrial septal defect occluder was used in five, the Cardioseal device in two and the Amplatzer patent foramen ovale occluder in one. A compliant sizing balloon was used to assess the stretched diameter of the defects.

RESULTS

Percutaneous closure was successful in all patients. The median age was 5.4 years (range: 3.7-16.6 years) and median weight was 18 kg (range: 14-65 kg). The mean duration of the procedure was 2.3 hours. There were no acute complications. Patients were followed up for a mean of 1.1 years. One child experienced severe headaches and another developed an atrial flutter and a small leak 7 months after implantation, both of which resolved.

CONCLUSIONS

Percutaneous closure of atrial septal defects and patent foramen ovale is effective and safe. In selected children, this may be offered as an alternative to surgery.

Low molecular weight heparin in the successful treatment of a spontaneous aortic thrombosis in a neonate

A successfully treated case of a spontaneous aortic thrombosis in a neonate is described as an illustration of the advantages of using low molecular weight heparin (LMWH) over unfractionated heparin (UFH) for anticoagulation therapy. A 5-day-old neonate presented with an abdominal aortic thrombosis detected by echocardiography. Intravenous UFH was commenced following thrombectomy. Poor venous access made monitoring the anticoagulation therapy problematic. Subcutaneous LMWH was substituted for UFH. It requires substantially less monitoring and no intravenous access, has fewer side effects, and allows for much earlier discharge from the hospital. Extensive investigation for a hypercoagulable state revealed no definite cause for the thrombus. The findings of homozygosity for a methylene tetrahydrofolate reductase (MTHFR) mutation and a mildly elevated homocysteine level are interesting but unlikely to account for the thrombotic event in this case. Anticoagulation with LMWH proved effective and more convenient than using UFH.

Cantharidin poisoning with neurological complications

Two cases of cantharidin poisoning are described in which the patients developed the well-known complications of acute renal failure and pseudopolycythaemia. In addition both developed a Guillain-Barré type of flaccid paralysis but spontaneous reversal occurred. Cantharidin poisoning may be responsible for some of the unexplained neurological presentations in Black South Africans.

The place of occupational therapy in rehabilitation

No abstract available.