Page 11 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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#0014
SILENT PATENT DUCTUS ARTERIOSIS: WHEN THINGS GO WRONG
Najla Kourireche, Rachida Amri, Jamila Zarzur, Mohammed Cherti
University Hospital AVICENNE Department of cardiology B, Rabat, Morocco
Introduction: Infective endocarditis (IE) of the pulmonary valve is uncommon and usually occurs in conjunction with tricuspid and/ or left-sided valvular endocarditis. There have been only sporadic re- ports of isolated pulmonary valvular infective endocarditis. Congen- ital heart diseases are usually associated. We report, here, a case of pulmonary IE with silent patent ductus arteriosus (PDA).
Case Report: A 22 years old female has presented 15 days ago a febrile syndrom and polyarthralgia with deterioration of general condition. She had a recent history of hemolytic anemia. . On the first physical examination, her blood pressure was 100/50 mmhg, heart rate 105 c/ min and regular, and her temperature was 38°C. Cardiac auscultation found two murmurs: a diastolic murmur heard at the pulmonic area increasing with inspiration, and a continuous systolic-diastolic mur- mur at the left-upper sternal border, associated to signs of right heart failure. The workup included transthoracic echocardiography which revealed many vegetations on the PV with important pulmonary re- gurgitation and patent ductus arteriosus (PDA). The patient was di- agnosed as endocarditis. The blood cultures were negative. She was initially treated with intravenous vancomycin, quinolone and genta- micin but the evolution was fatal.
Conclusion: The incidence of PDA is rising, and it seems likely that we will continue to discover previously unrecognized cases of PDA in our adult patient populations. Asymptomatic patients may not require closure of the PDA, but this can only be determined after a thorough evaluation has been completed.
#0015
OCCLUSION OF FENESTRATED ATRIAL SEPTUM USING MULTIPLE HELEX DEVICES
James Kuo
Cook Children's Hospital, Fort Worth, TX, USA
The Gore HELEX septal occluder has been used successfully to oc- clude atrial septal defects (ASDs). Several case series describe closure of fenestrated and multiple ASDs, but few have included use of the Gore HELEX device. We report our recent experience in 3 patients oc- cluding multiple ASDs with 2 devices.
Patient 1 was a 14 year old male with a 13 mm defect by balloon stop- flow technique. A second defect, measuring 5 mm, was identified more inferiorly and posteriorly. A 30 mm HELEX device was placed in the larger defect using an over-the-wire technique. The smaller defect was occluded using a 15 mm HELEX device. Patient 2 was a 10 year old female with 3 separate defects: a small defect in the fos- sa ovalis, an inferior defect, and a more anterior defect. The greatest distance between defects was close to 20 mm. A 20 mm HELEX de- vice was placed in the inferior defect. A 25 mm HELEX device was then placed in the PFO. Upon release of the devices, the device in the foramen ovale appeared to shift superiorly and there was now a residual leak from the anterior defect. The 25 mm HELEX device was
then removed using the retention suture without difficulty. A 30 mm HELEX device was deployed in the anterior defect. It appeared to be in good position and “sandwiching” the other device. Patient 3 was a 10 year old with 2 separate defects. Initially a 30 mm HELEX was used to try and occlude both defects, but the smaller defect was not oc- cluded. Ultimately, these defects were occluded using a 20 and a 25 mm HELEX with the larger device “sandwiching” the smaller device. Our technique on these 3 cases was to leave the first device attached to the delivery system until the second device was delivered. Then, both devices were released from the delivery system. This was felt to reduce the risk of device dislodgement while deploying the second device. There were no issues with interference from the first delivery system while placing the second device. All patients had acute suc- cess and longer term occlusion on 2 year follow up on Patient 1 and 1 year follow up Patients 2 and 3.
Multiple HELEX devices can be placed safely and successfully in pa- tients with fenestrated or multiple ASDs. The retention suture of the delivery system allows for withdrawal of a deployed HELEX without displacement of a previously placed device.
#0016
FACTORS PREDICTING BENEFIT OF AN INTERNAL JUGULAR VENOUS APPROACH FOR MELODYTM TRANSCATHETERPULMONARYVALVEIMPLANTATION Jeffrey Zampi1, Darren Berman2, Martin Bocks1, Sunkyung Yu1, Evan Zahn4, Jimmy Lu1, Justin Shaya3, Aimee Armstrong1 1University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
2Nationwide Children's Hospital, Columbus, Ohio, USA 3University of Michigan Medical School, Ann Arbor, Michigan, USA4Cedars-Sinai Medical Center, Los Angeles, California, USA
Background: Transcatheter pulmonary valve implantation (TPVi) is usually performed from a femoral venous (FV) approach, but this may not be the optimal method in some patients. This study aimed to determine factors associated with unsuccessful FV approach and which patients might benefit from an internal jugular (IJ) approach.
Methods: This multi-center retrospective study included all patients who underwent attempted Melody TPV (Medtronic, Inc. Minneapolis, MN) placement in either right ventricular outflow tract conduits or bioprosthetic pulmonary valves between April 2010 and June 2012 at 2 large congenital heart centers. Patients were divided into 2 groups based on the access site (FV or IJ) used to attempt TPVi. Patient char- acteristics, indications for TPVi, catheterization data, and procedural outcomes and complications were compared between groups. Rea- sons for using the IJ approach were also assessed.
Results: Of 81 patients meeting inclusion criteria (median age 16.4 years, IQR 11.7-22.8), the IJ approach was used in 14 (17%). The IJ group was younger (median age 11.9 vs. 17.3 years), had lower body surface area (mean 1.33 vs. 1.61 m2), more often had ≥ moderate tricuspid regurgitation (TR), and had a higher ratio of right ventri- cle to systemic systolic pressure (RVSP:Ao, mean 82.4 vs. 64.7). Sev- en patients in the IJ group had “technical limitations” using the FV approach as the indication for using the IJ route. Compared to the successful FV approach, the FV “technical limitations” group more of- ten had ≥ moderate TR and higher RVSP:Ao. There were no group dif- ferences in procedural complications. However, patients requiring an
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111