Page 12 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
IJ approach after unsuccessful FV approach had longer fluoroscopic times and procedure duration compared to the FV group or patients in whom the IJ approach was used from procedural onset.
Conclusions: The IJ approach for TPVi is used infrequently, but is more often used in younger and smaller patients. Technical limitations to TPVi from a FV approach may be anticipated if there is ≥ moderate TR or higher RVSP:Ao. In these patients, an IJ approach should be consid- ered early, to avoid prolonged procedural times and increased radia- tion exposure associated with unsuccessful FV approach.
#0018
STENT ANGIOPLASTY OF PULMONARY BRANCHES AS RESCUE THERAPY OF SUDDEN SPASM OF THEM AFTER RIGHT VENTRICULAR OUTFLOW TRACT STENT IMPLANTATION IN A PATIENT WITH TETRALOGY OF FALLOT.
Roberto Mijangos Vázquez, Jose Antonio García Montes, Jorge Manuel Guevara Anaya, Aldo Luis Campos Quintero, Adrian Sánchez Flores, Carlos Zabal
National Institute Of Cardiology Ignacio Chavez, Mexico City, Mexico
Female patient 4 years 6 months of age with a history of cyanosis since birth. She was taken to left systemic pulmonary shunt at two years of age. She has a history of hypoxia crisis a month prior to ad- mission. On admission, patient with SatO2 65%, rhythmic precordium, systolic murmur in pulmonary focus grade II/VI, normal second noise, normal pulses in all four limbs, clubbing.
Echocardiography was performed. Tetralogy of Fallot was diagnosed with left ventricular end-diastolic volume of 13ml (Z score -4.0). Com- puted tomography was done reporting significant hypoplasia of the pulmonary annulus as well as the trunk and pulmonary arteries, pul- monary systemic fistula occluded (Figure 1a and 1b). The case was dis- cussed in session and decided to take cardiac catheterization for right ventricular outflow tract stenting.
Hemodynamic study was performed, where the same pressures in both ventricles and gradient of 80 mmHg between pulmonary artery and right ventricle was reported. Severe hypoplasia of the pulmonary arteries with stenosis in the proximal third was observed (Figure 2a-c). Right ventricular outflow tract (RVOT) stenting (3910 Palmaz Genesis Stent) was performed (Figure 3a-c). During control angiography, dy- namic severe spasm of both pulmonary arteries with little passage of contrast to the distal pulmonary circulation was observed (Figure 4a and 4b). Suddenly, the patient developed significant hypotension and desaturation to 83% (PaO2 of 46mmHg). Two doses of nitroglyc- erin were administered without reversing spasm, so both pulmonary artery stenting was performed (1910 Palmaz Genesis Stent in right pulmonary artery and 9x16mm LD Mega Stent in left pulmonary ar- tery). Improved blood gas with 100% saturation and PaO2 235 mmHg (Figure 5a-d).
The patient remains under mechanical ventilation for 36 hours with adequate hemodynamic evolution without presenting evidence of re-perfusion syndrome. Hospital discharge was given four days after catheterization.
Conclusion. Right ventricular outflow tract stenting is a palliative
measure as an alternative to surgery that allows the gradual devel- opment of the pulmonary branches when they are not in adequate measures for total correction in a patient with tetralogy of Fallot.
We report a rare compilation such as the sudden spasm of pulmonary branches the same as when the pulmonary infundibulum is stimu- lated, compromising systemic cardiac output and systemic satura- tion, demonstrating that pulmonary arteries stenting is an excellent choice as rescue therapy to improve hemodynamics and oxygen- ation status in our patient.
We are not aware of the previous description of this complication during RVOT stenting.
#0019
PERCUTANEOUS
TRICUSPID PROSTHETIC PARAVALVULAR LEAKS WITH AMPLATZER VASCULAR PLUG III DEVICES VIA FEMORAL AND RIGHT INTERNAL JUGULAR APPROACH.
Roberto Mijangos Vázquez, Jose Antonio García Montes, Jorge Manuel Guevara Anaya, Aldo Luis Campos Quintero, Adrian Sánchez Flores, Carlos Zabal
National Institute Of Cardiology Ignacio Chavez, Mexico City, Mexico
Male 69 years old with a history of inactive rheumatic heart disease. He was taken to mitral valve replacement on four occasions and tri- cuspid valve replacement on one occasion, the last change was to ATS prosthesis in both. Patient who a year ago started with dyspnea of small efforts, lower limb edema and orthopnea 3 pillows. Also, the patient had clinical evidence of hemolysis. Therefore be admitted to the hospital, physical examination with jugular venous distension, with mitral regurgitant murmur grade III/IV radiating to the axilla, tri- cuspid regurgitant murmur, first sound with varying intensity, split second sound, holosistólico click is heard, normal pulses in four limbs.
Transesophageal echocardiography was performed and reported mechanical prosthesis in tricuspid position with opening preserved as well as the presence of significant paravalvular leak in septal re- gion. Mechanical prosthesis in the mitral position with opening preserved, prosthesis ring dehiscence in anterolateral region condi- tioning prosthetic valve insufficiency with significant hemodynamic repercussion.
It was decided to carry cardiac catheterization. In record pressures left atrium pressure of 36/12/20mmHg. Through femoral approach it was done right and left ventriculography observing moderate to severe regurgitation of both valve prostheses. With the help of transesophageal echocardiography (TEE) area of mitral paravalvular leakage in anterolateral region and tricuspid prosthetic leak in sep- tal region were observed, measured by color Doppler about 5 and 3mm, respectively. The defect in mitral prosthesis was crossed from the right atrium performing transseptal puncture. Arteriovenous loop was performed to finally achieve closure of the paravalvular leak with Amplatzer vascular plug device (AVP III 14/5mm). Through right internal jugular approach, it was possible to advance the guidewire through the tricuspid paravalvular leak and closure of the leak was performed with Amplatzer vascular device device (AVP III 8/4mm). Under fluoroscopic control and using 3D transesophageal echocar-
CLOSURE OF
MITRAL AND
19th Annual PICS/AICS Meeting Abstracts