Page 13 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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diogram, proper position of both devices with significant decrease in regurgitant flow of both prostheses was corroborated. New regis- tration pressures with pulmonary artery pressure of 28/12/20mmHg and left atrium pressure of 28/14/20 mmHg. The evolution of the pa- tient after the procedure was toward improvement, without clinical evidence of hemolysis and recovery of functional class. The patient was discharged three days after the cardiac catheterization.
Paravalvular leak as a complication of surgical valve replacement is well described, being uncommon mechanical prosthesis in tricuspid position. To date, there are 3 reported cases of percutaneous clo- sure of this type of paravalvular leak. We demonstrate the success- ful closure of two paravalvular leaks (mitral and tricuspid prosthesis) through the right internal jugular and femoral approach.
#0020
MODIFIED AMPLATZER SEPTAL OCCLUDER IN A PATIENT WITH OSTIUM SECUNDUM ATRIAL SEPTAL DEFECT
Allison Amidon1, Mehul Patel1, Bennett Samuel1, Joseph Vettukattil,
Helen DeVos Children's Hospital of Spectrum Health, Grand Rapids, MI, USA
A 23 year-old male with history of large ostium secundum atrial sep- tal defect (ASD) presented to the emergency department with an inguinal hernia. He was diagnosed with pulmonary edema. Echocar- diography demonstrated severe biventricular systolic dysfunction, bicuspid aortic valve with moderate aortic regurgitation, moderate to severe mitral valve regurgitation without mitral valve stenosis status-post mitral valve repair, moderately-severe tricuspid valve re- gurgitation and moderate residual ASD. An extracellular matrix (ECM) patch (CorMatrix® Cardiovascular, Inc., Roswell, Georgia, USA) was surgically placed 21 months prior to presentation. Due to patch fail- ure two ASDs measuring 38 mm x 12 mm and 10 mm x 6 mm were visualized on three-dimensional transesophageal echocardiography (3DTEE). As the patient’s left atrial pressure was 24 mmHg, balloon occlusion testing was not performed due to the risk of tissue inju- ry. Instead a 38 mm Amplatzer septal occluder device was manually fenestrated and placed in the larger ASD with immediate hemody- namic improvements. For larger ostium secundum ASDs, closure of the defect with a fenestrated ASO should be considered without balloon occlusion test to prevent complications. Closure of ASD in a patient with severe left ventricular (LV) dysfunction may cause vol- ume overload of the LV and pulmonary edema. However, if carefully planned allowing room for adequate left-to-right shunt, the LV can be trained to handle volume change in small increments over time. In our patient, there was a gradual increase in LV volume and decline in RV volume over 3 days of hospital stay.
#0021
RESIDUAL SHUNT AFTER OCCLUSION OF AN ATRIAL SEPTAL DEFECT WITH THE GORE HELEX SEPTAL OCCLUDER: CLOSURE WITH THE NEWER GORE SEPTAL OCCLUDER.
Heike Schneider, Matthias Sigler, Ulrich Krause, H Christoph Preuss, Thomas Paul
University Goettingen, Goettingen, Germany
Interventional closure of a secundum type atrial septal defect had been performed in a 5-year-old boy with a 25mm Gore Helex Sep- tal Occluder (Helex). Transesophageal echo (TEE) had confirmed an oval shaped (5 x 9 mm) ASD with a partially deficient aortic rim. Bal- loon-sizing had shown a size of 14.5 mm. After release of the Helex, a residual shunt was noted, but assessed as not significant. The position of the device, alignment of the islets had been assessed to be good. On follow-up echocardiograms over several years the shunt did not decrease and the patient was referred for closure of the residual de- fect because of right heart volume overload on echocardiography.
At cardiac catheterization, TEE with 3D confirmed a residual shunt between the aortic rim and the Helex device which was crescent shaped. The hole could be passed with a guiding catheter type Jud- kins right and subsequently easily crossed with the Gore delivery sheath. Balloon-sizing was omitted in order not to deform the previ- ous device. Maximal width of the defect was 7 mm, length difficult to assess for its crescent shape. To completely cover the residual hole at the side of the deficient aortic rim, exert enough radial strength and to capture especially the right atrial disc without covering the central islet of the Helex occluder, a 20 mm Gore Septal Occluder (GSO) was chosen. Closure could be achieved with the sandwich technique and good position of the GSO flat at the septum without residual shunt- ing was documented.
Conclusion: Retrospectively, reason for the residual shunt was likely an undersizing of the initial Helex occluder. A soft device such as the GSO appears to be a good choice to close a residual shunt after the Helex device to avoid its deformation. In addition, radial strength of the new GSO appears to be sufficient for this cause.
#0022
NON INVASIVE ULTRASONIC CHORDAL CUTTING Olivier Villemain1, Wojciech Kwiecinski2, Alain Bel1, Justin Robin2, Patrick Bruneval1, Bastien Arnal2, Mickael Tanter2, Mathieu Pernot2, Emmanuel Messas1
1Hôpital Européen Georges Pompidou, Université Paris Descartes, Cardio-Vascular Departement, UMR 970, Paris, France
2Institut Langevin, ESPCI, CNRS, Inserm U979, Paris, France
Objective: Basal chordae surgical section has been shown to be effec- tive to reduce mitral regurgitation. We investigate in vitro and in vivo the feasibility of using focused ultrasound (histotripsy) for non-inva- sive chordal cutting to avoid cardiopulmonary bypass and invasive surgery in infarcted heart.
Methods: Experiments were performed in vitro in explanted sheep hearts (N=10) and in vivo in sheep beating hearts (N=7). In vitro, the mitral valve apparatus including basal chordae was removed, fixed on a holder in a water tank. Very high intensity ultrasound pulses were emitted from the therapeutic device (1-MHz focused transduc- er) placed at a distance of 64 mm under echocardiography guidance. In vivo, after sternotomy, the same therapeutic device was applied on the beating heart. We analyzed mitral valve coaptation and chordae by real time 3D echocardiography before and after basal chordal cut- ting. Animals were sacrificed at the end for anatomical and histolog- ical postmortem explorations to confirm the section of the chordae.
Results: In vitro, all basal chordae were completely cut after mean procedure duration of 5.5 minutes. Duration of the procedure was
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111