Page 15 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
44
male patient admitted in our institute as an absent pulmonary valve syndrome (APVS), presenting with respiratory distress that required mechanical ventilation. A central venous access was required. During placement, easiness obtaining blood flow from elected puncture sites was noted however the wire would not advanced in any of the sites. It was decided to realized the procedure in the cath lab. Veno- grams were performed: neither right or left SVC were seen, both of the venous return drained in an Azygous Vein (AV), that connected to the hepatic portion of the Inferior Vena Cava (IVC). Right iliac vein was hypoplastic and stenosis was noted in the pre renal IVC. APVS diagnosed was corroborated. We present this case due to its oddity complicating a routine procedure such as a central access placement and the curious association between Bilateral absence of SVC a com- plex cardiac malformation such as APVS and IVC malformations.
#0025
TACKLING THE MEDUSA IN CATH LAB Neeraj Awasthy, S Radhakrishnan
Fortis Escorts Heart Institute, Delhi, India
A 25 year old female started complaining of easy fatigability, breath- lessness, lower limb swelling, facial puffiness and excessive sweating. On presentation she was found to be in cardiac failure with tachy- pnea , tachycardia and hepatomegaly. Echocardiogram showed huge right coronary artery with continuous signal in right atrium (RA) and the suspicion of coronary artery fistulae to RA. This was confirmed with CT scan at a local center and was referred to us for further man- agement. She was taken up for the coronary artery fistula closure after initial stabilization. PDA device 20/18 was deployed under fluo- roscopic guidance retrogradely after arteriovenous loop was formed. In view of residual shunt the patient was taken up for closure of the additional channel which was done using a 8 / 10 devise .In follow up it was observed that the shunt was still persistent on echo, chest xray showed the devise had migrated to the lungs. CT Scan was again reviewed and finally the fistulae was plugged with additional Amplatzer Vascular plugs II (20 mm x 16mm & 22mm x 18mm) re- spectively. The case highlights the need for proper evaluation of the coronary artery fistulae and how multiple tracts and openings can cause difficulty in such a case.
#0026
PALLIATING AORTIC STENOSIS BY BALLOON BEYOND ADOLESCENT : IS IT WORTH IT
Neeraj Awasthy, S Radhakrishnan, Savitri Shrivastava
Fortis Escorts Heart Institute, Delhi, India
Objective: To evaluate long term results of aortic valvoplasty particu- larly in adolescent and adults (>12 years) and compare the outcome in other age groups that is <1 year and between 1-11 years.
Patients: 165 consecutive patients treated at the median age of 9 years (0–64years). The follow up period was up to 14 years (median 3 years). The whole cohort of patients was divided into 3 age based subgroups: Group A (<1 year) n=45, Group B (1yr-11 years) n=52, Group C(> 12 years) n=68. The characteristics of each subgroup were mutually compared ,balloon to annulus ratio 0.93.
Outcome measures: Repeat BAV, grade 3 or more aortic regurgita- tion(AR) and surgery. Results: The incidence of significant AR from the whole cohort was 9.9% (8% moderate, 1.9% severe) n=16. Group
A= significant AR-9.6% (1% moderate, 2.4% severe). Group B=signif- icant AR 11.3%(9.4 % moderate, 1.9% severe). Group C= significant AR 9% (7.6% moderate, 1.6% severe); pvalue= 0.99(C vs A)and 0.92(C vs B). Repeat BAV rate was 13.3% (n=22 out of 165 patients). Group A – n=5, (11.9%), Group B- n=10, (18.1%), Group C- n=7,(10.3%). pval- ue= 0.78(C vs A) and 0.19(C vs B). Surgery in follow-up was needed in n=4(2.4%), none in group A, 2 patients in group B (3.6%) and 2 pa- tients in group C (2.9%). Patients were followed up for a period of 14 years; Mean survival probability after the procedure was 8 years (group A = 6.5 years, group B = 8.1 years, group C = 9.9 years), pvalue= 0.49 (A vs B), 0.23(B vs C), 0.4(A vs C).
#0027
ENDOCARDIC PACEMAKER IMPLANTATION IN PATIENTS LESS THAN 10 KG. EXPERIENCE IN THE NATIONAL INSTITUTE OF CARDIOLOGY IGNACIO CHAVEZ
Aldo Luis Campos Quintero, Roberto Mijangos Vázquez, Jorge Manuel Guevara Anaya, Adrian Sánchez Flores, Guillermo José Aristizabal Villa, José Antonio García Montes, Carlos Zabal
National Institute of Cardiology Ignacio Chavez, Mexico, DF, Mexico
Introduction: Pediatric patients represent less than 1% of the total of patients requiring pacemakers, therefore there are no specific devices for children, this makes the pacemaker implantation in tod- dlers difficult. The porpoise of this study is to evaluate the short and midterm follow up in the pediatric patient that undergo endocardic pacemaker implantation in our institution.
Method: Between 2006 and 2015; 25 patients weighting less than 10 Kg, were subjected to endocardic pacemaker implantation in our institution. In all of this patients the active fixation cables were intro- duced via a sub-clavian vein.
Results: From the 25 patients, 19 were female (76%), 6 were male (24%). The median age was 16.8±8.14 months, and the median weight 7.4±1.57 Kg. 24 patients had complete A-V block; 21 were post-chirurgic in nature (84%), 2 were congenital (8%), 1 (4%) pre- sented after an atrial flutter ablation and 1 patient presented with a sick sinus syndrome. In 100% of post-chirurgic patients a VSD was closed. In 72% of patients the pacemaker was set in DDR mode, 20% in DDD and the rest in VVIR. During follow up 2 presented with pace- maker exteriorization and 1 cable exteriorization.
Conclusions: In our experience midterm results were satisfactory, therefore we consider trans-venous pacemaker implantation is a safe and effective method in toddlers.
#0028
INITIAL RESULTS OF A NOVEL SELF-EXPANDING VALVE FOR PERCUTANEOUS PULMONARY VALVE IMPLANTATION
Wenzhi Pan1, Daxin Zhou1, Junbo Ge1, Qiling Cao1
1Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University,, Shanghai, China
2Medical Director-Echo & Research Laboratory Sidra
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111