Page 16 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
Cardiovascular Center of Excellence, Doha, Qatar
Introduction: Balloon expandable transcatheter pulmonary valve sys- tems are not applicable to the large majority of patients with chronic severe pulmonary regurgitation (PR) following surgical right ventric- ular outflow tract (RVOT) rehabilitation. This report describes the clin- ical use and follow-up of a novel transcatheter self-expanding pul- monary valve system (Venus P Valve) for rehabilitation of the RVOT in patients with chronic severe PR.
Methods: The Venus-P valve is consisted of a self-expanding, “dou- ble trumpet” shaped nitinol support frame with a trileaflet porcine pericardial tissue valve. Patients with native RVOT and severe PR were selected and implanted with this valve. Patient demographics and pre-procedural, intra-procedural, and follow-up data were reviewed.
Results: Ten patients (seven females, 20-48 years of age) were se- lected for attempted valve deployment. All patients had previously underwent surgical repair with RVOT reconstruction procedure be- cause of tetralogy of fallot (TOF,n=9 ) or double chamber of right ventricle (n=1). Patients were either NYHA class II (n=8) or class III (n=2) at baseline. Mean minimum "annular" diameter on transtho- racic echocardiogram was 22.1±2.4 mm and mean RVOT diameter was 30.4 ± 5.8 mm. All case were successful implanted with one valve without complication , with a mean fluoroscopy time of 21.0±8.2 min. Valve sizes used were 26 (n=4), 28(n=2), 30 (n=1), and 32 (n=3). Mean pulmonary artery diastolic pressure increased from 14.6 ± 4.0mm Hg to 22.8 ± 6.8 mm Hg (P = 0.01). On mean follow-up of 12 ± 5.6 months, PR grade is 0 in all cases. NYHA class has improved at least one class in all cases and right ventricular end-diastolic vol- umes on cardiac MRI was reduced from 162.0±18.8ml/m2 to 112± 12.5 ml/m2 (n=6,P=0.02) at six month follow-up . One patient died 4 months after procedure because of cardiac arrhythmias. No other adverse events occurred.
Conclusions: Our Initial results demonstrates the safety and efficacy of Venus P Valve in treating native RVOT patients with surgically in- duced chronic severe PR.
enlargement. The stretched ASD diameter measured 19 mm and was occluded with a 20 mm Atriasept TM Cardia ASD Device. There was no residual shunt immediately after the procedure. Three months lat- er, the patient was asymptomatic and control TTE depicted a small shunt through the central portion of the device, with significant reduction in the right heart enlargement. At six months follow-up, the patient resumed exercise-induced fatigue. TEE showed that the device was adequately positioned but a massive left-to-right shunt was now seen through the central portion of the prosthesis by color Doppler. Three-dimensional echo (3-D) images showed the Polyvinyl Alcohol (PVA) sail was missing, despite an intact metallic structure of the device. The right atrial and ventricle enlargement had worsened. A second transcatheter procedure was performed in February 2015. We then chose to cross the defect with a hydrophilic wire as close to the center of the first device as possible. A 30-30 mm Lifetech CERA TM Multifenestrated ASD device was loaded inside a 10 F Mullins sheath and successfully implanted over the CARDIA device. TEE showed the second device nicely placed over the first one with no flow through the atrial septum.
Conclusion: The reason why the PVA sail completely disappeared in this patient is still not fully understood. One can assume that delayed endothelialization of the device and complete bioresorbtion of the PVA (perhaps accelerated by the baseline inflammatory disease) could play a role. We herein describe a “device-in-device” technique as an alternative to surgical explantation of a defective device. Im- planting a second nitinol double disk with a connecting pin (instead of a central waist) device over the first one was technically easy, safe and effective. This device-in-device technique prevents surgical ex- plantation of a failing device, and may become a less invasive option in selected patients.
#0030
“PERCUTANEOUS LAA CLOSURE: ALL IS WELL WHEN IT ENDS WELL”
Francisco Chamie1, Enio Guerios2, Bernhard Meier3
1Hospital federal dos Servidores do Estado, MS, Rio de Janeiro, RJ, Brazil
2CONCEPT - Centro de Cardiopatias Congenitas e Estruturais do Parana, PR, Curitiba, PR, Brazil
3Bern University Hospital, Bern, Switzerland
Background: Percutaneous Left Atrial Appendage (LAA) transcathe- ter closure is becoming more popular as an alternative to oral antico- agulation, showing high procedural success and few complications. Incomplete LAA closure may increase the risk of embolic stroke and, therefore, the implant of more than one device may be advisable.
Case-Report: An 80 year-old, male patient was referred for LAA clo- sure due to a significant GI bleeding while on warfarin therapy. He had permanent atrial fibrillation and suffered two ischemic strokes. The CHA2DS2VASc and HAS-BLED risks scores were 7 and 3, respec- tively. During the index procedure an accessory superior lobe was identified and firstly occluded with a 16 mm ACP. The body of the appendage received a 25-18 mm AGA PFO device. The immediate result was excellent, with complete exclusion of the LAA. Four days later surveillance fluoroscopy showed that the PFO device embolized to the aortic arch. The device was retrieved with a 20 mm snare. After discussion with the Heart Team a second procedure was offered. Con- trast hand injections confirmed the uncovered body of the append-
#0029
“DEVICE-IN-DEVICE”:
ALTERNATIVE TO SURGICAL EXPLANTATION OF A FAILING INTRACARDIAC PROSTHESIS”
Francisco Chamie1, Daniel Chamie3, Julio Maia2, Jose Fabio Almiro da Silva2
1Hospital Federal dos Servidores do Estado, MS, Rio de Janeiro, RJ, Brazil
2CEDIPAR, Maringa, PR, Brazil
3Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil
Background: A failing intracardiac device is traditionally addressed by open-heart surgery. Surgical explantation of the device, although a simple procedure, carries risks that some patients are not able or willing to cope with. Thus, a non-surgical option seems desirable in selected cases.
Case-Report: A 28 year-old female patient, previously diagnosed with Takayasu Disease, underwent transcatheter closure of a secundum Atrial Septal Defect (ASD) in April 2014. At that time she presented with easy tiredness and fatigue on exertion. Transthoracic (TTE) and transesophageal echos (TEE) showed a 15 mm ASD with right heart
A TRANSCATHETER
19th Annual PICS/AICS Meeting Abstracts