Page 17 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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age and measurements of the new landing zone were made. A 30 mm ACP device was introduced and implanted on the desired target area only to immediately pop out of the appendage. The lobe was, then, completely configured at the ostium of the appendage, while the disk was still inside the sheath and the delivery cable was found to be unscrewed from the device and loose inside the sheath. The device was ultimately retrieved with a 5 mm snare. The ACP was re-in- serted but the tip of the sheath was collapsed preventing the device to come out. The sheath was removed and replaced by a new 13 F AGA 45/45o sheath and another attempt was made to implant the 30 mm ACP, only to see it pop out of the appendage again. This device was discarded and a 28 mm ACP was, at last, successfully implanted. The patient was discharged two days later on aspirin and clopidogrel and remains in excellent conditions 40 days after the procedure. Con- trol TTE at one month revealed the devices in place and the mouth of the LAA completely occluded.
Conclusion: Complete occlusion of the trabecular portion of the LAA should be aimed and sometimes more than on device may be neces- sary. This case shows that a two-lobe appendage can be difficult to recognize, even by experienced operators, and measurements can be misleading. It emphasizes the need for adequately trained personnel and a fully equipped cath lab for perfect results.
#0031
THE IMPACT ON VENTRICULAR FUNCTION AFTER PERCUTANEOUS PULMONARY VALVE IMPLANTATION -ONE YEAR FOLLOW UP BY THREE-DIMENSIONAL ECHOCARDIOGRAPHY
Cuizhen Pan
Zhongshan Hospital, Shanghai, China
Objective: Percutaneous pulmonary valve implantation (PPVI) is an efficient therapy for patients with severe pulmonary valve regurgi- tation who underwent cardiac surgery for tetralogy of Fallot (TOF). In this study, we followed up PPVI patients for 1 year and intend to investigate the variation of left ventricular and right ventricular func- tion in PPVI patients by means of three-dimensional echocardiogra- phy.
Methods: Eight patients who underwent cardiac surgery for TOF in youth and met severe pulmonary valve regurgitation which need PPVI were enrolled. Patients accepted two-dimensional and three-di- mensional echocardiography examination before PPVI, 1 month, 3 months, 6 month, and 1 year after PPVI. The regular parameters of chambers were acquired from two-dimensional echocardiography. Other parameters such as left ventricle end diastolic/systolic volume (LVEDV/LVESV), LVEF, global longitudinal strain (GLS), global circum- ferential strain (GCS), global right ventricle end diastolic/systolic vol- ume (RVEDV/RVESV), body region of right ventricle end diastolic/ systolic volume, outflow region of right ventricle end diastolic/sys- tolic volume, and inflow region of right ventricle end diastolic/sys- tolic volume were acquired and calculated from three-dimensional echocardiography.
Results: There showed no significant difference before PPVI and 1 year after PPVI in parameters of left ventricular chamber measure- ments and left ventricular systolic function, such as LVEF, LVEDV, LVESV, GLS, and GCS (p>0.05). The right ventricular end diastolic area was significantly reduced at 1 month after PPVI, while right ventric-
ular end systolic area reduced at 3 months after PPVI (p<0.05). Both RVEDV and RVESV showed significantly reduced at 6months after PPVI. When right ventricle was departed into three sections, the body region of right ventricle reduced significantly at 3 months after PPVI, while similar improvements of inflow and outflow region were met at 6 months after PPVI.
Conclusions: PPVI was efficient in improving right ventricular func- tion in patients with severe pulmonary valve regurgitation after TOF surgery. The improvement of body region of right ventricle was pre- ceded over inflow and outflow region after PPVI. Sequent improve- ments of each region of right ventricle after PPVI can be detected by three-dimensional echocardiography accurately and rapidly.
#0032
ADVANTAGES OF ENDOVASCULAR PDA CLOSURE BY VENOUS APPROACH IN NEONATOLOGY
Jesus Damsky Barbosa1, Jose Alonso2, Adelia Marques Vittorino1, Victorio Lucini1, Judith Ackerman1, Ana de Dios1 1Pedro de Elizalde, Pedro de Elizalde Hospital, Buenos Aires, Argentina
2Juan P Garraham Hospital, Buenos Aires, Argentina
The last 5 years, endovascular closure has began to solve this illness with fewer complications than surgery.Normally, surgeons perform the surgery in Neonatology. This was the reason why we tried to work in the same conditions. In prematures, the transportation can increase the risk of complications. Neil Wilson has promoted PDA clo- sure in Neonatology guided by Transthoracic Echo (TTE). However, he has chosen to do it through artery puncture given the ease of access to the PDA.
Objective:To compare PDA closure in the Cath lab and in Neonatolo- gy, both procedures by venous puncture.
Material and methods: Two patients (p) were treated. Ap: 1045 g and the second Bp: 900 g. Protocol used: a) venous puncture to avoid the artery injuries b) guided by Transthoracic echo (TTE). - P A: in the Cath lab. The p was transported inside a transport incubator. On arriv- al, the patient had to be conditioned. Altogether, it took us between 30 and 40’ to begin the procedure. - P B: in Neonatology. The p was placed in a radiant warmer. A C-arch and an ultrasound equipment were transported to Neonatology.
Results: P A had a PDA (type C): the transportation increased the heart insufficiency. Diam= 3.9 mm and length= 10 mm. A 4-5 ADO II device was used. Fluoroscopy time: 7’. Contrast: 6 mm. P B had a PDA (type C): the p stayed in Neonatology. Diam= 2.7 mm. A 4-2 Amplatzer type II AS was used. Fluoroscopy time: 3’. Contrast: 3 mm. Neither p had residual shunt in the immediate period. Two hours after procedures, the chest X ray showed the normalization of the heart´s size. The TTE allowed to measure the PDA, to position the device, to control the correct position and to assess the residual shunt. P B suffered hemo- dynamic changes with TTE. Therefore, a subcostal image was done to observe the PDA and its measurements. Both procedures finished without complications. The p improved their clinical condition. Both p died of sepsis.There were no vascular injuries.
Conclusions: 1) Having used the same protocol in both p, the differ- ence between the two was the transportation. Closing the PDA in Neonatology reduced the risks derived from the movement. 2) The
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111