Page 20 - Journal of Structural Heart Disease - Volume 1 Issue 2

49
Meeting Abstracts
of three devices, at least regarding neoendothelization are not shown a difference in children at the end of first month after the procedure.
#0038
PERVENTRICULAR PULMONARY VALVOTOMY AS A SUCCESSFUL THERAPEUTIC MEASURE IN A CASE OF PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM AND IATROGENIC PERFORATION OF RIGHT VENTRICULAR OUTFLOW TRACT.
Adrian Sanchez Flores, Carlos Zabal Cerdeira, Jose Antonio Garcia Montes, Roberto Mijangos Vazquez, Jorge Manuel Guevara Anaya, Aldo Luis Campos Quintero
National Institute of Cardiology ¨Ignacio Chavez¨, Mexico City, Mexico
An 8 day new born is admitted to hospitalization with clinical man- ifestations of central cyanosis that increments while crying with a pulse oximetry of 65%. At admission a transthoracic echocardiogram is realized with a reporting diagnosis of pulmonary atresia with intact ventricular septum with confluent pulmonary arteries. The patient is taken to the catheterization laboratory finding a right intraventricular pressure 90mmHg above the systemic pressure. While trying a tran- scatheter mechanical valvotomy with a hydrophilic guide wire a false way is created to the pericardial cavity, posteriorly the patient sud- denly deteriorates presenting hemodynamic compromise with hy- potension and bradicardia. The patient required adrenaline infusion but still persisted unstable. A urgent transthoracic echocardiogram is decides to be realized in the cath lab finding an important peri- cardial effusion with left cavity collapse requiring urgent pericardial drainage in the catheterization laboratory. The patient still under he- modynamic compromise is transferred to the operating room, with plans of realizing a hybrid procedure. In the operating room a midline thoracotomy was performed and a purse string stitch is made on the free wall of the right ventricle, posteriorly a guided puncture towards the pulmonary valve plan achieving its perforation. After the success- ful perforation of the pulmonary valve, a Tyshak mini 10x20mm bal- loon mounted on angioplasty guide wire is passed across the valve finally realizing a pulmonary valvotomy. In the control ventricle angi- ography, contrast material could bee seen passing to the pulmonary circulation. In the posterior pressure records, the final right ventricle pressure was of 49/2/9mmHg. The patient was transferred to the in- tensive care unit, with a favorable clinical progress, being discharged 2 weeks after.
The percutaneous interventional technique of pulmonary valve per- foration is a therapeutic option that provides pulmonary blood flow to patients with pulmonary atresia with intact ventricular septum. Cardiac tamponade is the major complication of this type of proce- dure following perforation of the pericardial space. Even though it is an unusual complication, it’s a serious one in these types of proce- dures, in which 3% of patients require urgent surgical management.
#0039
IMPACTS OF EARLY CARDIAC CATHETERIZATION FOR CHILDREN SUPPORTED BY EXTRACORPOREAL MEMBRANE OXYGENATION
Atsuko Kato, Mauro Lo Rito, Kyong-Jin Lee, Christoph Haller,
Anne Marie Guerguerian, Ben V. Sivarajan, Osami Honjo
The Hospital for Sick Children, Toronto, Ontario, Canada
Background: Cardiac catheterization is often required for pediatric patients supported on Extracorporeal membranous oxygenation (ECMO) to identify or intervene treatable lesions. The aim of this study was to assess the characteristics of catheterization for those patients and clarify the prognostic factors for successful weaning.
Methods: Single-center retrospective cohort study from 2000 to 2013. Patients who received cardiac catheterization while on cardiac ECMO support were eligible and divided according to their primary cardiac diagnosis; congenital heart disease (CHD; n=47) and cardiac muscle disease (CMD; n=15) and compared. Subgroup analysis in CHD was conducted to determine predictors for successful weaning by uni- variate and multivariate logistic regression analyses. Kaplan-Meier analysis and log-rank test were performed to compare the survival to analyze the impact of catheterization performed within 2 days of ECMO support.
Results: From a total of 309 patients placed on ECMO, sixty-one (13%) cardiac catheterizations were identified in 60 patients (median age 119 days, IQR: 24, 291). Catheterization was undertaken at median of 1 day (IQR: 0, 3) after initiation of ECMO. Catheter intervention was performed in 39 (64%) cases. Procedure-related complication was noted in 8 cases (11%). There was no procedure-related mortality. The success rate of weaning was not significantly different in between CHD and CMD (70% vs 93%; p=0.15), while CMD achieved higher survival rate on discharge (53% vs 86%; p=0.03). Subgroup analy- sis revealed that the shorter interval between ECMO initiation and catheterization (p=0.018), no requirement of subsequent surgery (p=0.043), and no respiratory, gastrointestinal, or renal complication (p<0.01) were better prognostic factors for successful decannulation in univariate analysis. Absence of renal failure (p=0.025) and respira- tory complication (p=0.0046) were significant prognostic factors in multivariate analysis. The Kaplan-Meyer analysis showed significant- ly better survival when patients received catheterization within 48 hours after ECMO implement (p=0.047).
Conclusion: Successful ECMO weaning was achieved in patients who had early catheter intervention. Cardiac catheterization should be prompted for patients who required ECMO when an anatomical re- sidual lesion is suspected, before end-organ complication may de- velop.
#0040
PERCUTANEOUS CLOSURE OF PERIMEMBRANOUS VENTRICULAR SEPTAL DEFECTS (PM- VSDS) USING THE SECOND GENERATION AMPLAZTER DUCT OCCLUDERS (ADO II)
Makram Ebeid, Jorge Salazar, Sarosh Batlivala, Ahmad Charaf Eddine, Avichal Aggarwal, Ali Dodge-Khatami, Douglas Maposa, Mary Taylor
University of Mississippi Medical Center, Jackson, MS, USA
Objective: The purpose of this study is to report the use of the soft- er second generation Amplatzer vascular occluders namely the Amplatzer Vascular Plug II (AVPII) and the Amplatzer Duct Occluder II (ADOII) for percutaneous closure of perimembranous ventricular septal defects (Pm VSDs).
19th Annual PICS/AICS Meeting Abstracts