Page 22 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
TRAPPING TECHNIQUE
Zakaria Jalal, Marie-Lou Dinet, Xavier Iriart, Pauline Renoux, Igor Sibon, Jean-Benoit Thambo
University Hospital of Bordeaux, Bordeaux, France
Objectives: Percutaneous LAA closure has emerged as an alternative therapeutic option for the prevention of embolic stroke in high-risk patients with non-valvular atrial fibrillation. The presence of throm- bus in the LAA remains so far a contraindication of the procedure.
We aimed to describe a modified left atrial appendage (LAA) closure technique that allows a safe procedure in patients with LAA throm- bus.
Methods: Between January 2011 and October 2014, LAA closure was performed in 8 patients (mean age = 75 ± 11 years old, 75 % males) with LAA thrombus and/or severe spontaneous echocardiographic contrast using a modified technique that avoids manipulations of catheters or angiography in the LAA.
Results: Two patients had a persistent thrombus despite appropriate antithrombotic therapy while all other patients had contraindica- tion for systemic anticoagulation. The procedure was successful us- ing the modified implantation technique in all patients. Implanted device was Amplatzer Cardiac Plug (St. Jude Medical, Minneapolis, Minnesota) in 4 patients and Amulet device in the remaining. No peri procedural complications occurred. After a mean follow-up of 7 ± 5 months, no death or late complications were observed.
Conclusions: The thrombus trapping technique is a safe and effective procedure. This modification of the implanting technique may allow an extension of LAA closure indication to patients with LAA thrombus who were formerly considered unsuitable.
#0044
TRANSCATHETER CATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS IN SMALL PEDIATRIC PATIENTS FROM AN EXCLUSIVE TRANSVENOUS APPROACH USING ANGIOGRAPHIC AND ECHOCARDIOGRAPHIC GUIDANCE
Basil (Vasileios) Thanopoulos1, Vlassis Ninios2, Andreas Giannopoulos3, Dan Deleanou4, Silvia Lancovici5
1Agios Loukas Clinic, Thessaloniki, Greece
2Agios Loukas Clinic, Thessaloniki, Greece
3Ahepa Hospital, Thessaloniki, Greece
4Ares Medical Center, Bucharest, Romania
5Ares Medical Center, Bucharest, Romania
Introduction: Transcatheter closure is the treatment of choice for the majority of patients with a patent ductus arteriosus (PDA). However, the standard technique of this procedure may be associated with ar- terial complications in small pediatric patients. The aim of this study was to report experience with catheter closure of PDA in 40 consecu- tive small children using an exclusive venous approach.
Methods: The age of the patients ranged from 3-36 months (mean 13 ± 11 mm) and the weight from 4-14 Kg (mean 7 ± 4 Kg). The anatomy and size of PDA were defined by transvenous retrograde aortography using a Pigtail or a Berman catheter. The PDA occluder was implanted through a 7-8 F (ADO I) and 5-6 F (ADO II, ADO AS) delivery sheath
(DS) in 15 (age 22 to 36 months, mean 26 ± 5) and 25 (3 to 18 months, mean 7 ± 6) patients, respectively. The procedure was guided using hand injections of contrast media through the DS and 2D and color Doppler echocardiography from suprasternal and parasternal long and short axis, respectively.
Results: The PDA occluders were permanently implanted in all 40 pa- tients. The mean PDA diameter (at the pulmonary end) was 3.8±0.9 mm (range, 2.5 to 5.2 mm). The mean device diameter was 5 ± 1 mm (range 4 to 8 mm) and 4.2 ± 1.5 (range, 3-6 mm) for the ADO I and the ADO II occluders. Complete echocardiographic closure of the ductus at 1-month follow-up was observed in all 38 patients (100%). Imme- diately after the procedure there was a mild left pulmonary stenosis (peak pressure gradient of ranging from 6-8 mm Hg), in 3 patients. Five minor groin venous hematomas were the only complications of the procedure.
Conclusions: Exclusive transvenous PDA occlusion using combined angiographic and echocardiographic guidance is an effective and safe method that prevents the arterial complications of the standard approach particularly in small children. In contrast to ADO I the ADO II, AS occluders due to their low profile can be delivered through a 5-6 F delivery sheath which facilitates crossing of PDA and the injections of contrast medium for guidance of the procedure.
#0045
INTERVENCIONIST MANAGEMENT OF CONGENITAL CORONARY FISTULA. CASE REPORT
Guillermo Aristizabal, Jorge Guevara, Roberto Mijangos, Aldo Campos, Adrian Sanchez, Carlos Zabal, Jose Garcia
Instituto Nacional de Cardiologia, Mexico D.F, Mexico
Introduction and objectives: Congenital coronary fistula is a rare en- tity, in which there´s a communication between one or two coronary arteries and a cardiac chamber, they represent 3.7% of all coronary circulation anomalies, followed by the left coronary artery in 36.3% and both coronary arteries in 18.1% (2). 90% of the cases drain in right structures of the heart. The right coronary artery is more fre- quently involve in 45.5% of cases. Indications for treatment are: large size fistulas, progressive left to right shunts, myocardial ischemia and heart failure. The objective of the following report is to show how the interventional management of this case can be applied in a success- ful manner.
Method: The case of a male 1 month and 20 days old toddler is pre- sented, with a cardiac murmur detected at birth, showing fatigue during feeding, diaphoresis and poor weight gain. Trans-thoracic echocardiography and angiotomography were performed showing a fistula between the anterior descending coronary artery and the left ventricle was diagnosed, aneurysmatic dilation of the main left coro- nary artery and the anterior descending coronary was demonstrated. The septal wall of the left ventricle was showed to have aneurismatyc dilation in the relation of the fistula drainage site.
Results: Cardiac catheterization was performed showing a fistu- la between the proximal ostium of the left coronary artery and the left ventricle with the presence of an aneurysmatic sac in the whole length of the interventricular septum with at least 2 sites of com- munication with the left ventricle, these sites were closed using an Amplatzer Ocludder. During placement the proximal device suffers
19th Annual PICS/AICS Meeting Abstracts