Page 23 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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cobra like deformation and the second one is deployed properly. The control angiography shows a significative lowering of the contrast shunt through the aneurysmatic structure. After de procedure, the patient required management with inotropes, achieving adequate control of the heart failure.
Conclusions: Since the beginning of the percutaneous closure of cor- onary fistulas in the 80´s this method has been recognized as a safe and effective option to treat this pathology. Chirurgic and interven- tionist approach show similar results in terms of efficiency, morbidity and mortality. In our case, the patient showed clinical improvement after the procedure.
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DUAL-AXIS ROTATIONAL ANGIOGRAPHY IS SAFE AND FEASIBLE TO DETECT CORONARY ALLOGRAFT VASCULOPATHY IN PEDIATRIC HEART TRANSPLANT PATIENTS A SINGLE CENTER EXPERIENCE
Rodrigo Rios1, Rohit Loomba1, Todd Gudausky1, 1Children's Hospital of Wisconsin - Medical College of Wisconsin, Milwaukee, WI, USA
Introduction: Coronary allograft vasculopathy (CAV) is the leading cause of graft failure in pediatric heart transplant recipients, also add- ing to mortality in this patient population. Coronary angiography is routinely performed to screen for CAV, with conventional single or bi-plane angiography being utilized. Dual-axis rotational coronary angiography (RA) has been described, mostly in the adult popula- tion, and may offer reduction in radiation dose and contrast volume. Experience with this in the pediatric population is limited. This study describes a single institution experience with RA for screening for CAV in pediatric patients.
Methods: The catheterization database at our institution was used to identify pediatric heart transplant recipients having undergone RA to screen for CAV. Procedural data including radiation dose, fluoroscopy time, contrast volume, and procedure time were collected for each catheterization. The number of instances in which RA was not suc- cessful, ECG changes were present, and CAV was detected were also collected for each catheterization.
Results: A total of 97 patients underwent 345 catheterizations utiliz- ing RA. The maximum number of catheterizations for a single patient utilizing RA was 5. Median radiation dose area product per kilogram was found to be 341.7 (mGy cm/kg), total air kerma 126.8 (mGy), pro- cedure time was 69 minutes, fluoroscopy time was 9.9 minutes, and contrast volume was 13 ml. A total of 17 (2%) coronary artery injec- tions out of 690 could not be successfully imaged using RA. A total of 14 patients had CAV noted at any point, 10 of whom had progressive CAV. Electrocardiographic changes occurred in a total of 10 (3%) RA catheterizations. Procedural characteristics did not differ between se- rial catheterizations.
Conclusions: Dual-axis rotational coronary angiography is safe and feasible for CAV screening in pediatric heart transplant recipients while offering coronary imaging in multiple planes compared to con- ventional angiography.
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A COMPARISON OF OUTCOMES AND COSTS IN TREATMENT OF ISOLATED PDA IN SINGAPORE – SURGICAL LIGATION VS TRANSCATHETER DEVICE OCCLUSION
Swee Chye Quek
National University of Singapore, Singapore, Singapore
Introduction: Closure of isolated patent ductus arteriosus (PDA) is indicated to reduce risk of infection, congestive heart failure and/or pulmonary hypertension. This can be achieved through surgical liga- tion or transcatheter device occlusion.
Aim: The objective of our study was to compare outcomes and cost of device closure through the transcatheter route using Amplatzer Ductal Occluder (ADO) vs. surgical ligation (SL).
Method: 35 patients who underwent PDA corrective procedures from February 2004 to April 2014 were included. We excluded preterm ba- bies or those with associated other defects or co-morbidities.
Results: 10 patients had SL and 25 had PDA obliteration using the ADO. The mean age at the time of operation was 2±3.7 years and 9±7.8 years for SL and ADO respectively (p=0.01). The PDA sizes were comparable. Four patients (40%) in the SL group and 2 (8%) in the ADO group developed minor complications (p=0.02). The mean length of stay for SL and ADO were 6±2.4 and 2±0.3 days respectively (p<0.001). Eight (80%) in the SL and 5 (20%) in the ADO had a mean ICU stay of 2.6±2.6 and of 0.2±0.4 days
respectively (p<0.001). The mean cost per procedure for SL was USD 8313±4371 and USD 7388±1766 for the ADO (p=0.37).
Conclusions: The outcomes were good for both SL and ADO but the SL group had longer LOS, ICU stay and incurred greater costs. The surgery group was younger and fewer, as most PDAs are now closed through the less invasive transcatheter method. The device occlusion has advantages of improved cosmesis with less pain/faster recovery in the post-operative period. Cost savings would be even more signif- icant when using an equally effective but cheaper device.
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TECHNOLOGICAL ADVANCES IN THE PEDIATRIC CARDIAC CATHETERIZATION LABORATORY RESULT IN REDUCED RADIATION DOSE
Lauren Glass, Anthony Hlavacek, G. Hamilton Baker
Medical University of South Carolina, South Carolina, USA
Objective: Reduction of ionizing radiation in pediatric/congenital car- diac catheterization is paramount. The goal should be to provide op- timal imaging in line with the ALARA (As Low As Reasonably Achiev- able) concept. There have been many recent advances in technology in the cardiac catheterization laboratory. We sought to determine if upgraded equipment results in a lower effective radiation dose.
Methods: This is a retrospective cohort study at a single institution. We compared the effective radiation dose in pediatric patients who underwent diagnostic cardiac catheterization before and after instal- lation of new equipment in our cardiac catheterization laboratory. The historical group underwent catheterization between July 2009
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111