Page 27 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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Background: It is hard to find an ideal device to use for every VSD successfully. If inappropriate device was chosen; complication rate increases, procedure time gets longer that prolongs exposure to ion- izing radiation. Therefore interventionalists are in the search for new ideal devices. Main aim of our study to show that ADO-II device can be used for small ventricular septal defects successfully, safely with low complication rates.
Material and Methods: Between the dates April 2011- October 2014, 17 VSD closures with ADO-II device. Actually there were 16 patients but one of the patient had 2 perimembranous defects which were closed separately. Patients having muscular and perimembranous VSD with hemodynamically significant left to right shunt detected by clinical examination and echocardiographywere included in the study.
Results: Age of patients ranged between 3-18years. Weight of the patients was between 14-76 kg.VSD diameter ranges between 2-6.7mm(3.75±1.25). One of them was muscular, eighteen of them were perimembranous type. Fourteen of the perimembranous de- fects were aneursymatic, tunnel shaped. We have used mostly venous route (12 patients) for closure. One of the patients had two separate VSDs. The distance between two defects were 7 mm. Therefore we have used two separate devices to occlude them. One of the defect was 3.2 mm, occluded with ADO II sized 5x4 from arterial side. The other one was 3.4 mm width and closed with 5x6mm ADO II from ve- nous side. All cases were successfully closed, no major complications were reported. There was no incidence of left bundle branch block, P-R prolongation, or complete heart block.
Conclusion: Perimembranous aneursymatic ventricular septal defects are difficult, risky for percutaneous closure because of its proximity to aortic, atrioventricular valves, conduction tissue. We have showed that ADO-II devices (infact they are off-label use) canbe used safely, effectively in such defects. Up to our knowledge this is the only study includes largest number of pediatric patients whose VSD were closed by ADO-II.
#0057
PERCUTANEOUS ASD AND VSD CLOSURE IN 4 MONTHS OLD INFANT IN THE SAME SESSION
Özge Pamukçu, Ali Baykan, Kazim Uzum
Erciyes University Pediatric Cardiology, Kayseri, Turkey
Transcatheter VSD and ASD closure have been done successfully for a long period of time.We report percutaneous VSD and ASD closure at the same session in a malnourished infant with a significant left to right shunt. As far as we know; this case is the youngest one that per- cutaneous VSD closure done when hybrid procedures are excluded.
Case: A four months old male infant weighing 4.6kg; was referred to pediatric cardiology for a systolic murmur heard during newborn period. Perimembranous inlet typed VSD sized 4mm and 8mm sized secundum ASD were detected by echocardiographic examination. During the follow-up period weight gain of the patient was insuffi- cient and tachypnea was seen therefore decongestive treatment was given. Despite the medical treatment his symptoms persisted and got worse. Surgical treatment was planned but it was found too risky. Therefore we planned to close the defects percutaneously. Qp/Qs ratio was calculated as 4, pulmonary arterial pressure measured as 37/10 mean 29mmHg. VSD was closed by 4x4 ADOII, ASD was closed
by 9mm sized ASO successfully .In the first control visit(6 months after percutaneous closure) his weight was 6.2kg. No residual shunt was seen in the echocardiography and the frequency af having lower respiratory infections were decreased.
Discussion: Ventricular septal defects with significant shunt cause dilatation in the left chambers of the heart, cardiac dysfunction and arrhythmia. It also increases the risk of infective endocarditis. For se- lected patients; percutaneous VSD closure is an alternative to surgery. Transcatheter VSD closure was performed successfully in older chil- dren As far as we know it is the first time that percutaneous VSD, ASD closure were done in such a small infant. We think this case will be promising for the other cases in future
#0058
TRANSCATHETER
OCCLUSION IN PREMATURE NEONATES: A SINGLE CENTER EXPERIENCE
Matthew Schwartz1, David Nykanen1, Jose Perez2, Michael McMahan2, Hamish Munro2, Sukumar Narasimhulu1
1Arnold Palmer Hospital for Children, Orlando, FL, USA
2Winnie Palmer Hospital, Orlando, FL, USA
Background: Transcatheter patent ductus arteriosus (PDA) occlusion is feasible in premature neonates and may improve lung function. Reports documenting the success and safety of PDA occlusion in this patient group are lacking.
Methods: All patients in the Neonatal Intensive Care Unit at our center who were referred for transcatheter PDA occlusion between 1/2010 and 11/2014 were retrospectively identified. Relevant clinical and procedural details were extracted. A modification of the respi- ratory severity score (RSS) (FiO2 x mean airway pressure) was used to characterize degree of pulmonary support before and at intervals after catheterization.
Results: 20 patients were identified with median age of 96 days (13- 247) and weight of 3.1 kg (1.7-4.7). Prior to intervention, 4 (20%) pa- tients were on no pulmonary support, 7 (35%) on nasal cannula, 3 (15%) on non-invasive continuous positive airway pressure, and 6 (30%) mechanically ventilated. The PDA was type C tubular morphol- ogy in 19 (95%) patients with median minimum diameter of 2.4 mm (1-5) and length of 10 mm (3-14). Exclusive echocardiographic imag- ing was used in 2 (10%) patients. The PDA was successfully occluded in 16 (80%) patients and deemed too short for occlusion in 4. Ratio of minimum PDA diameter/PDA length was > 0.5 in all unsuccessful attempts and < 0.5 in all successful cases. Of the 16 cases of occlusion, Amplatzer Vascular Plug II was used in 15 (94%) and angiographic occlusion demonstrable in all. No deaths or vascular complications occurred and no pulmonary artery or aortic obstruction was seen. 4 (20%) patients required blood transfusion of < 15 cc/kg due to hy- potension and another required transfusion > 15 cc/kg due to un- expected bleeding around the vascular sheath. Excluding 1 patient with significant comorbid congenital heart disease, the RSS improved at 3 days in 9 (60%) patients and at 7 days in 11 (73%) compared to pre-intervention value.
Conclusions: Transcatheter PDA occlusion was safe and feasible in this population. A ratio of minimum PDA diameter/PDA length of < 0.5 was predictive of technical success. Using a surrogate marker for
PATENT DUCTUS
ARTERIOSUS
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111