Page 29 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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Methods: Single center descriptive, retrospective review of all cases from 9/06 – 11/14 in which a surgeon provided direct access either to the heart, aorta or pulmonary artery for diagnostic or interventional purposes. Hypoplastic left heart hybrid stage 1 procedures were ex- cluded. Categorical data are presented as median with range.
Results: 12 patients (6 male) underwent surgical hybrid access pro- cedures; median age 4.1 years (range 0 days – 14 years), median weight 17.6 kg (range 3.3-126), median BSA 0.72 m2 (range 0.20-2.3). Diagnoses included aortic coarctation (3), tetralogy of Fallot (3), hy- poplastic left heart syndrome with intact/restrictive atrial septum (2), single ventricle s/p BT shunt with possible shunt narrowing/occlusion (2), single ventricle with restrictive atrial septum after BDG (1) and Swiss cheese ventricular septum (1). 8/12 patients underwent inter- ventions. Interventions included coarctation stenting from direct cut down on femoral or carotid arteries (3), per-atrial septoplasty (3), per-ventricular VSD closure (1) and LPA stent dilation in-situ (1). All interventions were successful. Diagnostic usages included assess- ment of BTS in the setting of cyanosis (2) and “exit” pulmonary artery angiography (2). Complications included aortic coarctation stent em- bolization (1; retrieved and stabilized in aorta), blood loss requiring transfusion (1) and SVT requiring IV adenosine. No deaths.
Conclusions: Surgical hybrid access to the heart and great vessels allowed for effective intervention and also provided important diag- nostic information in multiple varied complex congenital heart ab- normalities with low morbidity and no mortality in this single center experience.
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A LOGICAL METHOD OF SELECTING AN APPROACH FOR AMPLATZER SEPTAL OCCLUDER IMPLANTATION USING TRANSESOPHAGEAL ECHOCARDIOGRAPHY Noami Nakagawa1, Masahiro Kamada1, Yukiko Ishiguchi1, Yuji Moritoh1, Seigo Okada1, Mayuko Shohi1
Hiroshima City Hiroshima Citizens Hp., Hiroshima, Japan
Percutaneous closure of atrial septal defects (ASDs) using an Am- platzer Septal Occluder (ASO) has become the first choice procedure recently. However, when ASO deployment using the ordinary (left upper pulmonary vein [LUPV]) approach is difficult, the procedure may be prolonged and complications may occur. We have previous- ly reported a method for identifing cases in which ASO deployment would be difficult using the LUPV approach. Our findings revealed that ASO deployment is predicted to be difficult in patients with an ASO size exceeding the {(angle between Superstiff Guidewire and intra-atrial septum) × 1.44 + 48.1} × left atrium diameter (mm) on transesophageal echocardiography, and we recommend that an alternative approach to deploy ASO should be introduced from the beginning in such cases. In this study, we examined the validity of this method for determining the appropriate approach.
Between January 2009 and May 2015, in 127 cases (age, 2.5 – 86.6 [median 12.5] years; weight, 12.1 – 78.9 [median 41.3] kg), the ap- proach used for ASO deployment was decided based on this method.
In 103 patients, it was predicted to be able to deploy the ASO using the LUPV approach, while in 24 were predicted to be difficult. 98 of the 103 patients (94%) were successfully treated with the LUPV ap- proach; however in the remaining 5 patients, the deployment ASO
was unsuccessful using the LUPV approach and was subsequently successfully performed using another approach (right pulmonary vein approach). 2 of these 5 patients had fenestrated ASDs and 1 had a floppy rim, however the other 2 patients had no specific character- istics. In the 24 patients in whom the LUPV approach was predicted to be difficult, the ASO was successfully deployed using the right upper pulmonary vein approach at the first attempt.
This study showed that this method has a very high accuracy. We can avoid the risk of complications by using this method, as alternative procedure can be introduced from the beginning for indicated cases. Although this method is not perfect foe predicting difficulty, espe- cially in patients with fenestrated ASDs or floppy rims, we consider this method of selecting the ASO deployment approach to be ex- tremely useful for avoiding various risks.
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SUCCESSFUL PATENT DUCTUS ARTERIOSUS STENTING IN A 1.8 KG PRETERM NEWBORN WITH EXCELLENT OUTCOME - A CASE REPORT
Gaurav Garg
Max Hospital, New Delhi, India
Stenting of patent ductus arteriosus (PDA) is a palliative technique that is evolving as an alternative to shunt surgery. Patients with duct dependant pulmonary circulation are often palliated by shunt sur- gery. Performing shunt surgery below 2 kg weight in a preterm baby is associated with increased risk of complications and has variable outcomes in terms of morbidity and mortality. We present here a two days old 1.8 kg preterm male baby with duct dependant pulmonary circulation who was palliated successfully by transcatheter means. He successfully underwent bidirectional Glenn surgery 8 months after the procedure and currently doing very well. Ductal stenting in such a small preterm baby has rarely been described in the literature.
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TRANSCATHETER CLOSURE OF SINUS VENOSUS ATRIAL SEPTAL DEFECT WITH ANOMALOUS DRAINAGE OF RIGHT UPPER PULMONARY VEIN INTO SUPERIOR VENA CAVA- AN INNOVATIVE TECHNIQUE Gaurav Garg1, SR Anil2
1Max Hospital, New Delhi, India
2Apollo Hospital, Hyderabad, India
Sinus venosus atrial septal defect (SVASD) is located high in the atrial septum where the right superior vena cava (RSVC) enters the right atrium, and is commonly associated with partial anomalous pulmo- nary venous return of right upper pulmonary vein (RUPV) into RSVC. Transcatheter closure of such defects has not been described in the literature. We have developed an innovative technique to close this defect by transcatheter means. We present here a 35 year old patient with SVASD and anomalous drainage of RUPV in RSVC in whom we closed the defect along with rerouting of RUPV to left atrium (LA) us- ing a 12mm x 61 mm adventa V12 covered stent in the RSVC with good outcome.
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111