Page 31 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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Results: 125 coil occlusions were attempted in 103 patients. Patients were mostly female (82%) with median age 4.4 (range 0.6-74) years. Most PDAs were Krichenko class A (45%) or E (17%). Minimal diameter was 2 (0.6-6) mm. 15 patients (15%) required > 1 coil. 4 coils were re- moved with a snare/bioptome due to aortic/LPA obstruction after re- lease. 7 coils were malpositioned while still held by the MVC of which 3 embolized while attempting withdrawal. 5 embolized after full re- lease. Total embolization rate was 8/125 (6.4%). 3 patients underwent eventual PDA closure with the MVC and a larger coil, 2 were closed with an Amplatzer Duct Occluder, 2 with 0.052” coils and 1 ligated surgically. Embolizations were more likely in PDAs ≥ 2.5 mm (OR 14.6, 95% CI 2.6-83, p<0.01).
11/98 (11%) patients had trivial shunt by the final angiogram. 6/88 (6.8%) patients with echocardiograms had trivial shunt within 24 hours post-procedure by echocardiogram. No patient had > trivial residual shunt for an overall success rate of 92%. For PDAs < 2.5 mm the success rate was 97%.
Conclusions: Coil delivery using the MVC is safe and effective for small PDAs. While fully controlled release & retrieval devices are now avail- able for PDA closure, coil occlusion with the MVC should still be con- sidered for small PDAs, especially in resource limited regions.
#0068
PERCUTANEOUS CLOSURE OF PDA IN PATIENTS LESS THAN 4000 G
Ernesto Vallejo, Angelo Valencia, Victor Rodriguez
Centro Medico Imbanaco, Cali, Valle, Colombia
Introduction: PDA, a common condition in newborns has 1:2000 inci- dences in newborns over 38 weeks, and augments to 50-80% in low weight born preterms. PDA is associated with high mortality, mor- bidity, cardiac failure, necrotizing enterocolitis, and bronchopulmary dysplasia. Percutaneous closure of PDA is a more promising alterna- tive to surgical closure in low weight patients. Materials and Methods: Patients lower than 4000 g with hemodynamically significant PDA (cardiac failure, cardiomegaly, pulmonary hyperflow, left sided heart dilation, left atrial aortic ratio – (LA/AO) > 1.4) and/or pharmacologi- cal closure failure. Procedure: General anaesthesia, percutaneous clo- sure of PDA with ADO II AS dispositive (choice of the dispositive 2mm greater than pulmonary diameter) , femoral vein with 4 F sheath < 2000 g or femoral vein and artery > 2000 g, non-ionic contrast medi- um 0.5 – 2 cc/kg, angiographic PDA measurements (pulmonary and aortic diameters and length). Liberation of the dispositive in patients < 2000 g by use of echocardiography, and in patients > 2000g using aortography. Median variables with interquartile range variables are presented with frequency percentages. Results: 21 patients were en- rolled with median age, 46 days (range 22-89), 51.1% male, 52.4% < 2000 g, weight, 1900 g (1236 – 4000), 66.7% preterms, LA/AO, 1.55 (1.5 – 1.6), 52.4% with pharmacological closure failure, 42.9% requir- ing mechanical ventilation and inotropic support, PDA classification, 8% A1, 13% C, Pulmonary diameter, 2.5 mm (2-3), Aortic diameter, 5 mm (4.7 – 6), PDA length, 7 mm (7-8), 42.9% with ADO II AS 4/4 dispos- itive used and 42.9% ADO II AS 5/4. After closure 90.5% extubation < 48 hr, 23.8% inotropics, 28.6% transfusions, and no complications or vascular lesions occurred. Analyzing the pre and post variables: days hospitalized pre closure, 8 (1-29), post close, 3 (1-23). Heart Rate, pre close,155 bpm (145 – 168.5), post close, 135 (121 – 155), Systolic blood pressure, pre close, 77 mmHg (67 – 84), post close, 82 (74-86),
Diastolic blood pressure, pre close 38 mmHg (31.5 – 42.5), post close, 55 (50-61.5), Pulse Oximetry, pre close, 92% (90-96), post close, 98(94- 99.5). A significant difference occurred between differential pressure pre close and post close; 38 mmHg, (33 – 42) versus 27 (20.5 – 30) p 0.001. Conclusion: Percutaneous closure of PDA with ADO II AS is a secure alternative for patients less than 4000 g.
#0069
ACUTE MANAGEMENT OF HYPOXIC CRISIS WITH PERCUTANEOUS RIGHT VENTRICULAR OUTLET TRACT STENT
Ernesto Vallejo, Angelo Valencia, Victor Rodriguez
Centro Medico Imbanaco, Cali, Valle, Colombia
Introduction: TOF and other critical right ventricular outlet tract (RVOT) obstructions with ventricular septal defects (VSD) can cause hypoxic crisis. Percutaneous right ventricular outlet tract STENT is a saving measure in critically ill patients.
Material and Methods: Paediatric patients (0-18 years old) with TOF or RVOT obstruction with VSD and hypoxic crisis since the year 2010 until 2014. Procedure: General anaesthesia, right catheterization to implant STENT in RVOT (The STENT was chosen in relation to low- er infundibular diameter). Median variables with interquartile range variables are presented with frequency percentages.
Results: 6 patients were enrolled, 5 of them with TOF and 1 with with Atrioventricular Septal Defect with infundibular stenosis. The median age was 7 months (range 4.75-26.75), 50% males, RVOT gradient pre STENT 66.5 mmHg (58 – 72), pulse oximetry 69% (48,5 – 80,5), lower infundibular diameter 4.5 mm (3.7 – 5.6), cardiac structures Z – SCORE were, pulmonary annulus -3.7 (-4.1 - -2.2), right pulmonary artery -3 (-3.4 - -2.7), left pulmonary artery -2.7(-2.8 - -2.1), STENT size 5 x 18 mm until 8 x 29 mm, 86% 1 STENT and 3 patients with 2 STENT. During the procedure the patients were unstable, requiring high pharmacolog- ical and ventilatory assistance. Post procedure, pulse oximetry was 94% (88.5-95), post STENT implantation days 16 (9 – 47), definitive surgery 83.3% valvulotomy and RVOT repair, preserving the native valve and 16.6% prosthetic valve. 1 patient died from non cardiac complications (sepsis). The surgeon had no difficulties in the removal of STENT. 5 living patients had a satisfactory health in its following.
Conclusions: Percutaneous STENT in RVOT is a safe and effective al- ternative treatment in patients with hypoxic crisis. Unstable patients before and during the procedure changed favourably after STENT implantation allowing a more stable condition for surgery. Corrective surgery performed in less than 1 month after the stent provides re- tirement and keeps the native valve. Prospective studies are needed to clarify the indications for this procedure in critical and non-critical patients with TOF and other critical RVOT obstructions with ventric- ular VSD.
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TRANSTHORACIC
FLUOROSCOPIC INTEGRATION FOR RIGHT VENTRICULAR OUTFLOW TRACT STENT IMPLANTATION IN INFANTS WITH CYANOTIC FORMS OF TETRALOGY OF FALLOT
ECHOCARDIOGRAPHIC AND
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111