Page 32 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
Kasey Chaszczewski1, Brian McCrossan2, Carlos Miranda1, Gareth Morgan3, Kevin Walsh2 , Damien Kenny1
1Rush University Medical Center, Chicago, IL, USA 2Our Lady’s Hospital for Sick Children, Dublin, Ireland 3Evilina Children’s Hospital, London, UK
Background: Both systemic to pulmonary artery shunts and complete neonatal repair are associated with relatively high mortality rates in patients with cyanotic forms of Tetralogy of Fallot (TOF). The develop- ment of right ventricular outflow tract (RVOT) stenting has provided a less invasive means to improve pulmonary artery blood flow and de- lay definitive surgical repair. While typically performed solely under fluoroscopic guidance, the aim of this study was to assess the utility of fluoroscopic and transthoracic echocardiographic integration to improve RVOT characterization, and in turn efficacy of stent selection and deployment.
Methods: Retrospective data analysis of patients undergoing RVOT stenting with fluoroscopic and echocardiographic integration from January 2012 through May 2015 at three institutions. Pre-procedural investigation, patient demographics, and clinical follow-up data were included. Data is presented as mean ± standard deviation.
Results: Sixteen patients underwent RVOT stent placement of twenty total stents, utilizing a combination of fluoroscopy and echocardiog- raphy for RVOT characterization, stent selection, and deployment. Patients ranged in age from 9 to 63 days, with a mean age of 39.38 days (± 19.18), and mean weight at time of procedure of 3.53 kg (± 0.76). Mean pre-procedural annulus size was 4.49 mm (±1.23), with a mean oxygen saturation of 70.88 % (±5.58). Mean fluoroscopy time was 19.8 min (± 15.3). Mean balloon deployment size was 5.43 mm (±0.85). Three patients required deployment of multiple stents to achieve adequate relief of obstruction across the RVOT. Stent deploy- ment was successful in all cases. Following successful stent deploy- ment, mean improvement in oxygen saturation was 21.13 % (±4.43). Three patients experienced complications including transient hypo- tension requiring vasopressors, development of pericardial effusion, and balloon rupture with stent deployment. There were no procedur- al deaths. At a mean follow up of 16.13 months (±10.58), no patients required reintervention prior to surgical repair, and to date 14 of 16 patients have completed definitive surgical repair at an average of 186.97 days (±140.05).
Objective: To study PA growth in duct-dependent cyanotic CHD with branch PA stenosis following PDA stenting.
Methods: Prospective, non randomized study. Inclusion criteria : weight ≥ 2.75kg, age < 3 months. Presence of unilateral or bilateral branch PA stenosis. CT Scan was performed for morphologic eval- uation and case selection. Patient with severity tortuous PDA were excluded. Vascular access and PDA stenting techniques were accord- ing to ductus morphology. CT thorax was repeated 3 months post procedure for early evaluation and cardiac catheterization repeated at 9 months post stenting prior to surgical repair. P1 was labelled for distal diameter of an affected branch PA (mm) and distal diameter of a unaffected branch PA was labelled as P2 (mm).P1 to P2 ratio was then calculated. The measurement was then repeated at 3 month and 9 months post procedure respectively.
Results: Between February 2014 to May 2015, 34 patients who full filled the inclusion criteria underwent PDA stenting. Vascular access was by femoral artery in 17 patients (50.0 %), axillary artery in 12 (35.3 %), transvenous in 4 (11.8 %) and carotid artery in 1 (2.9 %). 21 patients had early evaluation by CT scan at 3 months post and 15 patients had repeat catheterization at 9 months. About 26 patients (75.5 %) had LPA stenosis, 5 (14.7 %) had RPA stenosis and 3 (8.8 %) had bilateral stenosis. At presentation P1 was 4.32 + 1.39 mm and P2 was 4.83 + 1.60 mm respectively, with P1/P2 ratio of 0.9. At 3 months post procedure, the ratio was 1.24. At 9 months post stenting, the ratio was 1.1. 3 patient required rescue Blalock Taussig shunt at day 4 of post stenting due to compressed stents. There was no deaths and no stent migration. The immediate complications were bleeding from puncture site in 11 (32.4%), hypotension in 12 (35%) and over shunting in 5 (14.7 %). 1 patient need balloon dilatation of stents at 9 months post stenting due to in-stent stenosis.9 underwent surgery 1 to 6 months after repeat cardiac catheterization. 6 underwent cor- rective surgeries and 3 underwent palliative Glenn shunt. All patients had uncomplicated surgeries.
Conclusions: Patent ductus arteriosus stenting is ductus related branch pulmonary artery stenosis results in satisfactory growth of PA despite jailing of an affected branch. This is a viable alternative to sur- gery for the early palliation of duct dependent cyanotic CHD. How- ever close monitoring is required and further studies are warranted.
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SEVERE CONTRALATERAL
HYPERTENSION FOLLOWING
RESUSCITATION OF ISOLATED DUCTAL ORIGIN OF A PULMONARY ARTERY
Hitesh Agrawal1, Damien Kenny2, Miro Joaquim3, Carlos D Miranda2, Henri Justino1
1Texas Children's Hospital, Baylor college of Medicine, Houston, TX, USA
2Rush University medical center, Chicago, IL, USA, 3St Justine Hospital, Montreal, CA, Canada
Background: In the rare situation where there is isolated ductal origin of a pulmonary artery (DOPA), intervention to establish re-perfusion of the affected lung without direct re-anastomosis may lead to pul- monary hypertension in the contralateral lung.
Methods: Multi-center review of patients with DOPA, who underwent palliation with a ductal stent and developed pulmonary hyperten-
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PROSPECTIVE
ARTERIOSUS STENTING IN CYANOTIC CONGENITAL HEART DISEASE WITH DUCTUS RELATED BRANCH PULMONARY ARTERY STENOSIS- A PRELIMINARY RESULT
Marhisham Che Mood, Mazeni Alwi, Hasri Samion, Haifa Abdul Latiff, Putri Yubbu, Anu Ratha Gopal, Johan Aref Jamaluddin
National Heart Institute, Kuala Lumpur, Malaysia
Ductus related branch pulmonary artery (PA) stenosis is common in cyanotic congenital heart disease (CHD). Patent ductus arteriosus (PDA) stenting is not recommended for concerns of jeopardizing fur- ther the affected branch. This however has not been based on exten- sive evidence.
PULMONARY TRANSCATHETER
STUDY ON
PATENT DUCTUS
19th Annual PICS/AICS Meeting Abstracts