Page 36 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
#0080
AORTO–RIGHT VENTRICULAR SHUNT AFTER AORTIC VALVE REPLACEMENT: INTERVENTIONAL OCCLUSION WITH AN AMPLATZER DUCT OCCLUDER II
Heike Schneider, Ulrich Krause, Matthias Sigler, Thomas Paul, Claudia Dellas
University Goettingen, Goettingen, Germany
Aortocardiac fistulas are rare, especially if they develop after surgi- cal aortic valve replacement. We present the case of a 62-year-old woman who sought care for dyspnea and heart failure symptoms 3 months after bioprosthetic aortic valve replacement. Her postoper- ative course was complicated by third degree AV block, and a DDD pacemaker had already been implanted. Echocardiography revealed an aorto-right ventricular (Ao-RV) shunt with preserved left ventric- ular function and mild stenosis of the bioprosthesis without a true paravalvular leak. Treatment of aorto-right ventricular fistulas can be accomplished interventionally or may otherwise require a surgical approach.
Cardiac catheterization confirmed the diagnosis and showed a left- to-right shunt from the right coronary cusp to the cavity of the right ventricle with a Qp:Qs of 1.4:1 and mild pulmonary hypertension. The fistulous connection could not be well delineated by transesopha- geal echocardiogram (TEE) and angiography alone. Therefore, bal- loon-sizing was performed using a Tyshak II balloon of 8 × 20 mm, un- til achieving a complete interruption of flow assessed by TEE. Minimal diameter of the defect was 4.2 mm, the distance to the right coronary artery measured 8 mm and the distance to the prosthetic valve ring 6.6 mm. It was decided to attempt closure retrogradely avoiding a arteriovenous loop by choosing an AmplatzerTM Duct Occluder (ADO) II device 06-04 (9-PDA2-06-04). An additional advantage of this de- vice is the small sheath size required. ADO II implantation could be performed easily and the final angiogram documented good posi- tion of the device and showed near complete closure while still under heparin. There was no interference with the prosthetic aortic valve or development of valve insufficiency and no compromise of flow to the right coronary artery. Echocardiography repeated the following day documented no residual shunt through the AO-RV fistula. Con- clusion: Percutaneous closure of an aorto-right ventricular shunt can be performed avoiding an arteriovenous loop using an ADO II via the retrograde approach if anatomical details including a sufficient dis- tance from the coronary arteries and aortic valve are documented.
#0081
CREATION OF A NOVEL PERCUTANEOUS ANIMAL MODEL OF PULMONARY VEIN STENOSIS
Matthew Crystal1, Genghua Yi2, Mariel Turner1, Alejandro Torres1, Juan Granada2, Greg Kaluza2, Julie Vincent1 1Columbia University Medical Center, New York, NY, USA
2CRF Skirball Center for Cardiovascular Research, Orange, NY, USA
Objective: To create and validate a percutaneous animal model of pulmonary vein stenosis applicable to congenital heart disease and/ or acquired pulmonary vein stenosis by using thermal injury within the pulmonary veins.
Background: Congenital and acquired pulmonary vein stenosis is rare, with a high mortality. Surgical and transcatheter (balloon an- gioplasty, stent implantation) interventions have similar challenges
with occurrence of restenosis being common. The optimal device for pulmonary vein stenosis has not yet been identified.
Methods: Yorkshire Swine piglets (4 animals, 2 weeks old, 5kg each) placed under GA, right and prograde left heart catheterization per- formed through the PFO. Thermal injury balloons (LesionGen) were heated using RF energy once fully inflated within the pulmonary vein to create a local injury/tissue response to approximate cellular changes. Each piglet received thermal injury in 2-3 vessels. Piglets were recovered and housed prior to follow-up diagnostic catheter- ization at either 30 or 60 days and were sacrificed and histopathology performed on all intervened vessels.
Results: All animals survived the initial procedure and underwent fol- low-up catheterization.
Hemodynamics: 30 day animals demonstrated increased mean PA pressure of 4-5mmHg. 60-day animals demonstrated no changed in mean PA pressure.
Angiography: Pulmonary vein stenosis measured by percent diam- eter stenosis relative to the normal vessel: 30-day animals 52.29 + 24.67%, 60-day animals 12.52 + 4.95% (mean + SD). One vessel was 100% occluded acutely after thermal balloon injury and remained oc- cluded at 30-day follow-up.
Histopathology: Thermal injury noted in one pulmonary vein in both 30-day animals (slight non-stenosing intimal hyperplasia) and in one 60-day animal (minimal non-stenosing intimal hyperplasia, slight perivenous fibrosis).
Conclusion: Thermal injury was able to successfully induce neointi- mal hyperplasia in neonatal swine pulmonary veins. Greater tissue proliferation was noted at 30 days compared with 60 days and may represent healing. Thermal injury is a feasible modality for percuta- neous induction of pulmonary vein stenosis. Additional investigation to determine the optimal balloon design and optimal thermal injury delivery is needed.
#0082
ANGIOPLASTY PROCEDURE IN AORTIC COARCTATION Ana Maria de Dios, Jesus Damsky Barbosa, Maria Fernanda Biancolini, Julio Cesar Biancolini, Victorio Lucchini, Marquez Adelia, Eugenia Bazan, Ines Martinez
Childrens Hospital Pedro Elizalde, Buenos Aires, Argentina
Hypothesis: follow up of patients (p) with Aortic Coarctation (Ao Co) post angioplasty (BCA) procedure.
Material and Methods: retrospective analysis of 84p post angioplasty procedure. 76p Ao Co native
Grouped by severity: mild <20mmHg, moderate 20 a 40 mmHg, se- vere >40mmHg. Topics reviewed: age at diagnosis, clinical manifes- tations (cardiac insufficiency (CI), arterial hypertension (AH)), defect extension (localized, extensive, isthmus hypoplasia), associations, ini- tial treatment (catheterization or surgery), and long term evolution. Multivariable statistical analysis T test p<:0.05.
Results: 84p with Ao Co post BCA; Age at diagnosis: 20% <1month, 50% 1-2 years, 30% >2 years;
19th Annual PICS/AICS Meeting Abstracts