Page 37 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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Age at BCA: median 8±8 month. Clinical exam: 95% no pulse, 33% CI and 21% AH; 1p AH without IC.
EKG: right ventricular hypertrophy in 53p, left in 31p. Associations: ventricular septal defect 23p (15p perimembranous, 7p muscular, 1p sub-aortic), 8p ductus, 1p mitral stenosis, 6p mitral insufficiency, 6p aortic insufficiency, 2p right aberrant subclavian artery.
Anatomic types: 83.1% localized: 9.9% membranous, the others fibro- muscular; 1p extensive; 14/84p hypoplasia of transverse aortic arch. Severity: 30% moderate, 60% severe. BCA: 52p procedures over 84p; 44p one BCA, 4p two BCA (2p native Ao Co), 1p: four BCA, 1p needed stent. Efficiency: efficient in 38/ 47p (80.8%); not efficient in 8p, 1p died of cardiogenic shock during the procedure. Gradient post pro- cedure: dropped from 50±18mmHg to 14±10mmHg (p: 0.00), and increase the size of the isthmus X: 14±2.43cm versus X: 18±3 (p: 007) . Re-coarctation (RC): 17/30p with native Ao Co, all <1 year old with CI, early RC X: 12±10month; 2p had small sacular aneurysms.
RC 57% native Ao Co, versus 13.3% after surgery. 4/84 small sacular aneurysm (4.2% in Ao Co native, 1.2% in after surgery). Stent: 33 p; X: 9.5±5 a, 25/33p Ao Co was severe, 8 p moderate. 2p aortic arch hypoplastic.
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SHOULD PULMONARY LOOP TECHNIQUE BE A ROUTINE ON PERCUTANEUS PDA CLOSURE IN ADULTS? TWO NATIONAL CENTERS EXPERIENCE. Manuel Acuna1, Justo Santiago2, Milka Marin1, Maria Solorzano2, Eugenio Ionescu1, Luis Gomez2, Jose Brito1, Carlos Garcia1, Asdrubal Alfonzo1
1Hospital Dr. Perez Carreno, Caracas, Venezuela
2Hospital Universitario De Los Andes, Merida, Venezuela
PDA is a congenital heart disease usually diagnosed and treated in childhood however a small amount of patients reach to adulthood unoperated. This heart condition varies from asymptomatic heart murmur, disturbed functional class to lv systolic dysfunction and pul- monary hypertension.
Percutaneous PDA closure is a worldwide well accepted technique for treat children with this disease however experience in adults is still on development.
Method: this is a retrospective study of two national university cath labs in Venezuela. Our study describes the population, devices, pro- cedure and follow-up in adults with PDA treated percutaneously from April 2001 to April 2015.
Results: a total of 45 patients were included in the study and for epi- demiological reasons older than 12 years were considered as adults. There were 37 females and 8 male patients. The medium age was 28.1 years. The more used device was the Amplatzer PDA occluder with 40 cases followed by Amplatzer septal occluder and coil with 2 cases each respectively. Duct occluder was used in one single case.
Aorto-pulmonary loop was performed in cases in which operators were unable to access descending aorta from pulmonary arteries de- spite multiples attempts. Pulmonary loop technique was used on 42 cases.
All cases but one were done with less than 15 minutes flouroscopy time. There were no residual shunts 24 hours after the procedure. No major complications were reported. Short after the procedure one of the patients developed AF with no embolic events after 4 years fol- low-up. Two patients required medication for lV systolic dysfunction
Conclusions: percutaneous PDA closure is a feasible and safe proce- dure in adults with high success rate without major complications. In most cases aorto-pulmonary loop would shorten the procedure in adults. Amplatzer PDA occluder is the more used device for this condition, however off label use of septal occluder and muscular VSD occluder should be considered in selected cases.
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TECHNIQUES
OF EMBOLIZED NIT-OCCLUD® PDA-R AND ASD-R DEVICES
Sanjay Sinha1, Daniel Levi1, Alejandro Peirone2, Carlos Pedra3 1UCLA, Los Angeles, USA
2Hospital Privado de Cordoba, Cordoba, Argentina
3Instituto Dante Pazzanese de Cardiologıa, Sao Paulo, Brazil
Background: Nit-Occlud® (Atrial Septal Defect) ASD-R and (Patent Ductus Arteriosus) PDA-R devices are used outside the USA for clo- sure of the patent ductus arteriosus and atrial septal defects. When embolization occurs, these devices have been difficult to retrieve. Methods: Bench simulations of retrieval of PDA-R and ASD-R devices were performed in a vascular model (Fig 1). Retrieval of each device wasattemptedusingsnaresorbioptomeforceps.Arangeofdevices were embolized in an animal model. Retrieval methods were system- atically tested in a range of sheath sizes, and graded in by difficulty and retrieval time.
Results: Devices grasped by the bioptome in the center of the prox- imal part of the devices were easily retrieved in both models. Bench studies determined the minimum sheath sizes needed to retrieve each device. Sheathes two french sizes greater than the delivery sheath were successful with this technique. Five of the six PDA-R de- vices were successfully retrieved in vivo (Fig 2). Four were retrieved by grasping the middle of the right atrial ASD-R disc or PA end of the PDA-R device with a bioptome, and one small PDA-R device was re- trieved using a 10mm snare. Nine ASD-R devices were retrieved suc- cessfully. For ASD-R 28 mm and 30 mm devices, a double bioptome technique was needed (Fig 3).
Conclusion: ASD-R and PDA-R devices can be successfully retrieved in the catheterization lab. It is critical to grab the center portion of the right atrial disc of the ASD-R device or pulmonary portion of the PDA-R device and to use adequately sized sheathes.
FOR TRANS-CATHETER
RETRIEVAL
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111