Page 40 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
Results: Procedure was successful in 28 cases (96.5%). Median VSD size was 7 mm (range 3–22). Fluoroscopy time was 24±15’ (range 3–146).
Complications: with AMPLATZER device: 1p tricuspid regurgitation (no surgery was necessary), minor rhythm disturbances in 3p, complete atrioventricular block (CAVB) in 3 p (perimembranous, 2 transitory, 1 required pacemaker); left anterior hemiblock (transitory), 2 muscular VSD). 1p stenotic tricuspid valve.
Multivariable analysis: the only variables associated with risk of com- plications were age (P: 0.012) and weight (P: 0.0035).
Univariable analysis: risk factors for CAVB were the device type (P: 0.03) and VSD location (P: 0.05). With NIT OCCLUD device: emboliza- tion in 1case, 1p minimal aortic regurgitation, 3p haemolysis (2 main, 1 severe that required Nit Occlud ductus 9/6).
In both type of device residual shunt was immediate in 11/34, 6 month later 2/34 minimal shunt, 2/34 light aortic regurgitation (1 minimal, 1 light)
Multivariable Cox proportional hazards analysis: no others risk factors were found.
Conclusion: Transcatheter closure of congenital VSD offers encour- aging results. Complications are limited; the most relevant one is complete atrioventricular block in perimembranous VSD. More expe- rience and long-term follow-up are mandatory to assess its safety and effectiveness
#0089
CARDIAC CATHETERIZATION OF PEDIATRIC PATIENTS SUPPORTED BY EXTRACORPOREAL MEMBRANE OXYGENATION
Nicholas Boscamp1, Mariel Turner2, Matthew Crystal2, Julie Vincent2, Alejandro Torres2
1Columbia University College of Physicians and Surgeons, New York, NY, USA
2Children's Hospital of New York Presbyterian, New York, NY, USA
Objective: Heart catheterization (HC) is commonly performed in pts being supported by extracorporeal membrane oxygenation (ECMO). We aimed to evaluate the safety and utility of HC in pediatric pts on ECMO.
Methods: Retrospective analysis of HC performed between 1/2000 and 5/2015 in pts <18 years of age while on ECMO. Pts placed on ECMO at the time of HC were excluded. Pt and procedural data ob- tained included indications for HC, interventions, procedural compli- cations and outcome.
Results: A total of 365pts received ECMO support during the study period. Of those, 51pts underwent 53 ECMO runs and 55 HC. Nine- teen pts had congenital heart disease (two-ventricle physiology in 13 and single-ventricle in 6), 12 acute myocarditis, 9 chronic car- diomyopathy, 8 heart transplant, 2 pulmonary hypertension and 1 ischemia. Indications for ECMO included ventricular dysfunction in 22, cardiac arrest in 20, unable to wean from surgical bypass in 7 and cyanosis in 4. An intervention was performed in 42/55 HC (79%), in- cluding septostomy for LA decompression in 34, stent placement in 6
(pulmonary artery 2, BT shunt 2, Fontan fenestration 1 and coronary artery 1), collateral embolization in 1 and adjustment of Fontan fen- estration size in 1. Diagnostic HC was performed to image coronary arteries in 4pts, pulmonary veins and arteries in 3 and 2 respective- ly and aorta and central shunt in 1 each. Biopsy was performed in 1pt and in 1pt septostomy was deferred due to an atrial thrombus. Diagnostic HC was followed by surgery in 4pts (30%): 2pts required pulmonary artery plasty and shunt revision, 1pt had compression of circumflex artery by external pacemaker lead and 1pt had repair of anomalous LCA. Major complications occurred in 3pts (5.6%): 1pt died due to hemothorax after pulmonary stent placement, 1 suffered perforation of the right femoral vein requiring a covered stent and 1 developed a pericardial effusion due to perforation of the atrial wall but needed no further intervention. Median follow-up time after HC was 141 days (IQR 13.5-1493). Outcome of the 53 ECMO runs includ- ed decannulation in 27 (53%), heart transplantation in 9 (17%) and transition to ventricular assist device in 3 (4%). ECMO was withdrawn in 14 pts (26%).
Conclusion: HC can be safely performed in pts on ECMO for diagnosis or therapeutic interventions. Early HC is recommended in pts with circulatory collapse of unclear etiology.
#0090
INACCURACY OF A CONTINUOUS ARTERIAL PRESSURE WAVEFORM MONITOR WHEN USED FOR CONGENITAL CARDIAC CATHETERIZATION
Michael D. Seckeler1, Katri Typpo2, Jen Deschenes2, Ricardo Samson1, Peter Lichtenthal3
1University of Arizona, Department of Pediatrics (Cardiology), Tucson, AZ, USA
2University of Arizona, Department of Pediatrics (Critical Care), Tucson, AZ, USA
3University of Arizona, Department of Anesthesiology, Tucson, AZ, USA
Background: Cardiac index (CI) is vital for hemodynamic calculations in cardiac catheterizations for congenital heart disease (CHD). Oxy- gen consumption (VO2), used in the Fick equation to calculate CI in patients with intracardiac shunts, is cumbersome to measure. Many catheterization labs rely on published predictive equations for VO2 which are known to be suboptimal. The FloTrac sensor (Edwards Life- sciences Corp., Irvine, CA) uses real-time arterial waveform tracings to calculate CI but has not been used in children with CHD undergoing cardiac catheterization (cath).
Methods: Patients undergoing clinically indicated caths were pro- spectively enrolled from 9/2014 to 5/2015. All caths were performed with general endotracheal anesthesia. VO2 was measured using the Vmax® Encore 229 monitor attached to the ventilator circuit. While in a steady hemodynamic state, the FloTrac transducer was connect- ed to a 4 or 5-Fr pigtail catheter in the descending aorta and CI was obtained. CI by the Fick equation using measured VO2 was compared to CI from the FloTrac sensor using paired t-test and Bland-Altman analysis.
19th Annual PICS/AICS Meeting Abstracts