Page 41 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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Results: 26 patients (median age 5.2 years, 1.5 – 18.3) were studied. Indications for cath included: ASD (n = 6), PDA (n = 6), coarctation (n = 3), pre-Fontan hemodynamics (n = 2), pulmonary artery/RV-PA conduit intervention (n = 2), pulmonary hypertension (n = 2), shunt quantification (n = 2), IVC obstruction (n = 1), post-Fontan evaluation (n = 1) and post-transplant evaluation (n = 1). CI by FloTrac was high- er than CI by Fick (6.28 vs. 3.92 L/min/m2, p = 0.002). Bland-Altman analysis (Figure) showed a consistent overestimation of CI by FloTrac which worsened as CI increased (mean bias 2.36 L/min/m2, 95% limits of agreement -4.4, 9.1).
Conclusion: The results of this study show that the FloTrac sensor can be used to measure CI in children with CHD undergoing catheteriza- tion. However, for children with higher CI, the sensor is too inaccurate for routine clinical use. Further studies may allow for modifications of the algorithms to obtain more accurate CI in this population.
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INITIAL EXPERIENCE WITH THE NEW PUL-STENT IN TREATING POST-OPERATIVE BRANCH PULMONARY ARTERY STENOSIS
Tingliang Liu, Ying Guo, Wei Gao
Shanghai Children's Medical Center, Shanghai, China
Objective: The Pul-Stent(MED-zenith medical scientific co. Ltd, Bei- jing, China) is a new cobalt alloys stent with hybrid cell design (a com- bination of closed and open cells), specially licensed for pulmonary artery stenosis. The aim of this study was to evaluate its effectiveness, safety and maneuverability.
Methods: 21 patients were enrolled in this study. Among them 8 cas- es were post surgical repair of tetralogy of Fallot, 7 patients were post surgical repair of pulmonary atresia with ventricular septal defect, 2 cases were after Fontan procedures, and 1 patient has stenosis at Glenn pathway, and 3 cases were isolated pulmonary branch steno- sis. The median age was 7.2 years (range 2.0 -13.7 years). The median weight was 21.1kg (range 13-32 kg).And there were 20 cases of tran- scatheter stent implantation and 1 case of hybrid procedure.
Results: Totally 23 Pul-stents have been implanted in successfully 21
patients(14 males and 7 females) through 7-12 F delivery sheaths, among them 17 stents in left pulmonary artery and 6 stents in the right side. The catheter-measured pressure gradient at the stenosis decreased from 32.7 ± 13.2 mmHg to 12.0 ± 12.7 mm Hg ( p < 0.001) and the diameter of the narrowest segment increased from 4.5 ± 1.4 mm to 9.5 ± 2.1 mm ( p < 0.001). The right ventricle pressure to aortic pressure ratio decreased from 0.55 ±0.12 to 0.36 ±0.08 p < 0.003. The total procedure time ranged from 30 to 220min median 109min, and the fluoroscopy time ranged from 9 to 67min (median 26 min). There were 3 cases of stent micro-migration, further stent implantation were performed in 2 cases, and there were 2 cases of post-stenting pneumorrhagia. No balloon rupure, no stent fracture and other se- vere complications were observed. No significant restenosis was de- tected by following cardiac ultrasound studies and selected cardiac catheterization in 6-months Follow-up.
Conclusion: Pul-Stent tracking and delivery was excellent, the initial experience has shown that Pul-Stent implantation was effective and safe in treating post-operative branch pulmonary artery stenosis. Fur- ther follow-up study should be investigated to make sure whether those good results will be permanent or not.
Key words: Branch pulmonary • Stenosis • Stent implantation • Children
#0093
HYBRID MITRAL
TRANSCATHETER
APPROACH FOR INFANTS AND SMALL CHILDREN WITH MITRAL VALVE DISEASE
Alejandro Torres, Matthew Crystal, Mariel Turner, Tamar Mendelsberg, Julie Vincent
Columbia University Medical Center, New York, NY, USA
Objective: Treatment of mitral valve (MV) disease in small pts is a chal- lenging issue as there are few options available for MV replacement (MVR). We present our experience using current transcatheter heart valve (THV) technologies for the treatment of MV disease in infants and small children.
Methods: Review of surgical database and hospital records for all pts who underwent hybrid MVR with THV’s.
Results: From 02/2013 - 06/2015, 5 pts (4 males) underwent hybrid MVR using a THV; 3/5 had previous MV repair. Main indication for MVR included symptoms associated with stenosis (3) and insufficiency (2). In all cases intrinsic MV tissue and chordae were removed surgically before THV was placed. Three pts (age 22, 34, 37 months, 10-13kg) received a Melody valve (Medtronic, Minneapolis, MN) implanted on a 16mm balloon (1pt) and 18mm in 2. Two infants (5, 9 months; 4, 5kg) had an Edwards Sapien 3 valve (Edwards, Irvine CA) implanted under compassionate use criteria on 16 and 18mm balloons. Melody valves were secured to the MV annulus with sutures to the stent in 2 pts and to a surgically created cuff in 1 or to the fabric “skirt” of the Sapien3. Two Melody pts required concurrent procedures to accom- modate the valve. Post-op TTE showed mean MV gradients <5mmHg in all but 1pt (9mmHg, Sapien). One pt had a small perivalvular leak (Melody). All pts had < mild MV insufficiency. New LVOT obstruction (20mmHg) was noted in 1 pt (Sapien). One pt (Melody) with history of pulmonary hypertension (PHTN) suffered PHTN crises in the early
VALVE HEART
REPLACEMENT VALVES: A
USING NOVEL
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111