Page 42 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
post-op period. Median follow up time was 7 months (range 1-28). Two pts required reintervention: 1 pt (Melody) underwent surgery for a subaortic membrane unrelated to the MVR and mild MV stenosis. The Melody THV leaflets had 2 holes and a few more appeared post redilation thus a 2nd Melody THV was placed within the previous. A second pt (Sapien3) developed progressive MV stenosis due to poor opening of valve leaflets underwent successful dilation at cath. On last follow-up, mean MV gradient tended to be higher among Sapien pts than Melody pts (16,22mmHg vs 4,8,11 respectively).
Conclusion: Hybrid MVR with THV’s is feasible in small children. LVOT tract obstruction or perivalvular leak at implantation may be avoid- ed using different techniques. Transcatheter redilation of the Sapien valve is possible. Further follow up to assess long-term function and durability of THV’s in the MV position is needed.
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OUTCOMES OF STENT IMPLANTATION IN PULMONARY VEIN STENOSIS FOLLOWING REPAIR OF TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION Hirotaka Oki1, Naofumi Sumitomo1, Hiroyuki Yamada1, Kouichi Miyata1, Naoya Fukushima1, Seiichirou Yokoyama1, Masaru Miura1, Kazuhiko Shibuya1, Hirofumi Haida2, Yusuke Yamamoto2, Mika Iwasaki2, Yukihiro Yoshimura2, Terada Masatsugu2
1Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
2Department of Cardiovascular Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
Introduction: Pulmonary vein stenosis (PVS) following repair of total anomalous pulmonary venous connection (TAPVC) is often acutely progressive and lethal. Neither surgery nor transcatheter interven- tions have yielded satisfactory long-term results.
Methods: Consecutive patients who underwent stent implantation (SI) for PVS following repair of TAPVC between January, 2008 and May, 2015 were identified retrospectively. In principle, sutureless re- pairs for PVS and atrial septum defect creation were performed ini- tially, and if possible, 7mm stents were implanted percutaneously or intraoperatively for recurrent PVS. Aggressive reinterventions for in- stent stenosis (ISS) were performed at intervals of a few months. The ISS was graded based on the ratio of lumen-to-stent : <0.5=severe, 0.5-0.7=moderate, 0.7-0.9=mild, >0.9=no stenosis.
Results: A total of 15 pulmonary veins (PV) were stented in 5 patients. Bare metal stents (BMS) were used in 15 PVs, including a 7mm Ex- press Vascular LD (n=13) and 4mm Liberte (n=2). Handmade covered stents (CS) were used in 2 PVs in 1 patient to overlap prior implanted stents in order to control relentless ISS (n=2). The age at the time of the SI was 8(4-38) months. During a cross-sectional follow-up of 30(6- 81) months, occlusion was documented in 2 stents and severe ISS in 4 stents, moderate ISS in 2 stents, mild ISS in 6 stents, and no steno- sis in 3 stents. Reinterventions were performed a median of 6(2-14) times over an interval of 1-7 months. There was a statistically signifi- cant improvement after SI in the lumen diameter (2.4mm to 6.3mm, p<0.001) and systolic right ventricle pressure to aortic pressure ratio (1.0 to 0.5, p=0.041) and a statistically significant difference between no/mild/moderate ISS and severe/occlusive ISS in the minimum di-
ameter (2.5mm versus 1.7mm, p=0.037) and reference diameter (6.5mm versus 3.5mm, p<0.001). The number of 7mm stents with no/ mild/moderate ISS was 2 in all 3 surviving patients, 1 in 1 deceased patient (due to pertussis), and 0 in the remaining decedent (due to chylothorax).
Conclusions: SI for PVS was acutely effective in relieving stenosis and pulmonary hypertension. ISS was common and more severe espe- cially in PVs with a smaller minimum diameter and reference diame- ter. Although aggressive reinterventions were needed, patients with more than two 7mm stents were able to survive over the long term.
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COIL EMBOLIZATION AS TREATMENT FOR CONDUIT RUPTURE DURING MELODY TRANSCATHETER PULMONARY VALVE IMPLANTATION
Sara Trucco, Jacqueline Kreutzer
Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
Objective: To describe the use of coil embolization for the successful treatment of right ventricular (RV) to pulmonary artery (PA) conduit rupture during MelodyTM transcatheter pulmonary valve implanta- tion.
Background: Conduit rupture is a known and serious complication of percutaneous pulmonary valve implantation. Coil embolization as treatment of conduit rupture has not been previously reported.
Case: The patient is a 29 year old male with a history of congenital aortic valve stenosis and tortuous aortic isthmus status-post surgical aortic valvotomy in infancy followed by Ross procedure at 12 years of age with placement of a 24 mm pulmonary homograft in the RV to PA position. He developed coarctation and severe homograft ste- nosis with moderate insufficiency (regurgitant fraction of 28%). Cath lab hemodynamics revealed RV pressure 75% of systemic with a 39 mmHg gradient from RV to PA. The homograft was heavily calcified and measured 16.4 mm at its narrowest. After stenting of the coarcta- tion, the homograft was pre-stented with a 4010 Palmaz XL stent and post-dilated using a 16 mm followed by an 18 mm Vida balloon. This resulted in a small contained conduit tear. Placement of two 18 mm MelodyTM valves was unsuccessful in covering the tear, which only expanded (Figure 1). The tear was then embolized using one MReye 35-14-12 and four Nester 35-14-10 embolization coils with complete resolution. Follow up CT scan showed no further extravasation or an- eurysm formation.
Conclusion: Coil embolization should be considered as a therapeutic option to treat conduit rupture, particularly when other modalities fail or are unavailable.
19th Annual PICS/AICS Meeting Abstracts