Page 45 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
74
venous access with complex congenital cardiac diseases or when this approach provides some advantage for the procedure. Transhepatic approach can be performed repeatedly and safely in small children sometimes requiring large venous access.
#0101
INTERMEDIATE FOLLOW-UP RESULTS OF AMPLATZER DEVICE OCCLUSION OF SECUNDUM ATRIAL SEPTAL DEFECTS
Georgios Hartas, Duraisamy Balaguru, Matthew Brown, P. Syamasundar Rao
University of Texas, Medical School at Houston, Houston, TX, USA
Background: The purposes of this study is to document the results of Amplatzer Septal Occluder (ASO) closures of atrial septal defects (ASD) in a large number of patients with particular emphasis on inter- mediate-term follow-up in an attempt to provide evidence for feasi- bility, safety, and effectiveness of this method of ASD closure. Imme- diate and short-term results of ASO occlusion of ASD in children have been well documented, but intermediate and long-term follow-up data are limited.
Methods: During a seven-year period ending June 2011, 65 patients with secundum ASDs were taken to cath lab with intent to occlude the ASDs. Transcatheter closure of ASDs was performed in 61 (93.8%) with an Amplatzer Atrial Septal Occluder. The device size selection was based on the balloon diameter by using the stop-flow technique. In 3 patients, no attempt was made to occlude the PDA either be- cause of inadequate posterior rims (n=1), inadequate length of atrial septum (n=1), or lack of surgical back-up (n=1). In 1 patient the de- vice was unstable due to thin flail superior rim and was uneventfully retrieved out of the patient. The follow-up data review protocol is ap- proved by the IRB.
Results: The ASDs measured 5.6-29.5 mm (mean 14) by TEE and 8.7-30 mm (mean 17.7) by using the balloon stop-flow technique. The ASDs were occluded with ASO devices measuring from 8 to 36 mm and were delivered via 7 Fr to 12 Fr sheaths. The Qp:Qs was 0.9-4.5 (mean 1.8). One patient developed 3° A-V block requiring implantation of a pacemaker. There were no other major complications reported (no device dislodgment, no aortic perforation and no thrombus/vegeta- tion formation during follow-ups. Minor complications included ar- rhythmias (first and second degree atrioventricular blocks (n=7) and mild mitral (n=2) insufficiency detected by color Doppler echocardi- ography were transient and resolved after 15 months of follow-up. There was also transient trivial (n=13), or small (n=9) residual ASD shunt. There was a reduction of small shunts to trivial and trivial to no shunts after 15 months of follow-up. No recurrence of paradoxic embolism was observed in the 2 patients in whom the atrial defect was closed to prevent further episodes of cerebrovascular accidents and headaches.
Conclusions: This large, single-institution experience with long-term follow-up confirms the feasibility, safety, and effectiveness of Am- platzer device closure of the ASDs. Most of the ASDs, irrespective of type, shape, length, and diameter can be effectively closed with no major long-term complications.
#0102 ANTEROGRADEANDRETROGRADECATHETERIZATION WITH THE MINIATURE PRESSURE-WIRE MANOMETRIC SYSTEM: AN EXCELLENT ALTERNATIVE FOR DIAGNOSIS IN CYANOTIC CHILDREN
Renata Mattos, Luiz Carlos Simões, Fabio Bergman, Paulo Soares, Victor Hugo Oliveira
Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Introduction: Measuring intravascular pressures is crucial when studying congenital heart diseases. However, in children, conven- tional catheterization might be difficult due to tortuosity and size of the vessels. In cyanotic patients, the passing of a catheter through a shunt might lead to further cyanosis. We present our experience with the PressureWire Certus (St Jude Medical Inc) manometric system for diagnostic catheterization.
Methods: We studied 8 patients (pts) with cyanotic heart disease (mean age: 18 months and mean weight: 13kg). All procedures were performed under general anesthesia. All pts had univentricular phys- iology with a variety of associated conditions. 4 pts had Blalock-Tauss- ig shunts. All pts were supposed to undergo a Glenn procedure in the near future but, even with 4 French catheters, it wasn’t possible to access the pulmonary arteries. The miniaturized Pressure Wire system was the only way to get pulmonary pressure waves.
Results: We were able to acquire pulmonary pressures in all pts. The miniaturized system allowed easy passage through stenotic areas and aortopulmonary shunts without worsening of the cyanosis. There were no complications related to the procedure or the anes- thesia.
Conclusion: The miniature Pressure-Wire manometric system pre- sented itself as a good method for studying pts with complex cya- notic diseases in cases where access to pulmonary arteries was not possible by conventional means.
#0103
PERCUTANEOUS CLOSURE OF A PATENT DUCTUS ARTERIOSUS THROUGH THE JUGULAR VEIN IN A PATIENT WITH LEFT ISOMERISM
Renata Mattos, Luiz Carlos Simões, Victor Hugo Oliveira Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Introduction: Pediatric catheter intervention has evolved with new devices, new delivery systems and mainly with the experience of operators. Therefore, patent ductus arteriosus (PDA) is almost always closed percutaneously. We report a case in which we bypassed an an- atomic pitfall safely and effectively.
Case report: 14 months old girl presenting with tachipnea and low weight. Echocardiogram revealed a large PDA with left atrium and left ventricle overload. The inferior vena cava was not seen on subxy- phoid view. In the cath lab, we confirmed absence of the inferior vena cava and venous drainage of lower body through the azygous vein to the superior vena cava. Aortographies were performed to show and measure the ductus. Through the right jugular vein we easily ac- cessed the right ventricle, pulmonary artery, ductus and descending aorta. Over a stiff wire we introduced the Steer Ease 7 French sheath. We then delivered the Nit-Occlud PDA-R 7mm device. After the pro-
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111