Page 47 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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minutes (range 4.6-133 minutes). The mean follow up duration was 21 months (range 1-69 months). The early and mid-term success rate was 92.3% (36/39). In addition, there was no CAVB except 1 transient atrioventricular block which disappeared in the lab, within 5 minutes. There were 3 cases with major complications: in 1 patient, immedi- ate result was good but next day the device was embolized into de- scending aorta, which was retrieved the through femoral artery; in 1 patient there was moderate residual leak and hemolysis through the device; in 1 patient the device was entangled in chordae of tricus- pid valve during procedure. All 3 patients underwent surgical closure with no significant sequelae. There was no significant difference be- tween types of VSD.
Conclusion: In selected case, transcatheter closure of VSD using ADO is safe and effective alternative treatment option for surgical closure. Especially we have no case of CAVB. However, long-term result may be needed.
#0107
INTERATRIAL SEPTUM THICKNESS IN PEDIATRIC PATIENTS AND ITS IMPACT ON CLOSURE OF INTERATRIAL SEPTUM DEFECTS WITH SELF- CENTERING DEVICES
Sonia El Saiedi, Wael Attia
Cairo University, Cairo, Egypt
Aim: Some difficult ASD cases with deficient rims or large defects may require specific maneuvers to facilitate transcatheter occlusion of these defects with self centering devices. In our center we developed a modification of balloon assisted technique (BAT) for difficult ASDs to assist proper positioning of the device. Our aim was to demon- strate the efficiency of ASD closure with self-centering devices in chil- dren and its relation to the interatrial septal thickness.
Methods and results: Over 2 years, 65 patients with ASD secundum were referred for closure; from which 50 cases were suitable for tran- scatheter closure by transthoracic echocardiography during precath- eter evaluation. In this study the IAS thickness of different rims were lesser than previously published ranges. Ten difficult defects required assisted techniques, where 6 of them were successfully closed using the pediatric version of BAT using a small sized valvuloplasty balloon.
Conclusion: This is the first paper to consider the delicacy and the easier giving in of the IAS in pediatric interventions that involve the IAS in the form of stretchability due to high elasticity or tearing of the thin IAS. Though the results showed weak relation to IAS thickness yet studying a larger number of patients might help prove the concept of weaker IAS in childhood. Modifying present techniques for closure of IAS defects and adopting newer techniques has to be considered. In this study the IAS thickness of different rims were lesser than pre- viously published ranges (32).This difference can be explained by the fact that those patients had ASDs and were young in age. Agmon Y et.al.(14) found that age and body surface area (BSA) were significant- ly associated with IAS thickness (median: 6 mm; range: 2-17 mm). IAS thickness increased by 12.6% per 10 years of age (95% confidence interval: 9.0-16.4%) adjusting for sex and BSA, and increased by 7.0% per 0.1 m 2 BSA (confidence interval: 5.0-9.2%) adjusting for age and sex. They reported that age, sex, and BSA are responsible for 22.5% of the variability in IAS thickness. They concluded that IAS thickening is an age-associated process. Similarly, Galzerano D. et al., (1995) (18) re-
sults demonstrate that IAS thickness increases by age; no correlation exists between IAS thinning and age. They noted that at the time of ventricular end-systolic phase, the IAS thickness ranged from 4 to 13 mm (mean 6.7 ± 1.9 mm).On the other hand Schwinger ME et.al (32) reviewed results of 119 transesophageal studies to study the effect of age. They found that the thickness correlated weakly with the age of the patient. In the present work we could not reach any significant difference between the patients who needed assisting techniques and those who did not. To our Knowledge, this is also the first paper to consider the delicacy and the easier giving in of the IAS in pediatric interventions that involve the IAS in the form of stretchability due to high elasticity or tearing of the thin IAS. Though the results showed weak relation to IAS thickness yet studying a larger number of pa- tients might help prove the concept of weaker IAS in childhood
#0108
PATHWAY TO INDEPENDENT INTERVENTIONAL PRACTICE: UGANDA HEART INSTITUTE PEDIATRIC CARDIAC CATHETERIZATION
Sulaiman Lubega1, Twalib Aliku1, Peter Lwabi1, Sanjay Daluvoy2, Craig Sable3, Shakeel Qureshi4, Krishna Kumar5, Kanishka Ratnayaka3
1Uganda Heart Institute, Mulago Hospital, Kampala, Uganda 2World Children's Initiative, Menlo Park, Ca, USA
3Children’s National Medical Center, Washington DC, USA 4Evelina London Children’s Healthcare, London, UK
5Amrita Institute of Medical Science and Research, Kochi, Kerala, India
Background: Population statistics estimate 10,000 children are born each year with congenital heart disease in Uganda. Over the past de- cade, Uganda Heart Institute has developed a cardiovascular surgi- cal program. A complementary cardiac catheterization program was started in February 2012 with the aim of developing independent operation after five years of mentorship.
Methods: A biplane X-ray cardiac catheterization lab was built adja- cent to a new cardiovascular operating room. Uganda Heart Institute physicians, nurses, and technologists began training with govern- ment and non-governmental organization support toward indepen- dent operation. Innovative prospective five-year independence plan includes visiting in-country clinical service and training trips, encour- aging autonomy through targeted case selection (diagnostic, balloon pulmonary valvuloplasty, patent ductus arteriosus device closure), out-of-country training fellowships, and weekly telemedicine case discussion/mentorship sessions.
Results: Since inception, Uganda Heart Institute has performed 139 congenital heart disease catheterization procedures [diagnostic (57); balloon pulmonary valvuloplasty (28); patent ductus arteriosus de- vice closure (41); other (13)]. 24% are independent Uganda Heart Institute procedures (no international provider presence) with the goal of increasing each year [2013 (3); 2014 (17); 2015 (5months: 13)]. In-country clinical service and training trips have been conducted by five organizations [total n = 10; World Children’s Initiative (4), Gift of Life/Chain of Hope (4)] traveling with physicians, nurses, and technol- ogists. Uganda Heart Institute catheterization operators have trained at Amrita Institute of Medical Science and Research for 4 months observing and participating in 192 procedures. Weekly telemedicine
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111