Page 50 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
plant procedures without negatively impacting the function of the transcatheter valve. Small, constricted, and homograft conduits were found to be more prone to rupture.
fistulae from the internal thoracic arteries and mediastinal vessels of moderate intensity were embolized, resulting in a significant reduc- tion of these flows. Patient 3 was a 2-months-old male who had had biventricular failure after corrective surgery for tetralogy of Fallot and AVC. Left pulmonary artery hypoplasia was demonstrated.
Conclusions: Cardiac catheterization requires careful consideration of procedural location, transport, and vascular access. It can be per- formed safely on patients with ECMO support. Catheterization during ECMO enables the diagnosis and treatment of residual lesions, help- ing the improvement of the patient condition.
#0115
TRANSCATHETER THERAPY FOR ACUTE OCCLUSION OR CRITICAL STENOSIS OF EXTRACARDIAC CONDUITS AFTER FONTAN COMPLETION
Grace Bichara, Paulo Vasconcelos, Armando Mangione, Salvador Cristovao
Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, Brazil
Introduction: The extracardiac conduit has been largely used for com- pletion of the Fontan operation in children with univentricular hearts. Acute occlusions of this pathway are life threatening and need to be promptly recognized and treated to provide better chances of surviv- al in this population.
Method: We report the percutaneous therapy in three critically ill patients with evidence of acute obstruction of extracardiac con- duits. Patient 1 was a 3-year-old male with pulmonary atresia with intact ventricular septum. Patient 2 was a 5-year-old male with hypo- plastic left heart syndrome . Patient 3 was a 3-year-old female with double-outlet right ventricle and non-committed VSD. They had all undergone Fontan palliation and had all presented with abdom- inal pain, vomiting and low output syndrome symptoms at the ER. Thrombolytic therapy was attempted without success in one of them. Total occlusion of the fontan pathway beginning at the suprahepatic veins level was seen at the Cath Lab in all three cases. A 0.014 guide- wire was advanced through the occlusion in all cases and thrombus aspiration was performed in 2 of them. Stent placement into the con- duit was performed in all cases. Unobstructed flow into the conduit was achieved in all 3 cases. Patient 1 had a Palmaz genesis 2910 stent placed into the conduit and balloon angioplasty of the upper side of the conduit with the same 15x40mm Maxi-LD balloon. Balloon di- lation of the left pulmonary artery was performed with a 10x20mm powerflex balloon. He died after 5 days from hepatic failure and brain hemorrhage. Patient 2 had undergone stent implantation into the left pulmonary artery and the fontan pathway a couple of months be- fore. There was total occlusion of the fontan pathway where the stent was placed. Balloon angioplasty of the conduit stent was performed with a 12x20mm powerflex balloon and a Palmaz Genesis 1910 stent was placed in the junction of the conduit with the pulmonary artery. Patient 3 had a Palmaz Blue 7 x 18mm stent implantation into the left pulmonary artery and two Palmaz genesis 2910 stents were placed into the conduit. Both patients demonstrated rapid improvement in their clinical status after the procedure, were extubated at the same day and are doing well, asymptomatic, 18 months after the proce- dure.
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TRANSCATHETER
SINUS VALSALVA WITH LIFETECH SYMETRICAL PERIMEMBRANOZ VSD DEVICE
Kemal Nisli, Umrah Aydogan
istanbul medical faculty, istanbul, Turkey
13-year old female presented emercency room with chest pain when echocardiography performed sinus valsalva ruptured and moderated aortic insuffiency detected. When she was 4 years old operated from perimembranoz VSD. 7 days ago she presented emercensy room with chest pain. Echocardiography was shown 7 mm sinus valsalva rup- ture to Right ventricul and moderated aortic insuffiency. Ruptered valsalva was transcatheter closed with 10 mm Lifetech symetrical perimembranoz device. After the prosuder sinus valsalva rupture closed completely and aortic insuffiency decreased. In conclusion ruptered sinus valsalva can be treatment trancatheter symetrical per- imembranoz VSD device is an alternative to surgical treatment.
#0114
INITIAL EXPERIENCE OF CARDIAC CATHETERIZATION ON ECMO SUPPORT
Grace Bichara1, Marcelo Prado1, Paulo Vasconcelos1, Jose Pedro Silva1, Glaucio Furlanetto1, Carlos Tossuniam2, Armando Mangione1, Salvador Cristovao1
1Beneficicencia Portuguesa de Sao Paulo, Sao Paulo, SP, Brazil 2Hospital Sepaco, Sao Paulo, SP, Brazil
Background: Extracorporeal membrane oxygenation is an important support for the failing circulation. There are diagnostic and therapeu- tic indications for cardiac catheterization in children on ECMO.
Objective: To report our experience in patients who underwent cardi- ac catheterization on ECMO.
Case Reports: Four catheterizations were performed in 3 patients on ECMO. The main indication for cardiac catheterization was eval- uation for possible pathology amenable to transcatheter or surgical therapy (n = 3) and planned transcatheter intervention for known pathology (n = 1). Patient 1 had interrupted aortic arch, aortic arch hypoplasia and aortic valvar and subvalvar stenosis. He underwent a Damus-Kay-Stencel (DKS) procedure. He developed severe biventric- ular dysfunction and was subject to ECMO. Patient had not improved, which led to the takedown of the DKS, performing enlargement of the ascending aorta and PT banding. He failed several attempts of weaning from ECMO and was referred to a diagnostic catheteriza- tion that showed stenosis of the origin of the pulmonary arteries. The team decided to correct it in surgery but he had gotten worse and was sent to cath lab again after 4 days. Balloon angioplasty of the right and left pulmonary arteries were successfully performed. Patient 2 was a 3-year-old patient who had Hypoplastic Left Heart Syndrome and just had a Fontan completion with poor outcome. He had the Fontan takedown. Because of the deterioration of his hemo- dynamics and oxygenation status, ECMO support had begun. Patient was referred to the cath lab where collateral systemic-pulmonary
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19th Annual PICS/AICS Meeting Abstracts