Page 52 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
Background: The hands of interventional cardiologists receive high doses of scatter radiation due to their proximity to the X-Ray beam. Radiation attenuating gloves have about a 26% attenuation rate, but may reduce dexterity and tactile sensation. The UltraBLOXTM is a new FDA approved X-Ray attenuating cream that can be applied to the operator’s hands for radio-protection (Figure). The aim of this study was to evaluate the effectiveness of this cream during lengthy cardiac catheterization procedures in children.
Methods and results: Two nanoDotTM dosimeters were secured side by side on the dorsum of the operator’s (n=2) left hand close to the wrist. One dosimeter and the rest of the hand were covered with 0.2 mm layer of the cream. The other dosimeter was unshielded. Proce- dures were performed using 110 kVp fluoroscopy at 15 pulses/sec. Four time categories were analysed for differences in attenuation. The patients in all 4 groups were well matched for age and size. Pro- cedural and cumulative hand radiation doses were higher with lon- ger procedural duration. The overall % attenuation by the cream was 39.7% (28.6 - 51.5) and was not affected by the length of the proce- dure (median: 40.9% at 30 min and 41.4% at 180 min; p=0.66) or the dose of radiation. The kappa statistic for inter observer agreement for good tactile sensitivity was 0.82.
Conclusions: The UltraBLOXTM provides a new option for radio-protec- tion for the hands of interventional cardiologists without impairing tactile sensitivity. The attenuation afforded did not reduce up to 180 min.
Figure (A) UltraBLOXTM cream shielding the left hand. (B) Fluoros- copy of the operator’s hands: the left hand is shielded by the cream while the right hand is unshielded (C) The left hand is shielded by the cream; the right hand is shielded by a radiation attenuating glove.
#0119
ULTRASOUND-GUIDED FEMORAL ARTERIAL ACCESS IN PEDIATRIC CARDIAC CATHETERIZATIONS: PREVALENCE AND RISK FACTORS FOR ACUTE LOSS OF ARTERIAL PULSE - A PROSPECTIVE SINGLE CENTER COHORT STUDY
John Alexander1, Rush Waller1, Thomas Yohannan1, Vijayakumar Agrawal1, David Zurakowski2, Shyam Sathanandam1
1University of Tennessee, LeBonheur Children's Hospital, Memphis, TN, USA
2Harvard Medical School, Boston, MA, USA
Objective: The objectives of this study was to describe the prevalence of and identify risk factors for acute loss of arterial pulse (LOP) in chil- dren who had ultrasound guided femoral arterial access (UGFAA) during cardiac catheterization procedures.
Background: LOP is a known complication in children following arte-
rial access for cardiac catheterizations. The prevalence of LOP requir- ing treatment when UGFAA is not employed in ranges between 4% and 8% in most studies. Younger age has been the most consistent risk factor identified for LOP in most studies.
Methods: A prospective study was performed including 486 cardi- ac catheterizations using UGFAA in children (≤18 years) over a 20 months period. Ultrasound and Doppler evaluation were performed prior to and at the end of the procedure. Treatment was initiated for the presence of thrombus or with absence of Doppler pulsations an hour post-procedure. Multivariate analysis was performed to identify independent risk factors for LOP.
Results: LOP was identified in 33 cases (6.8%) with 23 (4.7%) requir- ing treatment. Femoral artery thrombus was diagnosed in 9 patients (1.8%). For children ≤ 6 months the incidence of LOP was 22% with 13.6% requiring treatment. Though Age ≤ 6 months and weight ≤ 5 Kg were strong predictors for LOP, a femoral artery diameter of ≤ 2.2 mm was the only significant independent predictor for LOP (OR = 3.8, 95% CI: 1.8 – 8.8, P = 0.002). Number of access attempts, time required for access, operator experience, sheath size, sheath exchanges, acti- vated clotting time, hemoglobin, cardiac output, procedure length, etc., were not found to be significant factors.
Conclusions: The overall incidence of LOP requiring treatment of 4.7% is similar to reports where UGFAA is not used. A femoral artery diameter of ≤ 2.2 mm was the only significant independent predictor for LOP in this carefully designed prospective study.
#0120
GROWTH CURVES FOR FEMORAL VEIN AND ARTERY IN CHILDREN UNDER FIVE YEARS OF AGE
Shyam Sathanandam1, Thomas Yohannan1, John Alexander1, Vijayakumar Agrawal1, Natasha Winders1, Rush Waller1, David Zurakowski2
1University of Tennessee, LeBonheur Children's Hospital, Memphis, tn, USA
2Harvard Medical School, Boston, MA, USA
Background: The femoral vein (FV) and artery (FA) are the most com- mon vessels used for catheter access in children. However, nomo- grams based on the sex, race, age or size of children are not avail- able at present. This knowledge, however, may be of fundamental importance for pediatric interventional cardiologists who use these vessels to perform complex interventions, requiring large catheter and sheath sizes. The objective of this study was to construct growth curves for FV and FA in children ≤ 5 years of age.
Methods: A prospective study was performed on 400 children with congenital heart diseases ≤ 5 years of age undergoing cardiac cath- eterization procedures over a 20 months’ period. Patients who had previous cannulation of these vessels were not included in this study. Ultrasound evaluation was performed under anesthesia just prior to obtaining access on both the right and left femoral vein and artery. The diameter and the cross sectional area of these vessels were mea- sured at a level just proximal to the bifurcation of the common FA. Regression modeling was applied to derive the growth curves based on quantile polynomial regression, which yielded good fit to the data judged by R-squared and the LMS transformation method was used to determine the smoothed percentile.
19th Annual PICS/AICS Meeting Abstracts