Page 53 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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Results: Growth curves were constructed for the diameter and CSA of the FA and FV against patient age and body surface area (BSA). Dis- tinction for sex and race was not made secondary to the small sample size. Only the right femoral vein and artery was used for analysis. The Figure below illustrates the findings.
Conclusions: It is now possible to predict the normal diameter of the femoral vein and artery, and these nomograms may help with plan- ning an interventional procedure. Future studies with larger sample size may be useful.
in evolution. Transcatheter procedures are commonly required and contribute for the success of the palliation. Most commonly we have performed diagnostic catheterizations and interventions after the second-stage of the treatment, preparing the patient for the Fontan procedure.
#0122
CONTINUOUS DIALYSIS DURING INTERVENTIONAL CARDIAC CATHETERIZATION IN PEDIATRIC PATIENTS WITH SEVERE RENAL FAILURE
Angeline Opina1, Sarah Swartz2, Ewa Elenberg2, Athar Qureshi2, Henri Justino2
1Baylor College of Medicine/ Texas Children's Hospital, Houston, TX, USA
2Texas Children's Hospital, Houston, TX, USA
Introduction: Interventional catheterization (cath) may be needed for pts with severe renal failure requiring dialysis. In these pts, long complex caths pose a challenge due to high contrast load and risk of electrolyte disturbances and fluid overload. There are no reports of continuous renal replacement therapy (CRRT) or peritoneal dialysis (PD) during caths.
Methods: retrospective review of intra-procedural CRRT or PD during caths from 2013-15.
Results: 4 pts in severe renal failure (3 in chronic renal failure; 1 in acute renal failure with concomitant chronic liver failure) were de- pendent on CRRT (n=3) and PD (1). 3 had systemic vein thromboses referred for recanalization & stenting, of which 2 were being denied renal transplantation due to severe and widespread venous throm- boses. 1 had aortopulmonary collaterals referred for embolization, which were precluding listing for liver transplant. CRRT (3) and PD (1) were performed with dialysis team present in cath lab throughout the entire cases. Median (range) weights and ages were 36 (11.4-62.6) kg and 8.5 (8 months-17 years) yrs. Procedure time was 474 (220-651) min, and fluoroscopy time was 111 (65-142) min. Total contrast dose was 4.7 (3.5-7.9) cc/kg. Intended cath interventions were successful in all 4. 1 pt had cath complications (vena cava tear and liver hemato- ma, both successfully treated). There were no complications related to CRRT or PD, and no contrast or fluid-related complications. All 3 pts needing transplants were listed after interventional cath, and all 3 received organs, of which 1 died after renal transplant.
Conclusion: Pts with severe renal failure and significant cardiovascular morbidities need not be denied complex interventional caths due to concerns regarding fluid-overload or contrast-related complications. In some pts, listing for organ transplantation may be dependent on ability to perform a cath intervention. Radiographic contrast is freely dialyzable using CRRT or PD, and both modalities can be instrumental in removing excess fluid administered at cath, especially in anuric pa- tients. We demonstrate safety and feasibility of performing long and complex cath procedures while providing intra-procedural CRRT or PD, even in young children. Close collaboration between nephrology, cardiology, and the dialysis team is necessary for management of this challenging patient population.
#0121
9 YEARS
HYPOPLASTIC LEFT HEART SYNDROME CARDIAC CATHETERIZATION
Grace Bichara, Paulo Vasconcelos, Jose Pedro Silva, Luciana Fonseca, Glaucio Furlanetto, Beatriz Furlanetto, Armando Mangione, Salvador Cristovao
Beneficencia Portuguesa de SP, Sao Paulo, SP, Brazil
Introduction: Hypoplastic left heart syndrome (HLHS) patients are more likely to have catheter interventions as the prognosis of this condition has improved over the years. Various transcatheter pro- cedures can be performed in order to access the hemodynamic and morphological status and to ameliorate the patient condition. We reviewed our institutional experience of transcatheter cardiac cath- eterization in HLHS patients.
Methods: Retrospective review of all HLHS patients who underwent cardiac catheterization since 2006 in our institution.
Results: A total of 273 operations were performed in 162 patients with HLHS. Forty percent of those patients (66 patients) had a total of 209 transcatheter procedures (diagnostic or therapeutic). Twenty pro- cedures were performed after the first stage of palliation (post-nor- wood) (9.5%), at the mean age of 7.4 ± 3.6 months, 139 were after sec- ond-stage (post-Glenn) (66.5%) at the mean age of 2.2 ± 1.6 years and 50 procedures were after third-stage (post-Fontan) (24%) at the mean age of 6.3 ± 3.2 years. Procedures were more commonly performed in patients after second-stage (66.5%) compared to patients after oth- er stages (P = 0.016). Similarly, interventions were more commonly required in patients after second-stage (65.3%) (P = 0.042). Fifty-two patients (78.9%) needed 78 therapeutic interventions. Interventions performed included collaterals arteries embolization= 64%, pulmo- nary arteries stents = 18%, venovenous channels embolization= 4%, balloon PA angioplasty = 4%, aortoplasty using balloon or stent = 4%, stent or balloon fenestration opening = 2%, occlusion of fenestration = 2%, venous system stent placement = 2%. Median number of pro- cedures/patient was 3.16 ± 1.88 (range 1-10). Median number of in- tervention/patient was 1.5 ± 1.3 (range 1-5). Most of the procedures (72%) were performed after 2010.
Conclusion: The optimal treatment of patients with HLHS is a process
SINGLE-CENTER
EXPERIENCE IN
#0123 DISCREPANCY
BETWEEN
TRANSTHORACIC AND
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111