Page 54 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
TRANSESOPHAGEAL ECHOCARDIOGRAPHY EVALUATION OF ATRIAL SEPTAL DEFECTS IMPACTS THE CATHETERIZATION PROCEDURE
George Nicholson, Morgan Whelchel, Ritu Sachdeva, Michael Kelleman, Dennis Kim, Robert Vincent, Christopher Petit Emory University/Children's Healthcare of Atlanta, Atlanta, GA, USA
Introduction: Percutaneous closure of atrial septal defects (ASDs) is reliant on appropriate anatomy, traditionally evaluated by both transthoracic and transesophageal echocardiography (TTE and TEE respectively). The inherent discrepancy between TEE and TTE has been incompletely described.
Methods: The primary objective of this study was to examine instanc- es in which more than one ASD device was attempted prior to pro- cedural completion to determine discrepancies between TTE and TEE assessment. In addition to overall ASD dimension, the following ASD rims were measured: inferior, posterior, anterior-inferior, anterior-su- perior (ie retroaortic), superior, and right upper pulmonary vein. The ratio of the device left atrial (LA) disc diameter to overall defect diam- eter (by TEE) was noted for each case.
Results: 116 patients underwent a pre-procedure echocardiogram. A total of 18 patients had >1 ASD device attempted prior to procedur- al completion, with 4 patients having different device type (Helex to ASO, eg) and 14 patients having similar device type, but different size. All patients had only a single ASD and therefore no patient had more than one ASD device implanted at procedural completion. In com- paring TTE to TEE rim measurements for the entire cohort, the right upper pulmonary vein rim (p=0.02) and posterior rims (p=0.02) were larger on TEE by 25.7% and 10% respectively. On the other hand, the anterior inferior (p=0.01) and inferior (p<0.01) rims were smaller by 13.4% and 17.2% on TEE. However, the overall defect size was com- parable between TTE and TEE (p=0.79). Interestingly, there were no significant differences in individual ASD rim assessment between TTE and TEE in those cases where >1 ASD device was attempted. In cases with >1 ASD device attempt, the ratio of the initial LA disc to defect size was smaller at 1.91, compared with 2.27 for the cohort with only a single ASD device attempt. Ultimately, the cohort with >1 ASD device had a final ratio of 2.24.
Conclusion: Careful pre-assessment should be undertaken with the understanding that TEE provides a more reliable evaluation of atrial septal anatomy. Importantly, pre-procedural counselling should take into account an expected discrepancy between the two imaging modes and the potential procedural impact on ASD device occlusion.
#0124
IDENTIFYING GAPS IN TECHNOLOGY FOR CONGENITAL INTERVENTIONS: ANALYSIS OF A NEEDS SURVEY FROM CONGENITAL INTERVENTIONAL CARDIOLOGISTS
Kamel Shibbani1, Damien Kenny2, Doff McElhinney3, Ziyad Hijazi4, Tim Moran5
1Lieber Institute for Brain Development, Baltimore, Maryland, USA 2Rush Center for Congenital and Structural Heart Disease,
Chicago, Illinois, USA
3Stanford University School of Medicine, Stanford, California, USA
4Weill Cornell Medical College, Doha, Qatar 5Pediaworks, Cleveland, Ohio, USA
There is an evolving need for modification and development of devic- es and equipment dealing with congenital heart lesions. We carried out a device-needs survey to evaluate gaps in device and equipment availability inside and outside the US. The survey was sent out via e-mail to members of the CCISC and the SCAI with a reach of over 350 congenital interventionalists. The survey consisted of 16 questions. Responses were received from 68 cardiologists in 8 countries, 90% from inside the US. In terms of the most desired devices, 25 respon- dents (37%) ranked bioresorbable stents as their first choice from a list of 12 possible devices. Similarly, 14 participants (21%) ranked large covered stents as their first choice. Respondents predicted that annual bioresorbable stent usage for pulmonary artery stenosis and aortic coarctation is expected to average at 27 and 20 stents per year respectively and 82% of participants indicated the most commonly required bioresorbable stent diameter to be between 6-10mm.Biore- sorbable stents for coarctation were expected to be larger, with 40% of participants suggesting the most commonly used bioresorbable diameter to be 10mm. For PDA stenting, 71% participants indicated a required stent diameter between 4 and 6mm, and 32% of respon- dents identified a preferable stent length of 20mm.Bioresorbable materials, nitinol and stainless steel were equally identified by in- terventional cardiologists. 64% of all participants reported that a 4 Fr sheath size as the maximum size desired for PDA stenting. As for covered stents, 33% of all respondents indicated the maximum di- ameter for a large covered stent as 30mm with the most requested length being 40mm (36%). The number of large covered stents need- ed annually at different institutes varied from 0-40 with the highest numbers being 10 stents per year (26%) followed by 20 and 40 stents per year (11% each). Participants were also asked which new or mod- ified device would affect the greatest number of their patients with results outlined in Fig1. These data clearly point towards a need for the development/approval of pediatric bioresorbable stents, and the need to approve the use of large covered stents in the pediatric age group in the USA.
#0125
PERCUTANEOUS
INSERTION ON RCA IN ASYMPTOMATIC 11 YEAR-OLD CHILD WITH 3 CORONARY VESSELS STENOSIS AFTER KAWASAKI DISEASE
Seokwon Huh, Se Yong Jung, Nam Kyun Kim, Jo Won Jung, Jae Young Choi
Severance Hospital, Seoul, Republic of Korea
ANGIOPLASTY
AND STENT
19th Annual PICS/AICS Meeting Abstracts