Page 55 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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Kawasaki disease is an acute vasculitis of childhood that affects the coronary arteries and has rare long-term complication of coronary aneurysm stenosis. We report a case of patient, who had giant cor- onary aneurysms and stenosis of 3 coronary arteries and undergone PTCA and stent insertion on RCA. This 4 years-old boy transferred to our hospital for aggravating coronary aneurysms with diagnosis of Kawasaki disease. He did not show any clinical symptoms such as fe- ver and chest pain. Normal sinus rhythm and no ST segment change were presented on electrocardiography (ECG) and also no significant finding on Tc-99m myocardial SPECT (MIBI) study was showed. On the initial coronary angiography, multiple fusiform aneurysms in RCA and proximal giant aneurysm (diameter 12mm) in proximal LAD were found (Figure 1). He has taken anticoagulant medications (Warfarin, Clopidogrel) and regular ECG, echocardiography, chest radiograph were followed up from diagnosis of Kawasaki disease. Subtotal occlu- sion of proximal LAD were detected on the heart computed tomog- raphy (CT) 4 years after diagnosis. Close observation was decided, be- cause he had no coronary symptoms, normal ECG finding, uneventful result in the tread-mill test and well-developed collateral vessels of the coronary arteries were seen in the coronary angiography. When he was 12 year-old 8 years after diagnosis, scheduled heart CT re- vealed total occlusion in the proximal giant aneurysm of the LAD, and aggravated stenosis and calcification in the middle portion of RCA, LCX and massive collaterals inter-coronary arteries. Similar finding were also found in the coronary angiography (Figure 2). Coronary by- pass surgery was excluded because of high possibility of re-stenosis in the bypass graft by suggestion of cardiac surgeons. Finally he un- derwent percutaneous coronary ballooning and stent implantation (3.5mm *15mm) on stenotic part of RCA (Figure 2). After intervention, ECG showed normal sinus rhythm and echocardiography showed no regional wall motion and heart CT revealed relief of intraluminal ste- nosis in the middle RCA with pseudoaneurysm formation (Figure 3). In patient with multiple coronary aneurysms after Kawasaki disease, progressive coronary stenosis is a challenge to pediatric cardiologist. Cardiac intervention can be an optimal choice in such patient but Multidisciplinary approach should be considered in the management of multiple coronary stenosis in children.
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INITIAL AND MEDIUM-TERM RESULTS OF BALLOON VALVULOPLASTY OF CRITICAL PULMONARY STENOSIS: A SINGLE CENTER EXPERIENCE
Gehan Alsawah, Mona Hafez, Mohamed Matter, Hany Abo-Hadeed, Hala Almarsafawy
Children's Hospital, Mansoura university, Mansoura, Egypt
Background: Critical pulmonary valve stenosis (CPS) represents an emergency, and immediate treatment is mandatory. CPS is a duc- tus-dependent CHD because the open ductus arteriosus supplies pulmonary circulation. Balloon valvuloplasty (BVP) is now the first therapeutic option.
Objective: Here, we present our mid-term results in Pediatric Cardi- ology Unit, Children Hospital, Mansoura University in percutaneous balloon pulmonary valve valvuloplasty (PBV) in cases of critical pul- monary stenosis (CPS) in the period from 2005 to 2013 to assess the safety and efficacy of transcatheter intervention for critical pulmo- nary stenosis.
Method: Between April 2005 to June 2013, all consecutive patients
with CPS treated with balloon valvuloplasty in our hospital were an- alyzed retrospectively. Patients were followed up from 18 months to 8years (mean 64.8 months [5.4years]) by clinical examination and echocardiography.
Result: Sixty four consecutive patients were analyzed. Their gestation- al age was 38.63±1.48 weeks. Eight patients (12.5%) were preterm newborn. Postnatal age 15.5 ± 7.6 days, range 4-35 days). Weight 3.06±0.3 Kg. 58.5 % was male and 41.5 % was female. Fifty-two of patient (81.2%) received PGE1 infusion before the procedure to main- tain the ductal patency in a dose of 0.05 to 0.1 μg/kg/min. Balloon valvuloplasty was accomplished in 61 (95.3%) of 64 interventions. The procedural success, early outcome, complication rates, midterm results and pulmonary regurgitation were retrospectively stud- ied. Pre-dilatation by Brio coronary balloon was used in 18 patients (28.1%) followed by TAYSHAk® mini balloon. TAYSHAk® mini balloon was used from the start in 46 patients (67.1%) with balloon annulus ratio 1.3. Arterial oxygen saturation elevated from (67.5±8.5%) to (91.4±4%). Peak-to-peak pressure gradient across the valve fell from (94.5 ± 15.0) to (27.6 ± 12.0) (P<0.001). Right ventricular pressure fell from (111.5 ± 18.0) mmHg to (46.5 ± 12.5) mmHg (P < 0.001). The ratio of right ventricular pressure and aortic pressure fell from 1.87 ± 0.21 to 0.45± 0.4 (P < 0.001). Prostaglandin E was continued because the right ventricle showed a dynamic infundibular pulmonary steno- sis in 4 patients, Prostaglandin was discontinued 3-4 days later and the PDA closed spontaneously in all. Propranolol was started to treat secondary infundibular obstruction in 15 patients for 3-4 months. Two patients had very difficult pulmonary valve cannulation with the wire due to severe TR severe RVH so, PDA stent was inserted in each to maintain pulmonary circulation. Six months later, both patients underwent successful balloon pulmonary valvuloplasty. Two pa- tients lost follow up. Echocardiography on follow up revealed a mean trans-pulmonary systolic gradient of <30 mmHg, trivial to grade I pul- monary valve regurgitation, and in the short axis the ventricular sep- tum was convex, confirming infra-systemic RV pressure in 55 patients (85%). On follow-up five children (7.8%) required a second balloon dilatation with good results.
Conclusion: Balloon pulmonary valvuloplasty is relatively safe and ef- fective in neonatal CPS. It may be associated with a lower morbidity and mortality than surgical treatment.
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THE ROLE OF CATHETER INTERVENTION FOR ADULT PATIENTS WITH SINGLE VENTRICLE PHYSIOLOGY Kenji Baba1, Maiko Kondo1, Yoshihiko Kurita1, Takahiro Eitoku1, Yuusuke Shigemitsu1, Kenta Hirai1, Yuusuke Fukushima1, Shunji Sano2, Shin-ichi Ohtsuki1
1Pediatric Cardiology,Okayama University Hospital, Okayama, Japan
2Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
Background: Little data is available on efficacy of catheter interven- tion for adult patients with single ventricle physiology.
Methods: We retrospectively reviewed all patients over 20 years old who underwent catheter intervention (CI) for single ventricle phys- iology at our institution between January 2005 and December 2014.
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111