Page 57 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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SUCCESSFUL CLOSURE OF AN APICAL MUSCULAR VSD USING AMPLATZER DUCT OCCLUDER II DEVICE ON POSTOPERATIVE PATIENT ON ECMO
Levent Saltik2, Reyhan Dedeoglu1
1Department of Pediatric Cardiology, Istanbul University, Cerrahpasa Medical Faculty, istanbul, Turkey
2Anadolu Medical Center, istanbul, Turkey
Residual ventricular septal defects (VSDs) following cardiac surgery are not uncommon and were defined as haemodynamically signifi- cant and surgically remediable lesions present after surgeryVenoar- terial extracorporeal membrane oxygenation (ECMO) is the most potent form of acute cardiorespiratory support available and enables complete relief of cardiac workload.
We describe the successful closure of an apical muscular VSD using Amplatzer Duct Occluder II (ADO II) device on postoperative patient on ECMO
A 5year-old patient, weighing 12 kg, had presented with having dif- fuculties in weaning from cardiopulmonary by-pass after surgery for VSD closure and pulmonary conduit attached to the sistemic ven- tricule. Preoperative Echocardiography revealed mesocardia, correct- ed transposition, multipl VSDs, mitral valve insufficiency, pulmonary valve stenosis. At operation VSDs were closed and conduit placed be- tween pulmonary artery and the left ventricle (LV). After surgery child could not be weaned off bypass and ECMO was initiated for cardiac support Echocardiogram revealed one moderate apical VSD.There was a significant systemic ventricule volume overload. Because of the apical location of the VSD, the patient was taken up for a device clo- sure on ECMO.Cardiac catheterization was performed from left femo- ral artery and vein. A left ventricular angiogram and transesophageal echocardiogram were done. We chose to use the 6/6 ADO II device for VSD closure. Echocardiography showed the device optimally placed with minimal residual flow. The child could be extubated in 36 hours and was discharged in a stable condition at 1 week. The aim of car- diac ECMO is to profoundly unload the heart and decrease its work, Significant residual leaks may occur after repair of any type of VSD. Postoperative patients with residual VSD will not recover until these defects are addressed surgically or percutaneously. Percutaneous closure is less invasive and may be preferable. Hence, we thought of ADO II because of its better profile.
describe cardiovascular complications of Histoplasmosis in children.
Methods: We performed a retrospective review over a 5 year period between 2009 and 2014. Patients who had a diagnosis of Histoplas- mosis during childhood and developed cardiovascular sequelae were included in the study.
Results: We identified 15 children (12 female and 3 male) with cardio- vascular manifestations. The median age at presentation was 15 years (IQR: 13-16 years). The chief presenting symptom included chest pain in 5, shortness of breath in 5, fatigue in 4 and upper respiratory tract symptoms in 1. The diagnosis of histoplasmosis was confirmed either by antigen, IgM antibody testing or through biopsy. Six children had a hemorrhagic pericardial effusion at presentation requiring pericar- diocentesis, 2 of whom progressed to develop bilateral pulmonary artery stenosis requiring stent implantations. The remaining had cal- cified granulomas that caused a mass effect leading to stenosis in the right pulmonary artery (RPA) in 5, left pulmonary artery in 2, superi- or vena cava in 1, descending thoracic aorta in 1 and the pulmonary veins in 3. The interventions included angioplasty in 5 children, 10 stents implanted in 6 patients and 3 patients required resection of a mediastinal mass. In one patient who was left untreated till adult- hood, a stenosis in the RPA could not be resolved by angioplasty or stent implantation. Two children have mild vascular stenosis that have not yet required intervention.
Conclusions: Fibrosing mediastinitis secondary to Histoplasmosis in children is a rare finding. Complications may require aggressive in- terventions. It may be feasible to perform balloon angioplasty and/ or stent implantation to treat vascular stenosis. Refractory stenosis or airway compression may require surgery. Hemorrhagic effusions of an unknown etiology require close follow-up as fibrosing mediastini- tis may present at a later date.
#0131
CARDIOVASCULAR
HISTOPLASMOSIS IN CHILDREN: REPORT FROM A SINGLE CENTER IN AN ENDEMIC REGION
Michael Perez1, Mario Briceno-Medina1, Rush Waller1, Emily Hayes1, David Zurakowski2, Shyam Sathanandam1
1University of Tennessee, LeBonheur Children's Hospital, Memphis, TN, USA
2Harvard Medical School, Boston, MA, USA
Background: Histoplasmosis is endemic to the Mississippi river valley. Fibrosing mediastinitis is a rare complication that may lead to thorac- ic vascular stenosis, compression of the airways and pericarditis. It is an indolent process leading to sequelae that usually present in adult- hood. Rarely, it manifests in children. The aim of this study was to
COMPLICATIONS OF
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EXPERIENCES
SELECTIVE PULMONARY VASODILATORS AFTER THE TRANS-CATHETER CLOSURE IN ATRIAL SEPTAL DEFECT WITH PULMONARY ARTERIAL HYPERTENSION Lucy Eun, Nam Kyun Kim, Jae Young Choi
Yonsei University Severance Hospital, Seoul, Republic of Korea
Background: The clinical course of patient with transcatheter closure of atrial septal defect (ASD) with pulmonary arterial hypertension (PAH) has not been completely understood. Variable pattern of the disease progression and the severity of disease in similar underlying defects may be the important factors to predict the clinical outcome.
Methods and Results: From May 2006 to June 2012, 457 patients underwent transcatheter closure of ASD. Among them, 68 patients had PAH at the time of procedure. PAH was classified as mild (40- 49mmHg), moderate (50-59mmHg), severe (above 60mmHg) accord- ing to pulmonary artery systolic pressure (PASP). We reviewed the course of the PAH and complications in these subjects. In mild PAH group (n=37), thirty two patients had normalization after the tran- scatheter closure of ASD, and the remained patients had normaliza- tion within 1 month. In moderate PAH group (n=17), thirteen patients showed normal PA pressure after closure of ASD, and 4 patients nor- malized within during follow-up. In severe PAH group (n=14), there was no patient who showed immediate normalization after tran-
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Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111