Page 60 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
71.75 ± 44.17 and median, 71.83). The procedure time was compared to historic data obtained from patients who underwent similar proce- dures with AICE catheter. There was no statistical difference in time of procedure, despite initial learning curve with VICE.
Conclusion: The VICE catheter can be used safely in ASD/PFO closure in children and adult. It increases maneuverability by a self-locking capability allowing quick positioning and repositioning. The image quality appeared similar and the color quality was superior to AICE. The procedure time was similar despite initial learning curve. The VICE catheter can be an alternative option for imaging guidance in intracardiac interventions.
#0138
CLINICAL EVALUATION OF THE TOSHIBA 3D MULTI- MODALITY FUSION SOFTWARE APPLICATION IN CONGENITAL CARDIAC INTERVENTIONAL CATHETERIZATIONS
Shyam Sathanandam1, Mario Briceno-Medina1, Emily Hayes1, Adam Willis1, Ranjit Philip1, Andrew Kuhls-Gilcrist2, Jason Johnson1, Rush Waller1
1University of Tennessee, LeBonheur Children's Hospital, Memphis, TN, USA
2Toshiba America Medical Systems, Memphis, TN, USA
Background: The Toshiba, 3-D Multi-Modality Fusion Roadmap (3D-MMF) is a software application that enables overlay of previously acquired 3D-DICOM image data sets (vendor neutral) with live 2-D fluoroscopy images, to enhance 3-D anatomical reference. C-arm and table positioning is integrated with the 3-D reference image for automated tracking that aids procedure planning and catheter guid- ance. The objectives of this study was to determine the feasibility of performing multi-vendor 3D-MMF using 3-D datasets obtained from a either a Siemens® CT, GE® MR scanner or LCI or 3D-rotaional angi- ography (3DRA) using the Toshiba Infinix® system and to determine the differences in procedural radiation and contrast doses between 3DRA-Fusion, MR-Fusion and CT-Fusion during cardiac catheteriza- tions.
Methods: Catheterization data from matched patient groups under- going 3DRA-Fusion, MR-Fusion and CT-Fusion were reviewed. The radiation, contrast dose, anesthesia time, fluoroscopic time were compared including what was needed to obtain the CT or MR. Scores for the quality and utility of the 3D-fusion roadmap during the pro- cedure and clinician satisfaction were obtained from the operators and 4 qualified independent observers. Results: The 3DRA-Fusion (n=15), MR-Fusion (n=15) and the CY-Fusion (n=10) groups were well matched for age (mean 9.8, 10.2 and 11.1 years; p=0.39) and size (mean BSA 1.02, 1.08 and 1.2 m2; p=0.11). Patients in the MR-Fusion group compared to the CT-Fusion and 3DRA-Fusion groups had low- er indices of radiation exposure measured by fluoroscopy time (18 vs. 19.4 vs. 21.8 Minutes; p=0.04), total dose-area product (2454 vs. 5607 vs. 4101 cGy·cm2, p = 0.01), and total air kerma dose (499 vs. 806 vs. 654; p=0.01). There was also a significant reduction in contrast dose (2.7 vs. 5.9 vs. 4.9 mL/kg, p <0.001). Procedural time tended to be shorter in the MR-Fusion group (163 vs. 167 vs. 214 minutes; p <0.03) but anesthesia time was significantly longer (384 vs. 213 vs. 258 minutes; p <0.001). For clinical utility, 3DRA-Fusion had highest satisfaction scores (90%) among operators and independent observ- ers compared to MR-Fusion (82%) and CT fusion (84%).
Conclusions: It is feasible to perform multi-vendor, 3D MMF using the new Toshiba software with good clinician satisfaction scores. MR-Fu- sion helps reduce procedural radiation and contrast doses during congenital, cardiac, interventional catheterizations.
#0139
EXTRACARDIAC FONTAN FENESTRATION DEVICE CLOSURE: ACUTE RESULTS AND MID-TERM FOLLOW UP
Theodore Kremer1, Lyndsey Hunter1, Jodi Hundley2, Beth Price2, Saadeh Al-Jureidini1, Saar Danon1
1Saint Louis University, Saint Louis, MO, USA
2Cardinal Glennon Children's Medical Center, Saint Louis, MO, USA
Objectives: To evaluate the acute results and mid-term follow up of patients who have undergone device closure of an Extracardiac Fon- tan fenestration.
Background: A fenestrated Fontan is commonly performed as the fi- nal palliative surgery in single ventricle patients. In most cases these fenestrations are closed in the interventional catheterization labora- tory with various device types, allowing for improvement in oxygen saturations and eliminating the risk of paradoxical embolus. However, there is concern for long-term outcomes in these patients. Although there are several publications relating to device closure of Fontan fenestrations, we provide the experience of a single institution with comparatively longer term follow up in a larger number of patients.
Methods: A retrospective review of all patients who underwent at- tempt at device closure of a Fontan Fenestration at Cardinal Glennon Children's Medical Center/Saint Louis University was performed. Demographics, Fontan fenestration type, and procedural data were recorded, and medical records were reviewed for follow up data. O2 saturation and Fontan pressure pre and post fenestration closure were compared using a paired t-test.
Results: Forty-one patients were identified, one of which was not felt to be a candidate for fenestration closure, and of the remaining 40 patients, 31 (78.9%) had their fenestration closed with an Amplatzer Vascular Plug II and 9 (21.1%) were closed with the Amplatzer Septal Occluder. After device closure, the aortic saturation increased sig- nificantly by 8.8% (p<0.0001) and the conduit pressure did not sig- nificantly change (13.6 to 14.5 mmHg; p=0.061). The patients were followed for an average of 3 years (range 1 month to 6.4 years) after device closure. Mean transcutaneous oxygen saturation at follow-up was 96.1%. There was one procedural complication in which an AVPII embolized, was retrieved percutaneously, and then the fenestration was successfully closed. There was one patient who developed plastic bronchitis following device closure, but that was felt to be secondary to atrial septal restriction present prior to device closure, and symp- toms improved following surgical revision of the Fontan with atrial septectomy.
Conclusion: Device closure of Fontan fenestrations is a safe and effec- tive procedure resulting in increased aortic saturations with no signif- icant change in conduit pressure, with reassuring mid-term follow up.
19th Annual PICS/AICS Meeting Abstracts