Page 62 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
events due to rupture of aneurysmal vessel.1 About one third of total cases of the CAVF are from the left coronary system. The left ventricle is uncommon site of termination of CCF. 2
Methods: To analyse the course, dimensions of CCF and detailed coronary anatomy, CT angiogram was obtained on a 128 multi-slice computerized tomography scanner by Siemens. The fistulous tract was 11.3 mm in diameter through-out and narrowed to 9mm size just before its termination. The CCF had two elbows. The mouth of fistula was situated into the vicinity of posterior mitral valve leaflet and its tensor apparatus. A per-cutaneous tran-catheter closure with Am- platzer Vascular Plug II (St Jude Medical) was planned after analysis of findings and the review of literature. The location of mouth of CCF actually ruled out feasibility of an arterio-venous loop and deploy- ment of a device from the LV side. Therefore, an embolization device was thought to be more appropriate. AVPII has advantage of cross sectional coverage of fistula by controlled single device release due to its special design which includes multiple lobes and non-tapering ends. Coronary anatomy revealed, a right dominant coronary system hence the theoretical risk of compromising coronary circulation to in- ferior wall , was not an issue. The procedure was done under general anesthesia , in cath lab (Philips FD 10 System), under the guidance of fluoroscopy and trans –thoracic echo. The appropriate angled views (RAO 3-200 and Caudal angulation 15-340) were used for the visual- ization of transverse length CCF and its opening into LV. The left cor- onary artery (LCA) selective angiogram was taken with the help of a Judkin left coronary artery catheter (LCAC). Subsequently , LCAC was exchanged over the wire (0.035˝ x 260 cm Terumo exchange guide- wire, ‘J’ tip) with another 8 french Multipurpose braided guide cathe- ter . the wire was further secured by looping it into LV cavity. The wire was advanced into ascending aorta, arch and finally it was stationed into descending aorta , below the diaphragm. An AVP II (AVP2-016, 16 X 12 mm) was introduced with the help of the cable, under flu- oroscopy and ECG monitoring . After ascertaining the position and dye injection, the plug was embolized between two elbows of fistula (Figure-2). Post procedure angiogram showed insignificant whip of contrast. The AVP was released successfully. Post procedure coronary angiogram was normal.
Result: The Patient had chest discomfort transiently, in early post-pro- cedure period. On 6 months , follow-up, patient improved clinically and echocardiographically . There was no residual flow. Post proce- dure CT angiography revealed AVP in an appropriate position (Fig- ure-3).
Conclusion: We report a case where a CCF was detected on echocar- diography and CT angiography. The CCF was closed successfully with Amplatzer Vascular plug II. In best of our knowledge ,this is the first case of AVPII embolization used for percutaneous trans-catheter clo- sure of circumflex to left ventricle coronary –cameral fistula.
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FIRST EXPERIENCE WITH THE ABSORB BIORESORBABLE VASCULAR SCAFFOLD (BVS) IN CONGENITAL HEART DISEASE
Alejandro Rodriguez Ogando, Fernando Ballesteros Tejerizo, Jose Luis Zunzunegui
Gregorio Marañon, Madrid, Spain
Introduction: Children outgrow metal stents, obligating them to fu- ture transcatheter dilations and eventual surgical removal. A bioab- sorbable stent, or a stent that goes away with time, would solve this problem. The aim of our study is to describe our experience with BVS in the setting of different vascular lesions in children.
Methods: Clinical records, catheterization data, and operation notes of ten consecutive patients undergoing BVS implantation since July- 2013 were studied retrospectively.
Results: The patient´s median age was 11.2 months (14 days-11,6 years) and the median weight was 6.5 kg (2.3-48). The underlying vascular lesion was: Postoperative pulmonary vein stenosis in two patients; an anomalous infradiaphragmatic right pulmonary venous stenosis collector in a preterm infant; two hypoplastic left pulmonary arteries after Norwood procedure, one right coronary artery spasm in a William´s syndrome after percutaneous aortic valvuloplasty; one right lobar pulmonary artery in a Pulmonary Atresia after uni- focalization; one aortic arch coartation; and two renal arteries in the setting of mid aortic syndrome. Vascular stenting was achieved in all patients. Mean fluoroscopy time was 29 minutes. Based on the type of the lesion, vascular access was gained from the femoral vein(n=5), femoral artery(n=4) and one hybrid procedure through the dissec- tion of the right ventricular cavity. In 6 patients predilation of the vessel was performed. Stent´s size (mm) used were 3.5x12 (n=7), 2.5x12, 3x12 (n=2). In 7 patients, subsequent stent overdilation with coronary ballons, was neccesary to achieved the maximum diame- ter of the vessel. The angiographic result was satisfactory in all cases. No related complications and non acute obstruction were observed. Relief of the symptomatology was achieved in all cases in the acute follow-up: hipoxemia, ventricular dysfunction. A redilatation of stent was performed in one case, 71 days after implantation. Three patients underwent cardiac surgery (two on pulmonary veins, and one Glenn): 37, 76 and 94 days after stent implantation. At the time of surgery, stent structure was not found by the surgeon, and procedure was car- ried out without any difficulty.
Conclusion: Considering advances in percutaneous treatment of CHD, the biodegradable stents are already a reality, and BVS stenting is a reliable and safe alternative to angioplasty, metal stents, or surgi- cal approach in selected patients.
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EARLY EXPERIENCE OF CERAFLEX SEPTAL OCCLUDER: A MULTI-CENTRE STUDY
Brian McCrossan1, Kevin Walsh2, Andrew Sands1, Paul Oslizlok2 1Royal Belfast Hospital for Sick Children, Belfast, UK
2Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
Background: Concerns regarding cardiac erosion have spurred the development of more compliant atrial septal occluder devices, which theoretically may reduce the risk. We describe our early experience of the Ceraflex septal occluder (CSO).
Methods: Retrospective review of CSO device use at two tertiary units in Ireland over 12 month period.
Results: During the study 43 patients underwent cardiac cathteteri- sation in which CSO was deployed. Table 1 describes demographics and lesions occluded. The procedure was technically successful in 42 cases (98%) with excellent rates of residual flow. One CSO was recap-
19th Annual PICS/AICS Meeting Abstracts