Page 65 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
94
day 8. Procedures were either interventional (n=63) or non-interven- tional (n=20). Primary diagnoses were heterogeneous, but the ma- jority had complex intracardiac anomalies, and 43,4% had functional univentricular physiology.
Main indications for cardiac catheterization included: low cardiac out- put (51%), residual lesions by echo (25%) and persistent hypoxemia (13%). Twenty-seven children required extracorporeal cardiopulmo- nary support. Intervention procedures included: stent implantation (n=41), angioplasty (n=13) and vascular/shunt oclussion (n=11). Most of these interventions (67%) involved a recently created suture line. Ten catheterizations were associated with complications (acute renal failure, two stent migration, four arrhytmias and two superior cava vein perforations).There were no complications related to patient transport, and there was no procedural mortality. 31% of patients died during ICU postoperative period with an hospital discharge survival of 60%. Non-interventional catheterization (p=0,012), and extracorporeal cardiopulmonary support (p=0,025) were risk factors for death.
Conclusions: In our experience, transcatheter interventions can be successfully performed in the early postoperative period. Catheter- ism also allows undiagnosed residual lesions to be found which may have a positive impact on patient outcome. These procedures must be supported by a multidisciplinary team.
#0148
LONG-TERM OUTCOME OF COIL OCCLUSION IN PATIENTS WITH PATENT DUCTUS ARTERIOSUS
Irfan Levent Saltik1, Sezen Ugan Atik1, Reyhan Dedeoglu1, Kazim Oztarhan2, Selman Gökalp3
1Istanbul University Cerrahpasa Medical Faculty Pediatric Cardiology Department, ISTANBUL, Turkey
2Istanbul Kanuni Sultan Süleyman Investigation and Training Hospital, ISTANBUL, Turkey
3Bezmi Alem University Medical Faculty Pediatric Cardiology Department, ISTANBUL, Turkey
Objective: We aimed to evaluate the long term results of patients who underwent transcatheter closure of patent ductus arteriosus (PDA) using Cook detachable coils.
Methods: The records of 234 patients who underwent transcatheter closure of PDA using the detachable coils between 1996 and 2015 were reviewed. All patients underwent coil only occlusion until 2005. After 2005 when duct occluders became available, detachable coils were used only in elongated, some complex and small ducts. PDA was categorized according to the classification described by Kricheenko et al. All patients were followed up by color Doppler echocardiog- raphy at 24-48 hours, 1 month, 3 months, 6 months, 12 months and every 1-2 year after the procedure.
Results: Coil occlusion was attempted in 234 patients. Median patient age was 2.5 years (range, 10 months-39 years), median weight was 12 kg (range, 7-55 kg), and median PDA diameter was 2 mm (range, 1-4.3mm). The angiographic appearance of the ductus was type A in 124 (53%), type B in 16 (6.8%), type C in 18 (7.7%), type D in 98 (3.8%), type E in 54 (23.1%) and others in 13 (5.6%) patients (postoperative residual PDA in 9, residual shunt after umbrella occlusion in 3 and residual shunt after coil occlusion in 1). The catheter approach was
arterial in 176 (75.2%), venous in 36 (15.4%), a combination of arterial and venous in 22 (9.4%) procedures. The number of coils implanted in each procedure was 1 in 215 (91.9%), 2 in 15 (6.4%), 3 in 1 (0.4%) patients. Transcatheter coil occlusion procedure was successful in 229 patients (97.8%). In 5 (2.2%) patients, the coil occlusion was un- successful: detachable coil embolized in 2 patients (0.8%) and in 3 patients (1.2%) coil occlusion was abandoned after first attempt, as ducts were considered unsuitable for coil closure. In 1 patient hemo- lysis was observed after the procedure and resolved with additional detectable coil next day. Five infants had femoral artery occlusion, in 3 of them embolectomy was performed and 2 infants were treat- ed by heparinization and thrombolysis. Overall occlusion rate were 94.7% (217/229) on echocardiography at a median follow-up of 23 months (range, 1 day-17 years): 179/229 (76.5%) at the end of the procedure, and 183/229 (78.2%) at 24-48 hours post procedure. In most cases with residual shunt (23/29), spontaneous occlusion was observed in the first year, but not observed after 4 years. The latest documented time for residual shunt was 8.5 years.
Conclusions: Our results indicate that coil occlusion is an effective and safe procedure for patients with PDA. Small residual shunts tends to close spontaneously in first year, but may persist long time.
#0149
TRANSCATHETER
DECOMPRESSION
PULMONARY ATRESIA (PA) + INTACT VENTRICULAR SEPTUM (IVS) WITH SIGNIFICANT CORONARY SINUSOIDS (CS): IS IT SAFE?
Vikram Kudumula1, Marhisham Che Mood2, Hasri Samion2, Mazeni Alwi2
1East Midlands Congenital Heart Centre, Leicester, UK
2National Heart Institute, Kuala Lumpur, Malaysia
Introduction: Safety and outcome of transcatheter RVD procedure in infants with PA+ IVS with significant CS is not well described in the literature.
Aim: Evaluation of the transcatheter RVD procedure in patients with PA+ IVS with significant CS with emphasis on the safety and long term outcome.
Methods: Retrospective review of the database from February 2003 to February 2015.
Results: 11 patients with PA+IVS and significant CS had transcathe- ter RVD procedure. 7/11 patients had significant fistulous connection from right ventricule (RV) to both the right coronary (RCA) and left anterior descending (LAD) arteries, 2/11 patients had fistulous con- nections to only LAD and 2/11 patients had fistulous connection to only RCA. In 10/11 patients there was a good filling of left coronary artery (LCA) and RCA branches in aortogram and in one patient the LAD was extremely small distal to the fistula. Transcatheter RVD was achieved in all the 11 patients with the RV pressure decreasing from the median of 146 (range: 118-212)% to a median of 66 (range: 44-81) % of systemic blood pressure. Following the RVD, RV angiogram was done in 8/11 patients and none of them had any significant CS.
4/11 patients had procedure related complications. One patient with large CS to RCA and LAD with extremely small LAD distal to the fistu-
RIGHT (RVD) IN
VENTRICULAR INFANTS WITH
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111