Page 66 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
la died immediately after the procedure with myocardial ischaemia. Other complications in remaining 3 patients include transient hypo- tension, bradycardia and contrast induced acute renal failure.
7/ 9 live patients were followed at a median duration of 15 (13-123) months following the RVD. All seven patients had good left ventricular function at the time of recent follow up. Two patients with recurrent sub pulmonary stenosis had CS seen in the follow up angiograms, which disappeared following the surgical RVOT reconstruction.
Conclusion: Transcatheter RVD in patients with PA+ IVS with signifi- cant CS is relatively safe procedure with good long term outcome. It is essential to exclude any stenosis or atresia of coronary arteries before embarking on RVD procedure.
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INVOLVEMENT OF SUBCLAVIAN ARTERY INTO A SEVERE COARCTATION, IS IT A CONTRAINDICATION FOR STENTING?
Manuel Acuna Fernandez, Carlos Garcia, Asdrubal Alfonzo, Gonzalez Karina, Jesus Montero
Venezuelan Institute Of Social Security.hospital Perez Carreno & Hlo, Caracas, Venezuela
We describe a case of severe coarctation with subclavian artery in- volvement of a 22 years old symptomatic female referred to our cen- ter for endovascular resolution. She was under losartan, amlodipine, diuretics and beta blockers with mild response to medical treatment.
For admittance her BP was 180/100 mmHg and a soft pan systolic murmur was heard on left sternal border and between the spine and left scapula. Absence of pulses on inferior limbs was markedly noted.
Prior to angiography a CT contrast scan with 3d reconstruction was performed and details of anatomy and collaterals were discussed with the cath lab crew. After review of all data an endovascular pro- cedure was planned.
The case was done under general anaesthesia without pacing. Ad- equate stent deployment under balanced general anaesthesia, with remifentanil and sevoflurane was given. The main purpose was to induce a relative decrease of 20-25% of baseline BP values with he- modynamic stability, until the release of the stent. Controlled hypo- tension was carried out, increasing the dose infusion of remifentanil and propofol bolus of 50 to 75 mg .
Non significant residual gradient was detected and flow to left sub- clavian artery was normal .
Involment of left subclavian artery into a severe coarctation is infre- quent but it is an issue of concern.
These techniques helped to leave the non covered part of stent´s struts at the edge of coarctation, and where the clue for safe coarcta- tion relief and keep adequate flow to LSA.
Control CT scan one month after the procedure confirmed postop findings.
LSA involvement not should be considered an absolute contraindi- cation for coarctation stenting. Team work is essential for adequate stent deployment on these cases.
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USE OF 3D ROTATIONAL ANGIOGRAPHY (3DRA) IN HYPOPLASTIC LEFT HEART SYNDROME (HLHS) AFTER NORWOOD I OPERATION: UNMASKING AND TREATING COMPLEX STENOSIS NOT DETECTED BY BIPLANE ANGIOGRAPHY
Mirella Molenschot, Hans Breur, Gabrielle Iperen, Van, Gregor Krings
University Medical Center Utrecht, Utrecht, The Netherlands
Background: In patients with hypoplastic left heart syndrome (HLHS) severe deterioration can occur after Norwood I operation (NWI) based on AP shunt underperfusion or aortic arch stenosis. Best vi- sualization of the substrate is crucial. 3DRA at start-up can unmask complex substrates not visible by biplane angiography and guide the interventional approach.
Methods: We retrospectively studied our patients with HLHS and severe deterioration who underwent heart catheterization (Cath) between May 2013 and May 2015 and analysed procedural and epi- demiological data. 3DRA was used when the hemodynamic problem could not be identified with biplane angiography.
Results: (numbers represent median (min-max)). 6 patients were included with a weight of 4,1 kg (3,5-4,7) and age 43 days (8-92) at Cath which was performed 33 days (2-85) after NWI. Procedure time was 121 min (97-232). 3DRA required rapid pacing of the ventricle between 200 to 250/min. The entire morphology was visualized in one run using 16 ml (11-26) of contrast (Iohexal 300mg/ml). 3DRA dose area product (DAP) was 29 uGum2 (19-60) compared to a total procedural DAP of 444 (80-544) corresponding to 8,2% (3,6-40,3). In all 6 patients the substrate was not or not sufficiently visible on the initial biplane angiographies. After 3D reconstruction virtual angula- tions and segmentation technique delineated the complex substrate. In 3 patients the AP-shunt was stented. 1 patient underwent stenting of the neo-aortic-arch. In 1 patient the AP-shunt and in another the aortic arch were balloondilated. No 3DRA related complications oc- curred.
Conclusion: 3DRA can be performed safely in critical ill patients af- ter NWI. A single 3DRA run does visualize the entire topography and delineate shunt related stenosis and neo-aortic-arch substrates. 3D reconstruction enables virtual angulations not achievable by biplane angiography. Substrates would have been missed or misunderstood by the use of biplane angiography only. 3DRA radiation dose and contrast amount are low. Multiple angulated biplane angiographies with high amount of contrast and radiation can be avoided. 3DRA road mapping shortens procedure time and adds safeness.
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SHORT TERM OUTCOMES OF PATENT DUCTUS ARTERIOSUS CLOSURE WITH NEW OCCLUTECH DUCT OCCLUDER: A MULTICENTER STUDY
Sezen Ugan Atik1, Meki Bilici2, Fikri Demir2, Fadli Demir3, Onur Çaglar Acar4, Olgu Haliloglu5, Aysenur Pac6, Alev Kiziltas7, Duran Karabel8, Serdar Kula9, Derya Çimen10, Osman Baspinar11, Irfan Levent Saltik1
1Istanbul University Cerrahpasa Medical Faculty Pediatric
19th Annual PICS/AICS Meeting Abstracts