Page 67 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
96
Cardiology Department, Istanbul, Turkey
2Dicle University Medical Faculty Pediatric Cardiology Department, Diyarbakir, Turkey
3Cukurova University Medical Faculty Pediatric Cardiology Department, Adanaa, Turkey
4Derince Training and Research Hospital, Kocaeli, Turkey,
5Mersin University Medical Faculty Pediatric Cardiology, Mersin, Turkey
6Ankara Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
7Baskent University Medical Faculty Pediatric Cardiology Department, Ankara, Turkey
8Osman Gazi University Medical Faculty Pediatric Cardiology Department, Eskisehir, Turkey
9Gazi University Medical Faculty Pediatric Cardiology Department, Ankara, Turkey
10Selçuk University Medical Faculty Pediatric Cardiology Department, Konya, Turkey
11Gaziantep University Medical Faculty Pediatric Cardiology Department, Gazi Antep, Turkey
Background: The Occlutech duct occluder (ODO) is a new self-ex- panding nitinol device with a shape that is reminiscent of a “cham- pagne cork”. Its body is wider at the pulmonary artery end than the aortic end and has no distal protruding hub. It is available in longer lengths than the Amplatzer duct occluder.
Objective: We aimed to evaluate the characteristics and short term results of patients who underwent transcatheter closure of patent ductus arteriosus (PDA) using the ODO.
Methods: We reviewed the clinical records of 59 patients from differ- ent centers in Turkey, who underwent percutaneous closure of a PDA with an ODO between December 2013 and May 2015. PDA was clas- sified according to the classification described by Kricheenko et al.
Results: Median patient age was 2.5 years (range, 6 months-17 years), median weight was 15 kg (range, 5-60 kg), and median PDA diameter was 2.5 mm (range, 1.2-7 mm). The angiographic appearance of the ductus was type A in 49 (83%) patients, type B in 1 (1.6%) patient, type C in 3 (5%) patients, type E in 5 (8.4%) patients. Median fluoros- copy time was 14 minutes (range, 4.2-30 minutes). Fifty-seven out of 59 patients (96.6%) had successful ODO implantation. Occlusion rates were 36/57 (63.1%) at the end of the procedure, 50/57 (87.7%) at 24- 48 hours post procedure, and 56/57 (98.2%) on echocardiography at a median follow-up of 2.2 months (range, 1 day-17 months). In only one patient device-related complication was observed (emboliza- tion to aorta). In another patient, the device was withdrawn before release.
Conclusion: Our results indicate that transcatheter closure of PDA us- ing the ODO is safe and effective. While early residual shunt ratio was higher than the other duct occluders, the residual shunt ratio was equivalent to other devices during the follow up. Larger studies and longer follow up are required to assess whether its shape and longer length make it superior to other duct occluders.
TRANSESOPHAGEAL ECHOCARDIOGRAM AND LEFT VENTRICULAR ANGIOGRAM FOR POSITIONING AND RELEASE OF VENTRICULAR SEPTAL DEFECT DEVICE. Sripadh Upadhya
Health City Cayman Islands, Grand Cayman, Cayman Islands 2Narayana Hrudayalaya, Bangalore, India
Device closure for muscular ventricular septal defect(VSD) is a well established mode of treatment.Routinely it is done with the help of transesophageal echocardiography(TEE), fluoroscopic guidance and left ventricular angiogram in the catheterization laboratory.I describe a case, where the procedure was done using transthoracic echocar- diography (TTE) and fluoroscopic guidance and the device was re- leased with TTE guidance alone without angiogram.
6 year old male child presented with a history of recurrent respira- tory tract infections. Clinically had signs of left ventricular dilatation and 4/6 pansystolic murmur was heard best at the apex.TTE revealed single moderate sized(8mm on the left ventricular side and 6mm on the right ventricular side) posterior upper muscular VSD left to right shunt.The decision was made to close the VSD with device. Anatomy of VSD was delineated by doing left ventricular injection of contrast in atleast two views and the device size was marked as 12mm mus- cular Amplatzer VSD device. VSD was crossed retrogradely and arte- rio-venous loop was made through which Mullin’s sheath introduced anterogradely through the right femoral vein.Once the Sheath tip was positioned in the left ventricle facing the apex, the device was introduced through the sheath and pushed till the tip of the device came out of the sheath.TTE was done to confirm the tip position.Then left ventricular disc was released and positioned along the septum. Then an unexpected incident happened, the injector stopped work- ing.Left ventricular angiogram could not be done to confirm the de- vice position(The most important step in the procedure).I decided to go ahead with TTE(at least 3 views) for confirmation of the position of the device.The right ventricular disc was released with the TTE guid- ance.The final positioning of the device was confirmed with TTE.The device was unscrewed and released from the cable.Post procedure TTE showed device in good position and no residual shunting.
TTE could be used as a potential alternative for TEE during VSD de- vice procedure and risks of endotracheal intubation can be avoided.I learnt the hard way that TTE could potentially be used even if angio- gram could not be done(due to unexpected event) to confirm the positioning and releasing the device.
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STENT IMPLANTATION IN CRITICAL COARCTATION AS A BRIDGING THERAPY IN VERY-LOW-BIRTH-WEIGHT INFANTS
Gregor Krings1, Hans Breur1, Matthias Freund2, Mirella Molenschot1
1University Medical Center Utrecht, Utrecht, The Netherlands 2Klinikum Oldenburg, Oldenburg, Germany
Background: Surgical treatment is the therapy of choice for aortic coarctation (CoA) in term newborns. In very low birth weight new- borns (VLBW) therapy is challenging due to weight, vulnerability for side effects of Prostaglandin and unbalanced systemic versus pulmo- nary perfusion. Coronary-stent implantation can be used in critically ill VLBW newborns as a bridging-therapy to surgery.
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CASE REPORT: USE OF
ECHOCARDIOGRAM ALONE, WITHOUT
TRANSTHORACIC
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111