Page 68 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
Objective: We report on our experience with coronary stent implanta- tion in 4 VLBW infants with critical CoA.
Methods: Clinical, echocardiographic and angiographic data were reviewed for the 4 patients who underwent CoA stenting between 2011 and 2014 including follow until surgery.
Results: At intervention median age was 12 days (7-15), weight 950 gr. (680-1500). Invasive gradient at cath was 42,5 mmHg (40-55) with residual gradient of 0 (0-10) after stentimplantation. Stentdiameter ranged from 3-5mm. Median procedural time was 85 min.
There were no complications during the procedures. At follow up the femoral artery used for intervention was occluded in all infants with- out clinical compromise. All but one infant showed unremarkable follow-up until surgery which was performed at a median age of 6,25 months (3,5-8) with a weight of 5,35kg (5,0-5,8). In one infant re-cath was necessary to further postpone surgery because of early re-ste- nosis which was associated with a severe aortic aneurysm 2 months after stentimplantation. With still a low weight of 2,2kg a coronary graft stent was implanted and the aneurysm completely covered. All children received surgical correction with longitudinal incision of the coronary stent and patchplasty. During the postoperative follow up with a median of 1,6 years (0,1-3) no re-intervention was indicated.
Conclusions: Stentimplantation is an option to treat CoA in critical ill VLBW newborns in whom Prostaglandin had to be stopped or was ineffective. Our experience is limited to 4 patients below 1500gr of weight. The procedure is technically challenging and demands a spe- cial workflow. Bridging-to-operation was successful and all 4 new- borns underwent surgical correction months after stentimplantation.
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SEVERELY REGURGITANT LV-AAO CONDUIT IN A FAILING FONTAN PATIENT TREATED WITH A VASCULAR ENDOGRAFT AND MELODY TRANSCATHETER VALVE VIA A NOVEL HYBRID APPROACH
Brian Boe, Aimee Armstrong, Martin Bocks
University of Michigan, Ann Arbor, MI, USA
A 28 year-old male with d-transposition of the great arteries, hypo- plastic right ventricle (RV), ventricular septal defect (VSD) and strad- dling tricuspid valve status post Fontan palliation presents with in- creasing abdominal ascites and lower extremity edema. Four years following his Fontan operation, the patient underwent placement of a 20 mm homograft conduit from the left ventricular (LV) to ascend- ing aorta (LV-AAo) due to progressive severe restriction of the VSD. Given his new and progressive symptoms, the patient was referred to the catheterization laboratory where hemodynamic evaluation revealed Fontan pressures of 25 mmHg secondary to elevated RV and LV end diastolic pressures (EDP) of 22 and 21 mmHg, respec- tively. There was severe regurgitation of the LV-AAo conduit. As the patient was an extremely high-risk surgical candidate secondary to his numerous prior sternotomies, high Fontan pressures, and severe diastolic dysfunction, he was referred back to the catheterization lab- oratory 2 months later for transcatheter valve placement within the LV-AAo conduit. The LV-AAo conduit inserted on the leftward aspect of the ascending aorta following the lesser curve of the transverse arch. This created an almost 180 degree tight turn from the transverse arch to the distal LV-AAo conduit and precluded transcatheter valve
delivery from a femoral arterial approach. The proximal LV-AAo con- duit takeoff was from the LV apex with an oblique orientation to the ventricle, precluding a transapical approach. A vascular surgery team sutured an 8 mm Dacron tube graft directly to the right axillary ar- tery, which provided direct approach to the LV-AAo conduit via the right innominate artery. Once the conduit was accessed, an 82 mm Endurant II stent graft (Medtronic, Minneapolis, MN) was placed with- in the heavily calcified LV-AAo conduit prior to conduit stenting to protect from possible catastrophic rupture. A Melody® Transcatheter Pulmonary Valve (Medtronic, Minneapolis, MN) was implanted within the LV-AAo conduit entirely within the distal end of the stent graft. Post-procedural LV EDP dropped considerably to 10 mmHg and the LV-AAo conduit peak systolic ejection gradient was unchanged at 11 mmHg. Angiography demonstrated no residual LV-AAo conduit in- sufficiency. The patient tolerated the procedure well without compli- cation and was discharged to home the following day.
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OUTCOMES OF TRANSCATHETER ATRIAL SEPTAL INTERVENTIONS IN CONGENITAL HEART DEFECTS Dominick Figueroa, Subhrajit Lahiri, Yunin Gutierrez, Enrique Aregullin
Nicklaus Children's Hospital, Miami Children's Health System, Miami, FL, USA
Background: The atrial septum (AS) is an anatomic structure of para- mount physiological importance in critical congenital heart defects such as right and left heart obstruction, compromised Fontan circu- lation or LV failure. In this setting, an intervention to create or enlarge an atrial communication may improve the hemodynamics and be lifesaving.
Objective: The purpose of this study is to determine the frequency, type, complications and outcomes of transcatheter atrial septal inter- ventions (ASI) in a pediatric population with congenital heart defects.
Methods: Using our cardiac catheterization database and electron- ic medical record, we retrospectively reviewed all patients that had an intervention in the atrial septum in our catheterization laboratory between June 1996 and July 2013. We collected demographic, proce- dural and follow up data. The interventions were divided: 1) left heart obstruction, 2) right heart obstruction and 3) left atrial (LA) decom- pression during left ventricular mechanical support and 4) miscel- laneous. We used parametric statistics to compute and analyze the means, standard deviation and differences.
Results: A total of 52 patients (mean age 1.2 ±3.2 years; 30 (58%) males, underwent ASI during the study period. The ASI included: stent placement (n=9, 17.3%), septostomy using static (n=32, 61.5%) and cutting (n=12, 23%) balloon techniques, and radiofrequency perfora- tion (n=2, 3.8%). For the patients with available follow up data (n=39), mean follow up was 3.3±2.7 years; and all had stable hemodynamics and achieved complete surgical palliation. There were 3 non-pro- cedural deaths. For group 1 (n= 30), mean LA decreased (13±6 to 9±4 mmHg, p <0.01) and there was acute success in 26 (86%). The remaining 4 patients required subsequent interventions. There were minor complications in 3(10%). In group 2 (n=9), all achieved right atrial (RA) decompression (n=6) or improved filling of left ventricle (n=3). There were no major complications. In group 3(n=2) the LA was decompressed (18 to 12 mmHg, p=0.03) in both and there were no
19th Annual PICS/AICS Meeting Abstracts