Page 71 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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to procedure. There was an increase in DA average diameter of 1.93 mm to 3,68mm (p <0.001) and in the O2 saturation of 65% to 82% (p <0.001). 51% of patients had hypoplasia of the pulmonary arteries. Stent-related complications occurred in 26,6% and they have been: acute occlusion (6.3%), stent migration (5.1%) and obstruction of one of the pulmonary arteries (10%). Univentricular hearts were more as- sociated with stent-related complications (52%; p=0,01). There was a higher incidence of complications and deaths with hypoplastic pul- monary arteries (37%; p=0,08 and 39,5%, p=0,02, respectively) The mean ICU stay and hospital stay were 7,3 and 20 days respectively. The mortality rate at follow up were 8,8% before hospital discharge and 13,8% after. 7.6% related to stent or hypoxia. The mean follow up was 15,3 months (SD 21,5) and the mean time among procedure and surgery was 10 months (median 4,2). 22.6% of patients underwent other percutaneous intervention and 23.8% surgical approach. CON- CLUSION Stenting in ductus arteriosus is an alternative to the initial surgical palliation in most patients, but attention should be paid to the degree of hypoplasia of the pulmonary arteries and close moni- toring before the definitive approach.
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COLLABORATION
INTERVENTIONAL PROGRAMS FOR MELODY VALVE IMPLANTATION: BUILDING PROCEDURAL EXPERTISE AND A CONGENITAL CARDIAC TEAM
Stephen Kaine1, Michael Bingler1, Trip Zorn2, James O'Brien1, Pam Barham1, Susie Page2, Peter Tadros2
1Children's Mercy Hospitals and Clinics, Kansas City, MO, USA 2University of Kansas Medical Center, Kansas City, KS, USA
Objective: Interventional cardiologists and cardiac surgeons from two institutions sought to capitalize on individual program strengths to build a single, high-quality Melody Valve program.
Background: Interventionalists from a free-standing children’s hos- pital and an adult academic medical center possess separate exper- tise in congenital cardiac, coronary artery disease and transcatheter techniques. Combining the knowledge and procedural experience of each team could provide distinct advantages for children and adults undergoing Melody Valve implantation.
Methods: The two institutions formed a single interventional team to provide Melody Valve treatment at both centers. The team, consisting of adult and pediatric interventional cardiologists, an adult cardio- vascular surgeon and a congenital cardiovascular surgeon, collabo- rated on peer-to-peer training, shared clinical privileges, proctoring, patient selection and case scheduling. Generally, patients <18 years were treated at the children’s hospital and patients >18 years at the adult center.
Results: From July 2012 to May 2015, the team treated 31 patients meeting criteria for Melody Valve in right ventricle to pulmonary ar- tery conduits. Successful implantation was performed in 26 patients (14 at the children’s hospital, 12 at the adult center). Concern over potential coronary compression (3 patients) and inadequate landing zone (2 patients) prevented implantation in 5 patients. The successful team dynamic allowed further collaboration at the children’s hospital. In 2014, two children (age 16 months and 4 years) with severe coro- nary ostial stenosis underwent successful coronary stent angioplasty.
Conclusion: The collaborative approach led to more rapid procedural volume and expertise for the team. Collaboration of adult and pe- diatric interventionalists provided further clinical benefits, including successful complex coronary interventions in children.
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USE OF ISOPROTERENOL TO ASSESS GRADIENTS IN COARCTATION OF THE AORTA FOR INTERVENTIONS IN THE CATHETERIZATION LABORATORY: UNMASKING THE BORDERLINE COARCTATION
Neil Patel, Patrick Sullivan, Cheryl Takao, Sarah Badran, Joseph Ahdoot1, Frank Ing
Children's Hospital Los Angeles, Los Angeles, CA, USA
Introduction: One of the indications for intervention in coarctation of the aorta (CoA) is a peak-to-peak gradient >20 mmHg. However, gra- dients are dependent in part on the pt’s physiologic state. Those with borderline CoA may develop increased gradients during exercise, and those under general anesthesia may display falsely lower gradi- ents. Some data demonstrate that isoproterenol (ISO) may simulate a more active physiologic state under anesthesia resulting in larger and more accurate gradients at catheterization; however, the utility of ISO to assess gradients before and after CoA interventions has not been well studied. The objective of this study was to describe the use of ISO to assess borderline CoA gradients before and after an intervention.
Methods: A retrospective review was performed on 2-ventricle pts who underwent intervention for CoA with ISO testing from 10/2012 to 3/2015 at a single institution. Demographic, hemodynamic, and angiographic data were evaluated.
Results: Twenty-six pts were included (mean age 8.6±6.5 yrs). CoA was the underlying diagnosis in 22 pts. The remaining had hypoplas- tic (3) or interrupted (1) arch. Eight pts had prior surgery, 6 had prior catheter intervention, 4 had both, and 8 had no prior intervention. ISO increased the heart rate by 49±18%. The mean gradient doubled from 18.4±13.6 mmHg at rest to 39.3±19.5 mmHg with ISO chal- lenge (p<0.001). Among the 24 pts given ISO post-intervention, the gradient decreased from 40.6±19.7 to 16.9±16.7 mmHg (p<0.001). Seventeen pts had initial borderline resting gradients (≤20 mmHg). Within this sub-group, the gradient almost tripled from 10.1±5.7 mmHg at rest to 28.3±10.1 mmHg with ISO (p<0.001). Fourteen of these pts (82%) developed significant gradients (>20 mmHg). Follow- ing intervention, the CoA minimum diameter improved from 8.4±3.9 to 11.1±4.4 mm (p<0.001). In the 13 pts who received the same ISO challenge post-intervention, the gradient decreased from 31.6±8.2 to 9.7±7.8 mmHg (p<0.001).
Conclusion: ISO can be used to increase cardiac output to unmask a significant CoA gradient and to assess the effectiveness of an in- tervention for CoA. This is particularly useful in pts with a borderline gradient under general anesthesia. Stent implantation and balloon angioplasty can effectively reduce the gradient elicited by ISO and improve the vessel caliber.
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PRE-MOUNTED STENTS IN BRANCH PULMONARY ARTERIES: A SHORT TERM SOLUTION
OF PEDIATRIC AND
ADULT
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111