Page 72 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
Yinn Khurn Ooi1, Sung Kim2, Scott Gillespie1, Dennis Kim1, Robert Vincent1, Christopher Petit1
1Emory University School of Medicine, Atlanta, GA, USA
2Emory University Rollins School of Public Health, Atlanta, GA, USA
Background: Transcatheter stenting of branch pulmonary artery ste- nosis (BPAS) has been shown to be effective, however if placed in a young child will require serial re-dilation with growth. Use of small pre-mounted stents in growing children raises concern of long term viability with limited expandability.
Methods: 61 children underwent 83 pre-mounted stenting for BPAS from 1/1/2003 to 10/1/2013. Cardiac defects included 33% tetralogy of Fallot / double outlet right ventricle, 5% transposition, 20% pul- monary atresia (PA) with major aorto-pulmonary collateral arteries (MAPCAs), 7% PA without MAPCAs, 13% truncus, and 20% single ven- tricle. 28% of patients had genetic syndromes, including DiGeorge, Down and Alagille. 72% of patients had native BPAS, and the rest were post-op. Median age at procedure was 7.5 months and median weight was 6.3 kg. Stent sizes ranged from 4 mm to 9 mm; with a median of 6 mm. Average duration of follow up was 3.2 years. 14% of stents were placed within 30 days of a cardiac surgery.
Results: Short term outcomes were good, with mean improvement of stenotic vessel caliber by 153%, mean reduction of stenosis degree by 58%, and mean improvement of pressure gradient by 63%. There were 8 procedural complications (9.6%), including 5 embolizations, 1 ventricular tachycardia requiring electrical cardioversion, and 2 car- diopulmonary arrests. Long term outcomes were poor, with freedom from re-intervention at 1 year of 51% and 5 years of 14%. Post balloon dilations were not very effective, increasing mean stent diameter from 5.0 mm to 5.8 mm. Only 1 stent was able to be fractured longitu- dinally. Freedom from surgical stent removal (SSR) was 81% at 1 year 35% at 5 years. Predictors of poor outcome include Blalock-Taussig shunt surgery (79% requiring SSR, p 0.009) and smaller stent size (p 0.005). Predictors of good outcome include peripheral BPAS (0% re- quiring SSR vs 54% for central BPAS, p 0.049) and greater improve- ment of pressure gradient (72% improvement in the non-surgical group vs 56% in the SSR, p 0.045).
Conclusions: Pre-mounted stent is a short term solution for BPAS with very poor long term outcomes. Every effort should be made to avoid it as much as possible and use larger stents that can be dilated to adult size if able.
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SUCCESSFUL PERCUTANEOUS CLOSURE OF BILATERAL PULMONARY ARTERY MYCOTIC ANEURYSMS IN AN INFANT
Tom Summitt, Mary Porisch
Methodist Children's Hospital, San Antonio, TX, USA
Introduction: Mycotic aneurysms are rare in pediatrics compared to the adult population. Mycotic aneurysms are known to carry a high risk of spontaneous rupture and death. Surgical intervention also car- ries a high risk of rupture, significant bleeding and mortality. There are reports of percutaneous closure with coils or detachable balloons in adults. We describe the first reported case of successful percutane- ous closure of mycotic pulmonary aneurysms in an infant.
Procedure: The patient is a 5.2 kg 2 month old former premature in- fant transferred from an outside hospital with MRSA sepsis, menin- gitis and septic emboli to the lungs. On CTA, she was noted to have bilateral lower lobe pulmonary artery aneurysms measuring 2cm X 1.5 cm. She was treated with multiple IV antibiotics and clinically improved. Pediatric surgery and Interventional Radiology turned her down for exclusion of the aneurysms as the risk of rupture and death was felt to be too high.
After review of the CTA, she was taken to the cath lab and a 5 Fr. Sheath was placed in the RFV and a 2.5 Fr. monitoring cath was placed in the RFA. Multiple selective hand injections were performed in both low- er pulmonary arteries. Both aneurysms measured approx 2 cm with swirling flow. The aneurysmal branchs both measured 2.5-3 mm and were accessed with a Pilot wire, Contada microcatheter and angled glide combination under flouro road mapping being careful to not advance the catherers into the aneurysm. 4mm Amplatzer Vascular Plugs II were advanced and deployed at the neck of the aneurysm on both sides. Repeat angiograms demonstrated complete occlusion of the aneurysm and no obstruction to flow to normal branches. There were no complications. She was discharged to home 4 days later. She had a repeat CTA 2 months later which demonstrated complete reso- lution of the aneurysms.
Conclusion: Percutaneous occlusion of mycotic pulmonary aneu- rysms can be successfully performed in pediatric patients. Careful re- view of CTA for the location, size and feeding branch is very helpful in planning the cath. Significant care needs to be taken not to advance the catheters into these very thin walled aneurysms
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UTILIZING MOBILE TECHNOLOGY TO IMPROVE COMMUNICATION-THE EASE APP
Karen Iacono, Hamish Munro, Kevin De La Rosa, David Nykanen
Arnold Palmer Hospital for Children, Orlando, FL, USA
Introduction: Parents of children are naturally very anxious during any operative procedure. We sought to utilize current smartphone technology to explore how this could be improved utilizing an appli- cation called EASE (Electronic Access to Surgical Events). This appli- cation updates families of patients undergoing cardiac interventions utilizing text, photo and video.
Methods: All parents of children undergoing cardiac catheterization were offered use of an application on their smart phone, or one pro- vided to them during their child’s procedure to receive one way com- munication with the staff in the laboratory on the condition of their child via text message, video or photographs at a minimum of ev- ery 30 minutes. All parents who utilized the EASE Application during their child’s cardiac catheterization were surveyed after utilizing the application.
Results: The study cohort includes 118 patients that underwent car- diovascular interventions and utilized the EASE application. 99% of the parents reported they would use this application if they them- selves or their loved one required future medical procedures. 97% said the texts, photos and videos were appropriate, and 74% report- ed that the availability of EASE would influence their choice of hospi- tal should they themselves, or a loved one require future surgery or
19th Annual PICS/AICS Meeting Abstracts