Page 75 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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mm. Successful valve implantation was achieved in all patients; 26 mm in four, 29 mm in others in the same or subsequent sessions, 20 – 47 days later. Valve function was good in all immediate after and at the last follow-up; a median of 2,5 months ranging 7days - 9 months.
Conclusion: PPVI with ES-XT valve, which has larger sizes as 23, 26 and 29 mm, is feasible and safe in patients larger native RVOT without stenosis in adolescents and adults. Newer delivery system (Novaflex), which is used through 14-20 Fr smaller sheaths, gives us also an op- portunity of early transcatheter valvulation in smaller patients with native RVOT or early conduit dysfunction.
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TRANSCATHETER TREATMENT OF MIDDLE AORTIC SYNDROME (MAS) WITH BARE AND COVERED STENT IMPLANTATIONS
Ahmet Celebi, Orhan Bulut, Ilker Kemal Yucel, Sevket Balli, Mehmet Kucuk, Emine Hekim Yilmaz
Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery; Pediatric Cardiology, Istanbul, Turkey
Introduction: Middle aortic syndrome (MAS) is an uncommon cause of arterial hypertension in children and young adults characterized by long segment narrowing of the distal thoracic and/or abdominal aorta. Stenosis of the abdominal aorta may be associated with steno- ses of renal and visceral arteries.
Method: Between 2012 and 2015, five patients underwent stent implantation for the treatment of with MAS. In patients with severe sub-atretic stenosis, predilation with smaller sized balloons was re- quired before stent implantations. Balloon size that stents will mount was selected according the diameter of distal aorta (1-2 mm small- er). When first stent does not cover the lesion completely additional stents were implanted by telescopic method. If the lesion is close to the critical vessels bare stents if not covered stents were implanted. After implantation further dilation was performed to optimum size in the same session or subsequent session after 6 months.
Results: Median age was 17 years (14–22 years). None had inflam- matory signs of Takayasu arteritis but one had neurofibromatosis. Length of the stenosis varied between 19 mm and 105 mm (median 64 cm) and median diameter of the lesion was 3.3 mm (1.5-5.4 mm). Aortic narrowing was isolated in 4 patients and coexisted with left re- nal artery stenosis in one. 5 covered stents implantation was required for long segment sub-atretic lesion in one, two stents in three and single in one. Covered stents were used in two patients, both bare and covered stents in one and only bare stents in the last in two stag- es; cutting balloon suboptimal dilation in the first session than bare stents in the second. Balloon angioplasty for unilateral renal artery stenosis was performed in patient with neurofibromatosis. There was no procedural related complication. Redilation was needed due to suboptimal dilation in the first session in one and antihypertensive medication was continued in all.
Conclusion: Transcatheter treatment of long segment middle aortic syndrome is an effective and safe treatment option with excellent results. It improves both vessel diameter and pressure gradient by using multiple stents with telescopic method. Staged dilation may be preferred in some situations.
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TRANSCATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS WITH OCCLUTECH DUCT OCCLUDER: PRELIMINARY RESULTS
Ahmet Celebi, Ilker Kemal Yucel, Orhan Bulut, Sevket Balli, Evic Zeynep Basar, Emine Hekim Yilmaz
Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery; Pediatric Cardiology, Istanbul, Turkey
Introduction: Occlutech PDA occluder is a new device for PDA closure and limited data availbale on it. It is fundamentally different as the shank the device is 2 mm larger at the pulmonic end than the aortic end, contrary to Amplatzer duct occluder. The aim of this study was to evaluate the feasibility, safety, and efficacy of this new device.
Method: 10 selected patients with conical shape PDA underwent transcatheter closure with Occlutech PDA occluder from Novembers 2014 to May 2015. Decision for device size selection was based on the narrowest diameter of the PDA according to the manufacturer recommendation as the aortic end of the occluder shank to be at least 1.5-2.0 mm larger than the narrowest diameter of the duct. An- giogram was performed to confirm the device position and evaluate residual shunt just before and after the releasing the device. Patients were followed up by clinical examination and echocardiography at 24 hours, one month, 3 months and 6 months.
Results: The median age of the 10 patients was 2.5 years (6 months to 28 years) and median weight was 12.1 kg (7.5 to 50 kg). Narrow- est PDA diameter was median 2.55 mm (2.0-5.8 mm). All patients had continuous cardiac murmur on examination and all PDAs were type A. Intervention was successful in all. Final angiogram after ten minutes showed complete closure in 9 of them. A moderate residual shunt was seen in only one who has the largest PDA diameter among all. This patient had also hemolysis confirmed by hemoglobinuria. It resolved in five days with medical treatment. Complete closure was observed at one month after the intervention in this patient. None of the patients showed evidence of stenosis at branch pulmonary artery and descending aorta by echocardiography during the 4 months of median follow-up (3- 6)
Conclusion: Our immediate and early-term results showed that Oc- clutech PDA occluder is a safe and effective device in transcatheter PDA closure. We have not observed any significant left pulmonary artery stenosis event though it might have been expected due to im- proper shape of the device for the conical type ducts which is most frequently observed and have larger aortic side in all. Limitations of the preliminary study were nonrandomized and unperformed lung perfusion scintigraphy. Further studies are required in larger groups with long-term follow-up and lung perfusion studies.
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PERCUTANEOUS PULMONARY VALVE IMPLANTATION: EARLY AND INTERMEDIATE TERM RESULTS IN 36 PATIENTS
Ahmet Celebi, Orhan Bulut, Ilker Kemal Yucel, Sevket Balli, Neslihan Kiplapinar, Mehmet Kucuk, Evic Zeynep Basar
Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery, Istanbul, Turkey
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111