Page 76 - Journal of Structural Heart Disease - Volume 1 Issue 2

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Meeting Abstracts
Introduction: We report our initial experience in percutaneous pul- monary valve implantation (PPVI) in 30 patients with conduit and na- tive right ventricular outflow tract (RVOT).
Method: Between 2012 and 2014, 36 patients with RVOT dysfunction underwent to catheterization for PPVI. Pre-stenting was performed in all in the same or the previous session.
Results: Mean age and weight of the patients were 16.5 years (6.0–50) and 49 kg (19–90), respectively. The diagnoses were s/p repaired te- tralogy of Fallot (TOF) in 21 patients, s/p surgical correction of pulmo- nary atresia with VSD in six, Ross procedure for aortic valve in four, common arterial trunk in three, and s/p repaired transposition of the great arteries with VSD and pulmonary stenosis in two. 21 patients was repaired with a conduit whereas 15 patients with native RVOT. 13 patients were s/p repaired TOF with transsannular patch, 12 of them had free pulmonary regurgitation without significant stenosis (<25 mmHg). Implantation was successful in all attempted (19 Melody, 17 Edwards-Sapien). Valve implantation was performed in the same ses- sion after pre-stenting in 13 and in subsequent session in 23 patients. The valve sizes for Melody; were 20 mm in 5 patients, 22 mm in 14, for Edwards-Sapien; 20 mm in one, 23 mm in 4, 26 mm in 4, and 29 mm in 8. The pressure gradient between the right ventricle and the pulmonary artery decreased significantly from 50±14 mmHg to 11±6 mmHg. No more than trivial regurgitation was observed immediate after the implantation. No procedure-related mortality occurred. Af- ter Melody valve implantation, three patients experienced infective endocarditis. Medical therapy was sufficient in two, while one need- ed surgery due to severe valve dysfunction. No significant restenosis has occurred yet (median 8 months follow-up). One patient who had severe left ventricular dysfunction with implanted pacemaker after Ross surgery suddenly died at home three months after the proce- dure, probably due to ventricular arrhythmia.
Conclusion: PPVİ is a safe and effective option that can delay the need for redo surgery. We observed infective endocarditis in only Melody valves but no in Edwards–Sapien. PPVI is feasible not only in patients with a conduit but also in patients with large native RVOT with free pulmonary regurgitation using Edwards-Sapien valves.
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OUTCOMES AND PREDICTORS OF REINTERVENTION
51 patients(pts). Mean age and weight :13 +- 5 years and 41+-11 kg respectively. Balloon angioplasty was performed in patients under 18 kg and stent placement over it. Transverse aortic arch, aortic isthmus and aortic descendent diameter were measured and gradients pres- sure modifications registered.
Results: Aortic Coarctation angioplasty and stent placment was effec- tive in all patients. Initial mean systolic pressure gradient of 33,7+- 17 mmHg decreased to 5 +-3 mpatsmHg post stenting. Thirty eight patients underwent a single succesful procedure, 13 patients re- quired more than one intervention. The mean transverse aortic arch diameter, isthmus and aortic arch Zvalue expresing hypoplasia were 10,3+-3,8mm,7,5+-3,7 mm and Z -1,2. CPbare stent was implanted in 10pts with normal transverse aortic arch, CP covered stent in 24pts and Advanta V12 in 7 pts, all with critical isthmus diameter and Pal- matz 4014 in 3. There were 4 fracture, all in CP stent of first genera- tion that required Stent reimplantation. Only one patient who had underwent bare stenting of native CoA developed aneurysm wich was succesfully treated with a covered CP stent. When the transverse aortic arch and aortic isthmus diameter correlations were made by lo- gistyc regression analysis, there were significant association between the isthmus and the need of reintervention with p0,43. There were no significant tendence between the transverse aortic arch diameter and Z value p0,8.
Conclusions: Percutaneous treatment of native and recurrent CoA is safe and effective with technical success of 100% at inmediately. At medium and long follow up there were a strong correlation of com- plex anatomy and the need of reintervention .
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SUCCESSFUL TRANSCATHETER CLOSURE OF AN AORTICO-LEFT VENTRICULAR TUNNEL WITH AMPLATZER VASCULAR PLUG II
Ahmet Celebi, Ilker Kemal Yucel, Orhan Bulut, Sevket Balli, Mehmet Kucuk
Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery;, Istanbul, Turkey
Introduction: Aortico-left ventricular tunnel (ALVT) is an abnormal communication between the aortic root and the left ventricle by- passing the aortic valve. Reports on device closure of aortico-left ventricular tunnel are. We present a successful ALVT closure with an Amplatzer vascular plug II (AVP II) not reported before.
Case: 14-year-old male referred for grade 3/6 diastolic murmur. Echo- cardiography revealed a tunnel-like communication between the aortic root and left ventricle (LV) causing diastolic regurgitant flow and LV enlargement and systolic dysfunction (LVEDd was 7.2 cm and EF: 45 %, FS: 22%). Narrowest point of the tunnel was 7.7 mm in di- ameter and 27 mm in length by echocardiography. On angiography, narrowest point was measured 5.8 mm in the middle part and 11 mm at the left ventricular opening side. After crossing the defect, balloon sizing with was performed to delineate size and course of the defect and showed a loose indentation on the 8 mm Tyshak balloon. Firstly, a 12 mm AVP II was used for closure but could not be released due to significant residual flow. Then a 14x12 mm Amplatzer duct occluder was tried. It closed the defect satisfactorily but caused significant aor- tic regurgitation (AR). Finally, it could only be possible to close the de- fect with 16 mm AVP II completely without significant AR. Echocardi-
IN PERCUTANEOUS TREATMENT OF COARCTATION WITH AND WITHOUT IMPLANTATION
Liliana Ferrin, Juan Manuel Lange, Teresa Escudero Correa, Maria Elena Ferreiro, Alejandro Romero, Angel Perrotta Mussi, Claudia Perez
Corrientes Cardiology Institute, Corrientes, Argentina
Balloning and/or stenting Aortic Coarctation (CoA) had become the treatment of choice in late childhood and adolescents patients with native and recurrent CoA, the complex anatomy of the aortic arch may be determinant in the medium and long term outcomes.
Objetive: To show inmediate and late results of percutaneous treat- ment of CoA and identify predictors of early and late reintervention.
Material and Methods: Since January 2002 to July 2014, 71 procedures of Balloning and/or endovascular stent placement were performed in
AORTIC STENT
19th Annual PICS/AICS Meeting Abstracts