Page 77 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
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ography on the next day showed complete occlusion with significant reduction in LV dimension and trivial-mild AR. At 4 months after the device closure, echocardiogram showed the device positioned well with no residual shunt and trivia-mild aortic regurgitation.
Conclusion: AVP II can be preferred in transcatheter closure of ALVT because of the soft and good occlusive characteristics. Another ad- vantage of plug is not to protrude into the left ventricular outflow tract as duct occludes. However, measurements of ALVT dimensions on echo and angiography may be misleading due to complex mor- phology and larger devices than predicted may be required.
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STENTING OF THE ARTERIEL DUCT FOR PULMONARY CIRCULATION IN INFANTS WITH FUNCTIONAL UNIVENTRICULAR HEART: SINGLE CENTER EXPERIENCE IN 68 PATIENTS
Ahmet Celebi, Ilker Kemal Yucel, Orhan Bulut, Sevket Balli, Neslihan Kiplapinar, Mehmet Kucuk
Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery; Pediatric Cardiology,, Istanbul, Turkey
Introduction: Ductal stenting has emerged as a non-surgical alter- native to surgical aorto-pulmonary shunt in patients with duct-de- pendent or decreased pulmonary blood flow. This study reports our experience with duct stenting in 68 patients with functional univen- tricular heart (FUH).
Method: We retrospectively analyzed 68 infants who had FUH in 136 patients underwent cardiac catheterization for duct stenting in our institute between 2004 and 2014. Ductus was classified as Type A; Short, straight, originating from descending aorta (DAO), Type B; Lon- ger, somewhat tortuous, originating from DAO, Type C; Long, vertical, more tortuous, originating from distal arch, Type D; Originating from subclavian artery and Type E; Bilateral.
Results: Median age was 20 days (3 days–8 months) and median weight was 3.4 (2.7 – 6.8) kg in 68 patients. 26 had pulmonary atre- sia with intact ventricular septum, 15 had tricuspid atresia or severe hypoplasia, 10 had unbalanced complete AVSD, 10 had double/ single inlet ventricle and 7 had miscellaneous type of FUH. Ductus was Type A in 24, Type B in 26, Type C in 9, Type D in 6, Type E in 3. Implantation was successful in 65 of 68 (95%), unsuccessful due to acute ductal constriction in two and migration to descending aorta in one. Implantation was performed retrograde in 53, antegrade in 11 and both (bilateral duct stenting) in two. Oxygen saturation in- creased from 70±7.6% to 87±4.6%, immediate after the procedure. One patient died after successful stent implantation probably due to pulmonary overflow. The follow-up period ranged from 6 months to 10 years (median 66 months). 48 infants reached to Glenn anastomo- sis without surgical intervention. Fontan completion was achieved in 19 of them. However, aorto-pulmonary shunt was required in 11 in- fants after 3 days to 7 months of the procedure, 2 were lost to follow up. Three patients died without intervention 4 days-6 months later during follow-up. The deaths were not related to the procedure. Stent redilation was performed in 14 patients due to decreasing of oxygen saturation in 3 to 10 months.
Conclusion: Stenting of the duct in infants with FUH is effective and safe alternative option as a bridge to second stage palliation. Mortal-
ity rate is comparable even better to conventional surgical shunt in FUH. Additional advantages of duct stenting to surgery are shorten- ing hospital stay, eliminating problems of thoracotomy and reducing the number of operations.
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USING A STEERABLE DELIVERY CATHETER TO SUCCESSFULLY DELIVER A CERAFLEX SEPTAL OCCLUDER TO CLOSE AN ATRIAL SEPTAL DEFECT IN A CHILD WITH INTERRUPTED INFERIOR VENA CAVA- AZYGOS CONTINUATION
Ahmet Celebi, Ilker Kemal Yucel, Orhan Bulut, Mehmet Kucuk Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery; Pediatric Cardiology,, Istanbul, Turkey
Introduction: Transcatheter secundum atrial septal defect (ASD) clo- sure through the femoral vein is not always feasible in children with interrupted inferior vena cava (IVC), especially with large delivery sheaths. This paper reports on the jugular approach using a steerable delivery catheter to facilitate orientation of the device to the atrial septum in a child with interrupted IVC.
Case: A 12-year-old boy was referred to our hospital for percutane- ous closure of a secundum ASD. On echocardiography, enlarged right heart cavities, left atrial isomerism, secundum ASD, interrupted IVC with azygos continuation and atrial septal aneurysm was observed. Transesophageal echocardiography revealed with a 19,2 mm secun- dum ASD with sufficient rims except aortic rim (3,5 mm). Coloured flow diameter was measured 22,9 mm and total atrial septum size was 40 mm. Cardiac catheterization was performed with the aim of closing the defect through azygos continuation. Using this route, the sizing balloon catheter couldn’t be advanced through the femoral vein with azygos continuation. Therefore, trough the jugular vein and an extra-stiff guidewire was placed into inferior pulmonary vein. Siz- ing balloon was glided across the defect. The stop flow and stretched sizes were 22.7 mm and 25.6 mm, respectively. A 24-mm Ceraflex Septal Occluder (CSO) was chosen and attempts at deployment of the device failed due to prolapse of the retention disks. Therefore, an Fustar steerable guiding catheter, which can be bent by a handle located on the sheath to create a better angle was used in order to easily anchor and deploy the device. A 24-mm CSO was loaded and delivered to the left-sided atrium through a 12F curved long sheath and easily implanted due to perfect alignment of the device with the interatrial septum. The patient was discharged the next day and did not experience any problems during the six-month follow up period.
Conclusion: To our knowledge, this is the largest atrial septal defect that was closed percutaneously through jugular vein in children. In our case, we observed that transjugular use of a steerable guide cath- eter for percutaneous closure in a pediatric patient with large ASD and interrupted IVC is feasible and convenient.
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PERCUTANEOUS STENT IMPLANTATION FOR THE TREATMENT OF COMPLEX COARCTATION OF AORTA (COA) AND AORTIC ARCH OBSTRUCTIONS
Ahmet Celebi1, Ilker Kemal Yucel1, Orhan Bulut1, Sevket Balli1, Mehmet Kucuk1, Emine Hekim Yilmaz1, Evic Zeynep Basar1
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111