Page 78 - Journal of Structural Heart Disease - Volume 1 Issue 2

107
Meeting Abstracts
Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery; Pediatric Cardiology, Istanbul, Turkey
Background: Stent implantation (SI) has become an accepted mo- dality for treatment of COA in older children, adolescents and adults. However, It may be challenging and technically demanding proce- dure in complex anatomic variations; i.e. subatresia, aortic/isthmus atresia, transverse arch hypoplasia or stenoses, short segment COAs very close to the left subclavian artery, long segment middle aortic syndromes, thoraco-abdominal or abdominal COAs, COAs associated with aneurysm or PDA, COA in Turner syndrome, COA associated with abnormally origin right subclavian artery from the coarcted segment.
Method: 136 patients with COA underwent to SI in our institute be- tween 2007 and 2015. 45 of them had different properties and need- ed different techniques than standard SI. Antegrade approaches with radial artery puncture, perforation of the membrane or ligament between the proximal and distal parts, rapid pacing, multiple stent with telescopic method, double balloon-double wire technique, im- mediate asymmetric redilation with semi-compliant balloons were required in these complex COAs.
Results: Mean age was 17.7 ± 8.9 years (4.0- 49 years) and weight was 52.3 ± 20.3 kg (19-90). COA was subatretic in 8, was associated with PDA in nine and aneurysm in nine. Guidewire perforation of aortic atresia was performed in 4. Five patients had long middle aortic syn- drome and abdominal COA very close to the vital branches or side branches from the coarcted segment. Transverse aortic arch hypo- plasia or stenosis was treated by SI in 3. COA was very close to the left subclavian artery in seven. SI was successful in all. 53 stents (41 Covered CP, 7 Bare CP, 5 Andrastent) were used in 45 patients. Mean pressure gradient decreased from 49.5 ± 23 to 4.3 ± 5.6 mmHg. One patient with Turner syndrome died 10 days after the procedure due coronary artery thrombosis and myocardial infarction during the SI in spite of percutaneous thrombus aspiration and revascularization. During the median 50 months of the follow up, 5 re-interventions were required for restenosis in 4 and for stent fracture in one.
Conclusion: By the time, SI for the treatment of complex COAs have become safe and more effective alternative than the surgery with implementing new and different techniques as gaining more experi- ence using bare or covered stents up to specific situations.
#0181
SINGLE CENTER EXPERIENCE ON CUTTING BALLOON ANGIOPLASTY IN THE TREATMENT OF BRANCH PULMONARY ARTERY STENOSIS AFTER SURGERY IN SMALL CHILDREN
Ahmet Celebi, Neslihan Kiplapinar, Orhan Bulut, Ilker Kemal Yucel, Emine Hekim Yilmaz, Mehmet Kucuk, Sevket Balli
Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery; Pediatric Cardiology, Istanbul, Turkey
Introduction: Cutting balloon angioplasty (CBA) is a promising tech- nique for the treatment of highly challenging vascular stenosis es- pecially in peripheral pulmonary artery stenosis. We will present our experience on CBA for the treatment of branch pulmonary atery ste- nosis (BPS) in childhood.
Methods: Seventeen children <5 years old, median age of 18 (4.5-54) months, median weight of 9,5 kg (5.5-16), with BPS after surgical re-
pair of congenital heart diseases treated with CBA were prospectively analyzed. We used staged approach for dilation of stenotic vessel to avoid rupture. After CBA, further dilation was performed with opti- mal size low pressure balloon (LPB), and if it was not effective, dilated 1-2mm<optimal size high-pressure balloon (HPB) was used. If result was insufficient, optimal size LPB was used again.
Results: Diagnosis of children was s/p Jatene for TGA in 11, s/p re- paired TOF- PA 2, s/p repaired TA /interruption in 2, s/p Taussig-Bing and coarctation in 1, s/p Glenn in 1. 28 vessels were dilated with CBA. Stenotic vessels were RPA in 5, LPA in 1, bilateral pulmonary artery in 11. Two vessels underwent subsequent LPBA and 26 vessels un- derwent HPBA. The diameter of the vessels increased from 3.2±0.85 to 5.5±1.4 mm (p <0.001). The RV/LV pressure ratio decreased from 0.9±0.17 to 0.57±0.14 (p =0.001). Vessel diameter increased by >%50 in 15 patients; procedural success rate was 88%. Increase in vessel diameter <%50 was observed in 2 patients both associated with su- pravalvar stenosis that became prominat after balloon dialations. The procedure and fluoroscopy times were 213±57 and 59±21 minutes, respectively. In one s/p Jatene patient, ascending aorta to the RPA fistula was developed and underwent to surgery due to significant residual shunt after device closure. No procedure related mortality was observed. At a median follow-up of 18 months, 4 patients un- derwent to successful surgery for recurrent supravalvar stenosis, and additional moderate TR in one. The remaining children are well, last echocardiographic gradient, median 45 mmHg, range 25-55 mmHg.
Conclusions:CBA is a feasible technique for treatment of BPS. CBA can be useful to delay the intervention up to appropriate age for pulmo- nary stent implantation.
#0182
OUTCOMES OF RECANALIZATION IN CHILDREN WITH VENOUS OBSTRUCTION WHO UNDERWENT VENOPLASTY OR STENT PLACEMENT
Meagan Peek, Shabana Shahanavaz
1Washington University School of Medicine, St. Louis, MO, USA
Objective: To determine the outcome of venous recanalization via venoplasty or stent placement in children.
Methods: We reviewed all available charts between 2007 and 2015. Patients were included if they had obstruction of the SVC, IVC or Innominate vein requiring venoplasty or stent placement. Patients were excluded if age greater than 5 years or weight greater than 10kg at the time of catheterization.
Results: Twenty-three procedures were performed on 17 identified patients. Five of 17 patients required re-intervention (group 1) at an average time of 3.2 months, while 12 patients remained free from re-intervention for an average of 21 months (group 2). Age (7.0 vs 6.8 months) and weight (5.8 vs 6.0 kg) were similar between groups. Two patients in each group died, and 3 patients were lost to follow-up (1 vs. 2). Patients in Group 1 were treated with venoplasty alone (n=6) or both venolasty and stenting (n=5). Only one patient required a third intervention. The average reduction in pressure gradient was 9.6 mmHg. Sixty percent of patients were anticoagulated prior to cathe- terization, and 60% were anticoagulated post-catheterization. Three of the patients in Group 1 had undergone orthotropic heart trans- plant. Patients in Group 2 were treated with venoplasty alone (n=5), stent placement alone (n=3), or both (n=4). The average reduction in
19th Annual PICS/AICS Meeting Abstracts