Page 79 - Journal of Structural Heart Disease - Volume 1 Issue 2

Meeting Abstracts
108
pressure gradient was 3.6 mmHg. Fifty percent of patients were anti- coagulated prior to catheterization, while 66% were anticoagulated post-catheterization. 1 patient in Group 2 had undergone orthotro- pic heart transplant.
Discussion: The majority of pediatric patients undergoing venous recanalization will only require a single procedure. Re-intervention does not seem to be related to patient age, weight, affected vessel, anticoagulation regimen, or method of intervention.
septal defect 4 months ago. He had a protracted course with progres- sive heart failure, severe AV valve regurgitation and pulmonary vein stenosis. During cardiac catheterization, he was noted to have exten- sive thrombosis of the left internal jugular vein and L-SVC, draining to the coronary sinus. Thrombectomy was performed using the Angio- jet followed by local administration of t-PA overnight. Follow-up angi- ography the next day showed significant residual thrombus. The An- giojet system was therefore placed for overnight therapy. Follow-up angiogram revealed improved flow in the SVC with diminished clot burden. Further manual aspiration was performed with the Pronto catheter and patient switched to heparin with no further thrombo- sis noted on follow-up catheterization and Doppler studies. There was unobstructed flow in the femoral vein used for placement of the EKOS system.
Case #2: A 15 month old (8.1 kg) infant post heart transplant 4 days ago with donor-recipient size mismatch, after failed palliation of congenital heart disease. Post transplant he has required inotropic support with progressively worsening head and upper body edema. Echocardiogram was concerning for SVC obstruction. Angiography showed complete occlusion of the SVC, right and left innominate veins, with inadequate response to balloon angioplasty. The EKOS system was placed overnight. However, the patient developed pro- gressive hypotension, anuria, and low cardiac output due to severely depressed right ventricular function. He was therefore taken for ur- gent surgical thrombectomy. There was no evidence of pulmonary embolism noted during surgery.
Conclusion: We report the use of EKOS system for treatment of ve- nous occlusion in small children. There were no procedure-related adverse events with complete resolution of the thrombus in one case.
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PEDIATRIC
IMPELLA PERCUTANEOUS MECHANICAL SUPPORT FOR DECOMPENSATED CARDIOGENIC SHOCK
Dhaval Parekh, Sebastian Tume, Aamir Jeewa, William Dreyer, Athar Qureshi, Iki Adachi, Henri Justino
Baylor College of Medicine / Texas Children's Hospital, Houston, TX, USA
Background: Decompensated cardiogenic shock (DCS) remains a se- rious complication with high mortality and morbidity rates in chil- dren. Aggressive therapy with inotropic support and intubation may be insufficient requiring mechanical support. Pediatric experience with Impella is limited. We present the largest case series to date of patients treated with Impella at a single free standing children’s hos- pital.
Methods: Retrospective chart review of Impella devices in the setting of DCS.
Results: 6 patients (2 female) were supported with (7) devices in- cluding Impella 2.5 (n=1), CP (n=4), and 5.0 (n=2). Median age was 16 years (r=6.5-25), wt 60 kg (22-74) , and BSA 1.71 m2 (0.91-1.97). Median duration of support was 10 days (r=5-18). Baseline PCW/ EDP improved from 21.5 mmHg (r=15-28) to 15.2 mmHg (r=8-19). All patients survived 30 days post explant. 2 pts were placed while on ECMO in lieu of atrial septostomy for left heart decompression. 4 pts with femoral access with 2 required graft placement for 5.0 de- vice. 3 pts explanted without additional mechanical circ support. 2 pts (33%) had increased level of mechanical support after a period of initial stabilization to ECMO and BiVAD. 2 pts device placed under conscious sedation including 1 pt via percutaneous axillary insertion who developed a non limb threatening arterial occlusion. 2 pts had site bleeding due to underlying DIC or anticoagulation.
Conclusion: Use of Impella device should be considered in pts with DCS or as a means of left heart decompression on ECMO.
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USE OF THE EKOS SYSTEM IN VENOUS OCCLUSION IN PEDIATRIC POPULATION
Asra Khan, Dhaval Parekh, Athar Qureshi
Baylor College of Medicine, Houston, TX, USA
Background: Treatment of acute venous thrombosis can be challeng- ing in the pediatric population. We present the use of EKOS (EkoSonic Ultrasound Endovascular System) in 2 patients with acute massive venous thrombosis.
Case #1: A 9 month old (6.8 kg) infant post repair of atrioventricular
HEART CENTER
EXPERIENCE WITH
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PERCUTANEOUS
CLOSURE:A SINGLE CENTER EXPERIENCE
Liliana Ferrin, Teresa Escudero Correa, Juan Manuel Lange, Maria Elena Ferreiro, Alejandro Romero, Fernando Picoli, Corrientes Cardiology Institute, Corrientes, Argentina
Transcatheter VSD closure is an effective, safe and challenging tech- nique depending of the anathomy situation. We show the initial ex- perience in transcatheter congenital VSD closure with device’s choice in relation to the VSD anathomy
Material and Methods: Between 2005 and 2013 were performed 39 procedures in 38 patients(pts). Mean age was 12 years ( 3-27). All patients had clinical or echocardiography left ventricle overload evi- dence secondary to QP/QS >1,5:1, one patient with refractary cardi- ac left fealured. Low to moderate RV or PA elevation. All procedures were performed monitored by TEE.
Results: VSD Closure was effective in 37 of 39 procedures. Mean VSD diameter was 7,23 +- 3,7mm (from 4 to 14 mm). Amplatzer mVSD was implanted in 12 mVSD(mean diameter 8mm). ADOS II 6/4mm was used by retrograde approach in 3 hmVSD and in the last a NOPDA 7x6. 15 of 19 pmVSD were closured with NO LeVSD (8-12 mm). In the other 4 pmVSD: Amplatzer pmVSD, CERA pmVSD device in 2 pts and 2 Memopart excentric pmVSD in the last pt. Inmediate effective clo- sure was achieved in all mVSD, hmVSD and in 35 pmVSD. In a patient with NO LeVSD and in 1 of CERA device, trivial residual shunt with complete closure at 3 month. In the last patient were implanted 2
VENTRICULAR
SEPTAL
DEFECT
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 2: 36-111