Page 18 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
Materials and methods: We are presenting seven cases of second- ary arterial hypertension management in pregnant women due to aortic coarctation. One of the women had mid-aortic syndrome without involvement of visceral vessels and another one was diag- nosed with hypoplastic transverse arch after coarctation repair. Mean age of patients was 25,71±5,28 years, mean body weight was 69,57±9,74 kg. Mean term of gestation at the time of diagno- sis was 23,28±5,76 weeks. Mean systolic blood pressure on admission was 175,71±32,58 [from 140 to 240] mmHg.
Results. All patients received antihypertensive drugs. Mean SBP on medication was 147,86±29,70 [from 110 to 200] mmHg. Four patients whose SBP was higher than 160 mmHg had percutaneous interven- tion for their coarctation. Three of them had coarctation stenting. The woman with transverse aortic arch hypoplasia had arch stenting when she was at the 15-th week of pregnancy. She experienced spon- taneous rupture of the fetal membrane at the day of intervention which was managed conservatively. Spontaneous uneventful vagi- nal delivery occurred in three women who had intervention before labor. The patient with transverse arch stenting had caesarian sec- tion done due to the residual arterial hypertension after procedure. Three patients had coarctation stenting after childbirth. All patients with native coarctation were managed with caesarian section and strict blood pressure control. Of them one woman experienced acute aortic dissection type A on the day of caesarian section. On the same day she had coarctation stenting and supracoronary ascend- ing aorta replacement. All pregnancies were completed success- fully with healthy babies born in term. Mean SBP after intervention was 126,42±10,69 mmHg. Mean pressure gradient decreased from 55,0±20,81 to 13,71±8,79 mmHg.
Conclusion. Stenting of coarctation during pregnancy seems to be safe and e ective option. There is no su cient evidence still to draw de nite conclusions about the optimal time of interventions. But, in our opinion it should be done before the labor due to high risk of cardiovascular complications despite strict blood pressure control. Interventions before 24-th week of gestation should be avoided as well in order to prevent miscarriages. Further multicenter investiga- tions are warranted.
Key words: coarctation of aorta • pregnancy • arterial hypertension.
#0012
A NOVEL USE OF THE AMPLATZER VASCULAR PLUG III IN PERCUTANEOUS CLOSURE OF VENTRICULAR SEPTAL DEFECTS
Anas Abu Hazeem, Abdullah Al Huzaimi, Mansour Aljoufan, Ghassan Siblini, Fadel Alfadley
King Faisal Specilaist Hospital and Research Center,
Riyadh, Saudi Arabia
Background: Percutaneous ventricular septal defect (VSD) closure was rst reported by Lock in 1988. Since then, the procedure has undergone many modi cations to the technique and devices to avoid complications, especially to the conduction system. The search for an ideal device for VSD closure that simpli es the procedure and minimizes complications is still ongoing. Here we report the rst use of the Amplatzer Vascular Plug III in VSD closure.
Methods: Charts and baseline electrocardiograms (ECG) of patients who underwent VSD closure using AVP III were retrospectively reviewed. VSD dimensions and other relevant measurements were obtained from intra-operative trans-esophageal echocardiograms (TEE)andangiography.Thepatients’ rstpost-operativeechocardio- gram and ECG were reviewed as well as latest follow-up if present.
Results: 16 patients (9 males, 7 females) underwent successful clo- sure of VSD using the AVP III (13 were peri-membranous (pm), 3 were muscular). Median age was 5.2 (1.6 to 16) years and median weight 14.5 (8.7-52.2) Kg. The VSD size was 5.2 (2.6-10) mm on the left ventric- ular side and 4.2 (2.7-7.3) mm on the right ventricular side. There were no major complications to any of the patients. Procedure and uoros- copy times were 140.2 (80-200) and 30.4 (13-48) minutes respectively. Only one patient had trivial residual shunt on next day post-operative TTE. One patient developed mild tricuspid regurgitation (TR) post VSD closure and 2 patients had resolution of previously present TR. None of the patients developed new conduction system abnormalities. Follow up is available in 6 patients. None of the patients had increased TR nor have any developed new conduction system abnormalities.
Conclusion: The AVP III’s oblong shape can be a good match for select pm-VSDs and small muscular VSDs. The small pro le of the device’s wings minimizes interference with the aortic or tricuspid valves and the small central pedicle also decreases the risk of conduction sys- tem complications. The device can be delivered through a soft guide catheter, which can ease the manipulation of the device into the VSD. Our initial experience with this device to close VSDs is promising but long-term follow up is required.
#0013
TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECT USING DIFFERENT AMPLATZER DEVICE OCCLUDERS : INITIAL EXPERIENCE OF SOUHAG UNIVERSITY HOSPITAL
Safaa Ali1, Redaa Abuelatta2, Sharaf Eldeen Mahamoud1 1Souhag University Hospital, Souhag, Egypt
2Madina Cardiac Centter, Madina, Saudi Arabia
Objective: To assess the challenges, feasibility, and e cacy of tran- scatheter closure of ventricular septal defect (VSD); perimembera- nous or muscular using di erent Amplatzer device occluders in initial experience of Souhag University hospital.
Patients/Methods: between 2013 to 2016, 26 patients (14 male, 12 female) underwent percutaneous closure of VSD using di erent Amplatzer device occluders . After obtaining the size of VSD from the ventriculogram and TTE or TEE, a device of 2 mm larger than the narrow- est diameter was chosen. The device deployed either by creation of arte- riovenous loop or by retrograde arterial approach. The procedure was done under guidance of TTE or TEE . Follow up evaluations were done 1 month, 6 months, 12 months and yearly after procedure with transt- horacic echocardiography and 12 lead electrocardiography. A retrospec- tive review of the treatment results and adverse events was performed.
Results: Successful device placement was achieved in 25/26 of patients (96.2%). Median defect diameter was 6.7 mm (range 6 to 11 mm). Median weight was 21KG(range 12 to50). Median age was 7 years (range
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts