Page 23 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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When we tried to measure right pulmonary wedge pressure, she sud- denly complained chest pain and showed massive hemoptysis that progressively su ocated her. She fell in shock, but was successfully treated by volume expansion, intravenous adrenalin infusion, and placement of laryngeal mask successfully replaced with blind tra- cheal intubation.
Repeated exploratory pulmonary angiography showed uncon ned pulmonary bleeding that could lead to continuous bleeding without treatment. We placed a 4 French Judkins left coronary type catheter into right lower branch and placed 2 Flipper coils with loop-diameters of 6.5 mm and 5 mm. However, there was still continuous bleeding and we place a Amplatzer Vascular Plug of 8 mm in diameter that could suc- cessfully brought complete occlusion and stop pulmonary bleeding.
Conclusion: Cardiac catheterization of patients with pulmonary hypertension carries a risk of severe complication, namely pulmonary bleeding. Preparation of laryngeal mask and occlusion devices such as coils and Amplatzer vascular plugs are mandatory in this setting.
#0023
INTRA-CARDIAC ECHOCARDIOGRAPHY GUIDED TRANS-CATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS WITHOUT CONTRAST ANGIOGRAPHY Kenji Suda1, Hironori Kuwahara1, Yoshiyuki Kagiyama1, Hironaga Yoshimoto2, Yusuke Koteda1, Shintaro Kishimoto1, Motofumi Iemura2
1Kurume University School of Medicine, Kurume, Japan
2St. Mary’s Hospital, Kurume, Japan
Background: Though contrast angiography is the standard guidance of trans-catheter closure of patent ductus arteriosus (TC-PDA), it is contra-indicated in patients with severe renal disease that often seen in senile patients. We have developed intra-cardiac echocardiog- raphy (ICE) guided TC-PDA (Cathet Cardiovasc Intervent 2015). We report sequential 6 cases that successfully underwent TC-PDA with- out contrast angiography.
Materials and Methods: Subjects were 5 patients with PDA and median age of 57.4 (35.4 - 66.1) years old. The median size of PDA was 4.6 (3.2 - 11.7) mm with median Qp/Qs of 1.9 (1.4 and 2.4), respectively. The oldest patient su ered from renal dysfunction and 2 patients had pulmonary hypertension. Prior to the TC-PDA, all patients underwent contrast X-ray computed tomography to clarify the anatomy. ICE catheter was inserted through 2nd sheath at femoral vein and placed at main or left pulmonary artery. During the TC-PDA, we primarily used ICE to guide the procedure.
Results: We could successfully place Amplatzer Duct Occluders in 4 and Amplatzer Septal Occluder in 1 without contrast angiography. ICE at main or left pulmonary artery has allowed us to determine the diameter and length of PDA, to monitor the device placement, and to determine the residual shunts. ICE did not increase the risk of compli- cation except for transient arrhythmia, though new operator needs some learning time to understand orientation of ICE.
Conclusion: ICE-guided TC-PDA without contrast angiography is fea- sible and can be the standard treatment for adult patients with renal dysfunction.
#0024
COMPLICATIONS FOLLOWING PERVENTRICULAR DEVICE CLOSURE OF MUSCULAR VENTRICULAR SEPTAL DEFECT
Massimo Caputo, Damien Kenny, Karim Diab,
Gia Marzano, Amy Wilhelmi, Bassel Nijres
Rush University Medical Center, Chicago, IL, USA
A male infant was born with tricuspid valve (TV) dysplasia with severe regurgitation and Swiss-cheese muscular ventricular septal defects (MVSD). Diagnostic cardiac catheterization demonstrated signi cant left-to-right shunting with a Qp:Qs ratio of 2.29:1. He underwent attempted perventricular device closure of the MVSDs with surgical repair of the TV. A purse-string was placed into the mid-portion of the right ventricle (RV) free wall to provide direct access to the ante- rior MVSD. Attempts to close the apical-MVSD with a device were unsuccessful due to its crowding with RV trabeculations. Hence, the decision was made to leave the apical-MVSD without further intervention. Transesophageal echocardiogram suggested a small outpouching posterior to the left ventricle (LV) free wall measuring about 5x7mm that was concerning for a potential LV-PSA (pseudoan- eurysm) caused by the wire vs. sheath across the VSD. Therefore, car- diopulmonary bypass was initiated, the TV was repaired and a MPA band was placed.
An echocardiogram showed enlargement of the LV-PSA to 3.7x4.0x2.7 cm, which was con rmed with cardiovascular magnetic resonance, reveal- ing a narrow neck at its origin from the LV apex. Due to the concern for rupture, the aneurysm was repaired surgically. The two devices were extracted and the aneurysmal sack was completely resected.
#0025
INITIAL EXPERIENCE OF ATRIAL SEPTAL DEFECT CLOSURE USING THE NEW GENERATION CARDIA ULTRASEPT IITM DEVICE IN MEXICO.
Roberto Mijangos Vázquez
Pediatric Hospital, Tuxtla Gutiérrez, Chiapas, Mexico
We present the initial experience in Mexico of atrial septal defect closure using the new Cardia Ultrasept IITM device. We present a series of 9 patients with ASD previously selected as candidates with favourable anatomy (less than 38mm defect, rims greater tan 5mm) to be subjected for closure of the defect through interventionism treated in the period April-August 2016. Preliminary prospective, observational, transverse and descriptive study. The group included 7 female patients (76%) with a median age of 8 years (1-13). The hae- modynamic and anatomical data were as follows: pulmonary artery systolic pressure 25.14 ±3.9 mmHg, pulmonary to systemic ow ratio 2.38 ±0.66, septal defect diameter 17.78 ±6.18 mm, expanded defect diameter 22.6 ±5.82 mm. All septal occluder were delivered success- fully. No residual shunt evidenced by angiography and intracardiac echocardiography. At follow-up to 2.1 months, all patients showed complete closure of the defect and continuous decreased of right ventricular diastolic diameter with an initial median of 38mm (30–40) and after catheterization of 28.5mm (23–30), p=0.01 and Z-score of 3 (2.87–3.15) vs 1.8 (1.5–1.95), respectively, p=0.01. The new generation of the Cardia Ultrasept IITM device is a good alternative to percutane- ously treat atrial septal defect.
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306