Page 24 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
#0026
EMBOLIZATION OF A LARGE VENO-VENOUS COLLATERAL FROM THE INNOMINATE VEIN INTO THE LEFT ATRIUM WITH TWO AMPLATZER DUCT OCCLUDERS II VIA A HYBRID APPROACH AFTER FONTAN-OPERATION
Heike Schneider, Matthias Sigler, Ulrich Krause,
Thomas Paul
University Goettingen, Goettingen, Germany
Veno-venous collaterals (VVC) may lead to signi cant systemic desaturation after Fontan operation. We present a 16-year-old girl with univentricular physiology who had undergone palliation with a Damus-Kaye-Stansel procedure, Glenn operation and Fontan com- pletion at another institution. Cardiac catherterization had revealed mean Fontan pressures of 23 mmHg. Subsequent treatment with Bosentan had resulted in a drop to 15 mmHg several years before. A large VVC from the innominate vein to the left atrium had been iden- ti ed with systemic SaO2 ranging from 85-90%. Interventional closure had been attempted several times at three di erent large volume pediatric cardiac centers. Finally, this patient was transferred to our institution in severe heart failure with ascites, systemic desaturation and poor ventricular function. Under mechanical ventilation with FiO2 1.0 and NO 20 ppm, arterial SaO2 could not be increased above 60%. Despite optimal medical management, her status deteriorated rapidly. A single chamber cardiac assist device (Berlin Heart) was implanted and the girl was listed for urgent heart transplantation. Due to continued severe hypoxemia and metabolic acidosis it was decided to close the large VVC via a hybrid approach as other access routes had failed before. Access via the left ventricle was chosen in order to achieve a straight angle to the insertion of the VVC into the roof of the LA. After introduction of a sheath into the LV, the VVC could be entered with a right Judkins catheter and an 8F Amplatzer sheath could be advanced deep into the VVC subsequently. On angiography the VVC measured 12 x 14 mm in diameter at its nar- rowest portion, the widest site was 22 mm. Accordingly, an 18 mm Amplatzer Vascular Plug (AVP) II was deployed in the distal VVC. For complete closure a second AVP II (20 mm) was implanted slightly more proximally. Arterial oxygen saturation immediately increased to 80% thereafter. Final angiogram demonstrated adequate and stable position of the AVPs. The chest could be closed without complica- tions. Unfortunately, despite this successful intervention the patient died due to multi-system organ failure while awaiting heart trans- plantation. Conclusion: Embolization of signi cant VVC should not be deferred if typical access ways fail. Hybrid procedures may o er alternative access routes to bene t the patient’s individual needs.
#0027
THE EFFECTS OF APPLYING RADIATION DOSE REDUCTION MEASURES DURING PEDIATRIC CARDIAC CATHETERIZATION PROCEDURES
Beth Price, Saar Danon, Jodi Hundley, Saadeh Jureidini,
SSM Health Cardinal Glennon Children’s Hospital, St. Louis, Missouri, USA
Exposure to radiation has become an increasing concern among healthcare providers, workers and patients. The e ects of radiation can result in several complications, ranging from acute burns on the
skin to long term malignancies, which ultimately can result in serious morbidity or death. Due to the concerns of radiation exposure, our institution has initiated changes to our practice to help reduce the radiation exposure to our patients and sta .
During 2014, our cath lab implemented a lower uoroscopy rate of 3 frames/sec (when felt to be adequate by the provider), increased use of radiation shields and collimators, and increased the use of “ uoroscopy record” and “ uoroscopy save”. After reviewing the average radiation doses (mGy) and (mGy/min), it was found that our changes did indeed have a positive impact in decreasing the radiation exposure signi cantly. Prior to those changes, in 2013, the average total radiation dose for diagnostic caths was 164.4 mGy and for six types of interventional caths was 289.6 mGy. Following those changes in 2015, the average total radiation dose for diag- nostic caths decreased to 107.7 mGy (34% reduction), and for these same six types of interventional caths it decreased to 136.4 mGy (53% reduction). During that same time period the radiation dose/min of uoroscopy decreased from 9.7 mGy/min to 5.4 mGy/ min (44% reduction) for diagnostic caths and from 11.8 mGy/min to 6.1 mGy/min (48% reduction) for the interventional caths. The radiation exposure for each of the providers, as measured by a radi- ation badge, decreased by from 1546.5mGy in 2013 to 670mGy in 2015 (56.7% reduction). During this same time period, there was no increase in complication rate.
The data obtained demonstrates how relatively small changes in our practice and radiation awareness can decrease the amount of radi- ation exposure to the patients and sta in the cardiac cath lab. Our program will continue to remain aware of radiation exposure and strive to keep the dose as low as possible. With the guidance of the National Cardiovascular Data Registry (NCDR®) Impact RegistryTM, we are able to maintain and keep track of our improvements.
#0028
IMPACT OF ANESTHETIC MANAGEMENT DURING DIAGNOSTIC CATHETERIZATIONS PERFORMED IN SINGLE VENTRICLE PATIENTS PRIOR TO STAGE II PALLIATION
Ryan Romans, Nicole Wilder, Issac Davidovich, Olubukola Na u, Je tey Zampi
University of Michigan, Ann Arbor, MI, USA
Background: Infants with single ventricle (SV) physiology who undergo elective diagnostic cardiac catheterization prior to stage II palliation (pre-stage II catheterization) require either conscious seda- tion (CS) or general anesthesia (GA). Ideal anesthetic management provides a steady-state hemodynamic assessment with little impact on procedural safety. We sought to compare the safety and e cacy of various anesthetic management strategies (CS vs. GA) during the pre-stage II catheterization.
Methods: We performed a single center retrospective cohort study of SV patients undergoing pre-stage II catheterization between 2010 and 2015. Safe sedation was de ned by absence of cardiac or respi- ratory events during or within 24 hours of the procedure and no need for post-catheterization ICU admission. E ective sedation was de ned by stable hemodynamics (<2 episodes of heart rate increase
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts