Page 27 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
254
Method: 21 patients underwent transcatheter closure with CDO from November 2015 to August 2016. Decision for device size selection was based on the narrowest diameter of the PDA according to the manufacturer recommendation as the aortic end of the occluder shank to be at least 1.5-2.0 mm larger than the narrowest diameter of the duct.
Results: The median age of the patients was 1.2 years (6 months to 28 years) and weight was 9.6 kg (5.4 to 82 kg). 11 patients were under one-year-old and 11 had pulmonary hypertension (mean PA pressure >25 mmHg). All patients had continuous cardiac murmur on examination and all PDAs were type A. Narrowest PDA diameter at pulmonary side was 4.1 ± 1.7 mm (2.2-8.2 mm, median 3.8 mm). Intervention was successful in all. Final angiogram showed complete closure in 17/21 of them. Echocardiography achieved complete occlu- sion an all on the next day. In a patient with Down syndrome PDA was closed with 4/6 mm device, and device embolized to descending aorta after persistent cough 24 hours later. Than device was snared via femoral vein approach and closed with 6/8 mm device. None of the patients showed evidence of stenosis at branch pulmonary artery and descending aorta during the follow-up.
Discussion and conclusion: Our results showed us CDO is a safe and e cacious in closure moderate to large PDA’s whose duct morphol- ogy t to the ADO I. Its uniquely designed delivery/releasing system has an advantage in view of no applying tension to the device which provides the device in stable position and not changing the device position during and immediate after the releasing. It may give us an opportunity to be sure that the device not protrudes to the aorta after releasing, especially in infants those have small descending aorta.
#0034
THE RESULTS OF EMBOLIZATION AND DISLOCATION OF THE DEVICES AFTER TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT AND PATENT DUCTUS ARTERIOSUS
Ahmet Celebi, Ilker Kemal Yucel, Mustafa Orhan Bulut, Sevket Balli, Evic Zeynep Akgun, Gokmen Akgun,
Emine Hekim Yilmaz, Mehmet Kucuk
Dr. Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery, Department of Pediatric Cardiology, Istanbul, Turkey
Introduction: In this paper, we aimed to present the results and treatment methods of device embolization (DE) or malposition/ dislocations (DD) seen after transcatheter ASD and PDA device closure. Method: Between 2004 and 2016, the patients were retro- spectively analyzed regarding the DD and DE.
Results: Amongst the patients in whom a device closure of ASD was performed, DE and DD was encountered in ten and one, respectively. The median age of the patients was 19.5 (5-52) years. The septum was aneurysmatic in 2 , while the rims of the defect were either de cient or thin and mobile in 5. DE occurred due to spontaneous disconnec- tion of the devices during repeated attempts in three. The device embolized into PA in 5, into the left ventricle in 2, into the ascending aorta in one, into the right atrium in one and onto the mitral valve in one. The devices were retrieved with the use of a bioptome or a snare in 6 and the defect was closed with a larger device in 5 of these patients. 5 patients were referred for surgery. One patient was also referred for surgery due to DD at the aortic site causing signi cant
shunt. DE and DD was encountered after PDA closure in 8. DE was observed in 5 and DD into the descending aorta (DAO) was seen in 3. The median age was 2.5 years (1 month to 8 years), and the weight was 9.5 kg (3.3-24). PDA was conical in shape in 6 and tubular in 2. The median diameter of the PDA was 8.6 mm (3.7- 11.7). Except for one, pulmonary hypertension (PHT) equal to systemic pressure was present in all. Amongst 5 with DE, four devices embolized to the PA and to the DAO in one. 3 cases were referred for surgery. The devices were retrieved with the use of a snare from PA and DAO in 2. In one of these pts, PDA was occluded with a larger device. In the remaining, it could not be achieved even with a larger device. DD into the DAO led to a coarctation of the aorta in three. All of these patients had severe PHT. Two of these devices were repositioned successfully with the use of a bioptom, antegradely. In other patient, device was retrieved and PDA was closed with a muscular VSD device
Conclusion: The risk factors for DE after ASD closure are found to be the presence of a large defect, a de cient rim with an aneurysmatic septum, mismeasurement of the defect. The most important risk factor for DE after the PDA closure are found to be the presence of severe PHT. The retrieval rate is lower after with PDA devices than ASD devices.
#0035
ECHOCARDIOGRAPHY-GUIDED TRANSCATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS IN CHILDREN: FEASIBILITY AND SAFETY OF A NEW STRATEGY
Tianli Zhao, Weizhi Zhang, Lei Gao, Wancun Jin, Qin Wu, Yifeng Yang
Department of Cardiovascular Surgery, Changsha,
Hunan, China
Objective: The aim of this study was to evaluate the feasibility and safety of transcatheter closure of PDA under transesopha- geal echocardiaographic (TEE) guidance without uoroscopy and angiography.
Background: To avoid radiation exposure and contrast agent usage, the feasibility of transcatheter closure of atrial septal defects (ASD) without uoroscopy has been proven. However, it is unknown that weather or not the procedure is eligible for patent ductus arteriosus (PDA) closure.
Methords: From June 2014 to May 2016, a total of 102 children (38 males, 64 females), aged from 1 to 14 years (median, 2.3 years), and weighted from 6 to 46kg (median, 11.6kg), with isolated PDA (diameter of 2.5 to 7.5mm, median 3.8mm) underwent attempted transcatheter device closures. The procedures were performed under TEE guidance with- out uoroscopy and angiography and the occluders were deployed by using modi ed delivery system via femoral venous access alone.
The patients were followed up by clinical examination, electrocardio- gram, and TTE at 1, 3 and 6 months, and then yearly.
Results: PDA were successfully closed in 99 patients (97.1%). There were no acute procedural complications or severe adverse events. The procedure time ranged from 10 to 45 minutes (median, 21
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306