Page 28 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
minutes). Immediate complete closure of PDA was achieved in 87 patients (87.9%), and in 100% after 24 hours. The median hospital stay was 3.8 days. No intervention-related complications were detected during the period of 1-24 months (median, 12 months) follow-up.
Conclusions: Echocardiography-guided transcatheter closure of pat- ent ductus arteriosus is a feasible and safe procedure which is eligible for alternative use in children.
Key words: Patent ductus arteriosus • Transcatheter closure • Transesophageal echocardiography • Radiation protection
#0036
RESULTS OF TRANSCATHETER PULMONARY VALVULATION IN CHILDREN < 30 KG.
Alejandro Rodriguez Ogando, Fernando Ballesteros Tejerizo, Jose Luis Zunzunegui Martinez
Gregorio Marañon Hospital, Madrid, Spain
Introduction: Although widely accepted, indications for percutane- ous pulmonary valve replacement (PPVr), are limited to prosthetic conduits in the right ventricle out ow tract (RVOT) in patients ≥30kg.
Aim: To evaluate the outcomes of Melody valve insertion in patients <30Kg.
Methods: We analysed procedural and outcomes data from 23 patients <30 kg (9 patients <20 kg), who underwent Melody valve implantation for a native/patched RVOT(N=10), prosthetic conduit (12) and bioprosthesis (N=1).
Results: Median age and weight was 5.8 years (1.5-13) and 22kg (9-29.8). PPVr indication was regurgitation in 10, stenosis in 1 and mixed in 12. All procedures were successful. PPVr was performed through the femoral vein in 12 cases, jugular vein in 10 cases and transapical-perventricular in 1 case. Pre-stenting was performed in 95% of cases, 15/23 in the same procedure. No signi cant regurgita- tion was recorded after the procedure, and the trans-pulmonary gra- dient was signi cantly reduced. Early minor complications occurred in 2 cases (10%) The median hospital stay was 3 days (2-5). Median fol- low-up was 44 months (4-82). During follow-up, one patient under- went a new PPVr (valve-in-valve procedure); one patient required overdilation of the prosthesis; and one patient developed stent frac- ture. Follow-up with MRI demonstrated signi cant improvements in right ventricular volumes and function.
Conclusion: PPVr s highly feasible in children <30 kg, in both, native RVOT and prosthetic conduits, and mid-term follow-up, demon- strates good haemodynamic results and appear promising.
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STENTING OF THE NATIVE RIGHT VENTRICULAR OUTFLOW TRACT IN THE SYMPTOMATIC INFANT WITH TETRALOGY OF FALLOT (TOF)
Fernando Ballesteros Tejerizo, Alejandro Rodriguez Ogando, Jose Luis Zunzunegui Martinez
Gregorio Marañon Hospital, Madrid, Spain
Objective: To assess feasibility, safety and e ectiveness of right ven- tricular out ow tract (RVOT) stenting in symptomatic young infants with TOF.
Methods: Retrospective case note and procedure review of patients undergoing stenting of the RVOT over an 5 year period.
Results: Between 2010 and 2015, 9 patients underwent stent implanta- tion; median age was 48 (range 1–364) days , and median weight was 3.7 (2,2–7) kg. Median procedure time was 54 (30–233) min and uoroscopy time 20 (12,6–77) min. There was one procedural emergency surgery. Two patients required ECMO support during the procedure. The pulmo- nary valve was deemed unsalvageable in all patients but one (median valve diameter 5 mm (range 4–8), median Z-score -3 (range -5 to -0,5). Saturations increased from 77% (50–85%) to 95% (85–98%) (p<0.005). Two further catheter interventions were undertaken (balloon in 1, stent in 1). 7 patients underwent delayed surgery (complete repair in all of them) at a median of 140 (111–200) days post-stenting. No surgery was compromised by the presence of stents in the RVOT. There were no perioperative deaths. Median Nakata index increased from 80mm2/ m2 (50–200) to 126 mm2/m2 (100–251)(p <0.05) before surgical repair.
Conclusions: In the symptomatic young infant with TOF, stenting of the RVOT provides a safe and e ective management strategy, improving arterial oxygen saturation and encouraging pulmonary artery growth.
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PERSISTENT 5TH AORTIC ARCH IN A PATIENT WITH 22Q11.21 DELETION
Subhrajit Lahiri, Enrique Oliver Aregullin
Nicklaus Children’s Hospital, Miami, Florida, USA
Background: Double-barreled aorta or persistence of 5th aortic arch is an extremely rare cardiovascular anomaly and only few cases of persistence of 5th arch with Pulmonary atresia, ventricular septal defect, and aorto-pulmonary collaterals (PA, VSD, MAPCA) have been reported. We present a case of PA, VSD, MAPCA with persistence of the 5th aortic arch in a patient with a 22q11.21 mutation. This dou- ble barrel aorta is characterized by presence of a second systemic to systemic channel connecting the ascending and descending compo- nent s of the aorta.
Case Report: A full term female newborn failed pulse oximetry screening at 36 hours of life. First echocardiogram showed PA, VSD, MAPCA and discontinuous pulmonary arteries. Prostaglandin drip was started and patient transferred to our institution. Repeat echo followed by CT angiography con rmed anatomy and showed left sided arch with a persistent 5th arch.
In our patient a second vessel originated from the undersurface of the proximal transverse aortic arch (embryologic 4th aortic arch) just distal to the origin of the right common carotid artery and connected to the distal transverse aortic arch just distal to the origin of the left subclavian artery. The normal (4th) arch is small compared to the 5th arch and sequentially supplies the left common carotid, left vertebral, and left subclavian arteries before connecting to the 5th arch. The left sided ductus originated distally from this connection from the
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts