Page 31 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
258
#0043
CHALLENGES OF TRANSCATHETER INTERVENTIONS FOR CONGENITAL HEART DISEASES IN DEXTROCARDIA
I.B Vijayalakshmi
BMC&RI Super Specialty Hospital (PMSSY), Bengaluru, India
Background: Several challenges are faced by interventionalists while performing various percutaneous interventions for congenital heart disease (CHD) in patients with dextrocardia. The anatomical altera- tions in dextrocardia especially the lie of the interventricular septum (IVS) can cause impediment for device closure of ventricular septal defect (VSD) and lie of interatrial septum (IAS) for puncture.
Aim: The aim of our study is to evaluate the challenges, feasibility and e cacy of transcatheter interventions in children with CHD in dextrocardia.
Materials and Results: Out of 60 patients of CHD with dextrocardia catheterized, only 9 patients (15%) underwent transcatheter interven- tions. The age was 4 months to 16 years (mean 5.4 years), weight - 4.1 to 40 kgs (mean 8.4 kgs). 3 cases underwent successful device closure for patent ductus arteriosus (PDA). 2 cases of midmuscular VSD (MVSD) were closed. One had to be closed with Amplatzer ventricular septal occlude through the jugular approach and the other with Amplatzer duct occluder II (ADO II).There was a di culty in puncturing IAS during balloon valvuloplasty for mitral stenosis in a case of right-sided May Thurner Syndrome (MTS). Balloon valvuoplasty was done in one infant with severe pulmonary stenosis by ipping the cine image. One very sick patient with inferior vena cava web died after cavoplasty and stenting.
Conclusion: The catheter interventions in CHD with dextrocardia though di cult is feasible. The device closure of PDA and MVSD is not di cult especially with ADO II. The balloon mitral and aortic valvu- loplasty in the complex cardiac anatomy of situs inversus totallis is feasible and safe. Rarely right-sided MTS may cause problem for right femoral access during transcatheter procedure.
#0044
CHALLENGES OF INTERVENTIONS FOR ASSOCIATED LESIONS IN CASES OF APICAL NON-COMPACTION I.B Vijayalakshmi
BMC&RI Super Specialty Hospital (PMSSY), Bengaluru, India
Background: Isolated left ventricular non-compaction is reported extensively. But apical non-compaction (ANC) of both ventricles and septum is not reported much in literature. For the rst time in the world, we are reporting the challenges of various interventions for di erent associated lesions in ANC.
Aim: To know the challenges and feasibility of transcatheter interven- tions for the associated lesions in cases of ANC to reduce the pump failure.
Material and Results: Out of 100 consecutive patients diagnosed as ANC by transthoracic echocardiography (TTE), 30 cases underwent various transcatheter interventions, formed the material for this
study. Age ranged 3 days to 17 years ( mean 8 years ). The device clo- sure was done for PDA in 2, VSD in 15, ASD -1, ARVT in 1, ARAT in 1, ABV in 4, PBV in 2, aortoplasty in 1, PTMC in 2, pericardiocentesis in 3. 5 patients underwent two procedures in the same sitting. They were ABV and PBV, ABV and PTMC, ABV and PDA device closure, ASD and VSD device closure and PDA and VSD device closure. 3 cases of VSD were post- operative residual and one was closed with multi- ple devices. One 8 months infant had apical VSD closed with ADO II. Another 2 year old child underwent hybrid surgery for closure of VSD with 14 mm device. One child with mirror image dextrocardia and midmuscular VSD was closed with device. In one case procedure was abandoned as 18 mm VSD device slipped.
Discussion: Procedures in ANC is risky in presence LV/or RV dysfunc- tion with or without thrombosis. Positioning the device in apical VSD in ANC cases is very challenging as the device gets caught in trabe- culae in RV and if more tug is given the device slips through spongy myocardium. The results of interventions are very gratifying as the superadded pump failure due to pressure or volume overload caused by associated lesions improves signi cantly. One patient with severe AS and mitral stenosis had reverse May Thurner syndrome (obstruc- tion of right common iliac vein by right common ileac artery), hence procedure was done through left femoral puncture.
Conclusion: Associated lesions in ANC worsen the pump failure. Transcatheter interventions though challenging are feasible safe e ective and are lifesaving. Transcatheter interventions certainly reduce the morbidity and mortality in ANC patients who are at high risk for surgery or redo surgery.
#0045
RETROGRADE TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECTS
I.B Vijayalakshmi
BMC&RI Super Specialty Hospital (PMSSY), Bengaluru, India
Background: Amplatzer Duct Occluder II (ADO II) is designed for clos- ing long ducts in infants. There are few reports of “o -label” use of ADO II in non-ductal positions.
Aim: To evaluate the advantages and disadvantages of retrograde transcatheter closure of ventricular septal defects (VSD) with ADO II.
Material and Results: 102 cases of VSDS closed by retrograde tran- scatheter method with ADO II, formed the material for the pro- spective study. Age: 8 months to 23 years (mean 9.1 years). 74 perimembraneous VSDs, 14 muscular VSDs,13 Gerbode defects, one midmuscular VSD with dextrocardia, were closed. The shortest uo- roscopic time was 4.2 min, mean was 8.4± 4.1min. In six cases there was initially a small residual shunt which had closed on three months follow up. Only in one case the device embolized to left pulmonary artery and it was retrieved . Eleven cases developed transient com- plete heart block which resolved and only one of them needed tem- porary pacing.
Discussion: ADO II has a very low pro le and can be easily delivered through a 5F guiding catheter needs very short uoroscopic time as artero-venous (AV) loop is not needed. The cost is 1/3 the cost of
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306