Page 33 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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and muscular VSDs (MUSC VSD) treated with Cera® devices (Lifetech Scienti c, Shenzhen, China).
Background: Cera VSD Occluder is formed of a nitinol wire mesh, covered with a ceramic coating which reportedly reduces the risk of thrombus formation, encourages endothelialization, and minimizes systemic nickel ion release.
Material and Method: from October 2013 to September 2016, 14 p were treated with CERAÒ devices. This is a prospective analysis. Median age: 11 y/o (2.6 to 25 y/o). Median weight: 40 kg (14 to 70 kg). Gender: 9/14p M 6/14p F. All the p had femoral artery and venous approach. All the p with general anesthesia. X: QP/QS: >1.3:1. All the procedures were carried out with arterio-venous loop. LV angio- grams: a) perimembranous VSD: 60° cranial-20° LAO, b) muscular VSD: 40° cranial-20° LAO. All the procedures were guided with TEE and TTE. Measurements by echo and angiography: right and left diameter and length of the defect.
Results: 7/14 p: perimembranous VSD, 3/14 p post surgical (1/14 p double committed VSD, 1p PM VSD and 1/14 p Pulmonary atre- sia with VSD), 4/14 p: muscular VSD (1/14 mid ventricular VSD, 1/14 multiple VSD, 2/14 muscular-membranous VSD). Total proce- dures: 17 (1 p suffered an AV block during the catheterization of the VSD so that the procedure was cancel and in a second session the VSD was totally occluded). 1p the device embolized. In a sec- ond procedure, the device was retrieved and a bigger device was successfully positioned. Devices used: 1 type I, 8 type II, 2 type III, 3 muscular VSD. Complications: 1 embolization, the device was snared and the VSD was treated with a bigger device. This emboli- zation was in the third p. 3 AV blocks in the first 24 hs, treated with steroids. The p were discharged with sinusal rithm.One of them had sick sinus syndrome.
Follow up: 3p with residual shunt (2 mild and 1 moderate who is waiting for a second procedure). There weren’t av-block. As the initial experience was good, we decided to close VSDs in p under 10 kg. 1p with 8 grs had a perimemb VSD. It was closed with 7 type III peri- memb device with correct result.
Conclusions: 1) Lifetech devices are a good choice to close VSDs. 2) The AV-blocks after procedures were considered as in ammatory process for the maneuvers. The steroids diminished the in amma- tion. 3) The embolization described was due to the little experience. 4) There weren’t AV-blocks during follow up.
#0049
RIGHT VENTRICULAR OUTFLOW TRACT STENTING IN HIGH-RISK SYMPTOMATIC TETRALOGY OF FALLOT UNDER 10KG - A SINGLE CENTRE EXPERIENCE
Robin Hay Son Chen, Robert Yates, Sachin Khambadkone, Graham Derrick
Great Ormond Street Hospital for Children, London, UK
Introduction: Right ventricular out ow tract (RVOT) stenting is an attractive option for symptomatic patients who are at a high risk for surgical repair of Tetralogy of Fallot (TOF). We present our centre’s experience in RVOT stenting for patients <10kg.
Methods and Results: 31 catheterizations performed on 25 patients (18 males) weighing <10kg from Jan 2008 to June 2016 with the intention to relieve RVOTO were retrospectively reviewed. 18 procedures were rst palliations, 2 with initial surgical palliation, 6 being restenting procedures and 5 were on post-operative RVOTs. The primary diag- nosis was Tetralogy of Fallot including double outlet ventriculo-arte- rial connection in 10. 9 patients (36%) had associated cardiac lesions, with atrioventricular septal defect being the commonest (n=4, 16%). Prematurity and genetic disorder accounted for 32% and 24% respec- tively. The indication for RVOT stenting were low body weight preclud- ing surgery (n=16, median 2.59kg, IQR 1.9-3.42kg), high risk associated cardiac lesions (n=5), high risk comorbidities (n=3), severe cyanotic spells (n=2) and post-operative residual RVOTO (n=5). 9 (36%) patients were on prostaglandin infusion, 9 (36%) ventilated and 3 (12%) were on propranolol. Eight procedures (26%) were performed as emergent or salvage therapy. Overall procedural success rate was 93.5% (29/31 procedures) with 32 stents implanted and 3 procedures required 2 stents. Signi cant improvement of SaO2 was observed (71±14.6% to 88.7±7.9%;p<0.001). Six complications were recorded (19%) including 1 cardiac perforation that required no treatment, and 1 sudden car- diac arrest during diagnostic catheterization, the only in-lab mortality; others were minor complications. Catheter reinterventions were nec- essary for 11 patients, 2 patients required 2 reinterventions. Median time to reintervention was 8.4 months (IQR≈0.8-14.5). A lower main pulmonary artery z score (-4.3±1.7 vs -2.4±1.4, p=0.02) and pulmonary annular z score (-5.2±1.5 vs -3.4±2.2, p=0.04) were associated with rein- tervention. Twenty patients survived de nitive surgery, with a mean RVOT velocity of 2.6±0.7m/s from their latest echocardiogram; while 2≈patients were awaiting de nitive surgery.
Conclusion: RVOT stenting achieved good palliation with high success rate in this group of high-risk symptomatic TOF patients.
#0050
SUCCESSFUL TRANSFEMORAL TREATMENT OF
AN INNOMINATE ARTERY PSEUDOANEURYSM COMPLICATION FROM EXTRACORPOREAL MEMBRANE OXYGENATION IN A NEONATE WITH REVIEW OF THE LITERATURE
Aamisha Gupta, Zahid Amin, Emily Masoumi, Carlee Leopard Children’s Hospital of Georgia, Augusta, GA, USA
Background: We report successful repair of a large pseudo-aneurysm in a 7 week neonate which developed o of the innominate artery as a complication of ECMO cannulation. From review of the literature, this is the rst reported case to be successfully treated via transfemo- ral approach using covered stents.
Methods: A full term infant with history of biventricular hypertrophy and pulmonary hypertension was placed on VA ECMO soon after birth. At 7 weeks of life, post decannulation, a large pseudoaneurysm was found o of the innominate artery by echocardiogram. A CT with con- trast con rmed the diagnosis. During cardiac catheterization, angiog- raphy revealed that the pseudoaneurysm measured 24 mm x 25 mm. The diameter of the subclavian artery was 4 mm and the origin of the innominate artery measured approximately 5mm. The length that needed to be covered was approximately 25 mm. A wire was placed in the distal subclavian artery and exchanged of a 6F x 55 cm Flexor
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306