Page 34 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
Tuohy-Borst delivery sheath. We deployed two 6 mm x 22 mm Atrium Cast premounted covered stents in a tandem fashion to e ectively iso- late the aneurysm and maintain ow to the subclavian artery. Result: Follow up angiography demonstrated excellent result with nearly complete occlusion of the pseudoaneurysm and normal opaci cation of the right subclavian artery through the stent. There were no proce- dural or post procedural complications. Patient was electively started on heparin after sheath removal for 6 hour. The femoral artery pulses remained normal. Follow up echocardiography revealed trace shunt from the where the stents were overlapped. The patient was trans- ferred to the NICU and discharged home when his condition stabilized.
Conclusion: We reviewed the literature and found one case report where pseudoaneurysm had developed after ECMO, but no account was made as to the management of the pseudoaneurysm. Hence, to our knowledge, this is the rst successfully closed pseudoaneurysm case in a neonate. Management options in this patient included tran- scatheter management or proximal ligation of the innominate artery to prevent further dilation and rupture. Since the patient had the right carotid artery ligated after the ECMO cannula was removed, we wanted to maintain adequate blood ow to the right upper extremity and avoid steal phenomenon form the vertebral artery.
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PERCUTANEOUS STABILIZATION OF DUCTAL- DEPENDENT PULMONARY BLOOD FLOW USING PDA STENT IS ASSOCIATED WITH DECREASED MORBIDITY COMPARED TO SURGICAL SHUNT PLACEMENT
Britton Keeshan, Agustin Rubio, Brian Morray, Bhawna
Arya, D. Michael McMullan, Lester Permut, Troy Johnston, Jonathan Chen, Thomas Jones
Seattle Children’s Hospital / University of Washington, Seattle, WA., USA
Background: Transcatheter stenting of the patent ductus arteriosus (PDA) is becoming an accepted alternative to surgical aortopulmo- nary shunt for stabilization of ductal-dependent pulmonary blood ow. However, there is limited data comparing procedural and inter- mediate-term morbidity between these two palliative strategies. Methods: This is a retrospective single-center review of patients who underwent stenting of the PDA or surgical aortopulmonary shunt from 2005 to 2015. Primary outcomes were survival, length of stay and freedom from re-intervention. Patient charts and the Society for Thoracic Surgeons database were queried for procedure-related adverse events. Results: 55 patients were referred for PDA stenting and 55 patients were referred for surgical intervention with a Blalock- Taussig or central shunt. PDA stent placement was successful in 44 (80%) patients. Baseline characteristics were similar between the 2 groups. While there was no signi cant di erence in 30-day survival (95.4% vs. 97.9%, p=0.24), there was a trend towards improved over- all survival in the PDA stent group (93% vs. 81.1%, p=0.09, median follow-up 941 vs. 1967 days, respectively). The proportion of patients who underwent biventricular repair was similar between study groups. Patients with PDA stents had shorter median ICU and hospi- tal length of stays (2 vs. 7 days, p=0.04; 6 vs. 17 days, p<0.01, respec- tively), were less likely to require nasogastric tube feeds at discharge (p<0.01) and were less likely to require invasive intervention in the rst 30 days after initial palliation (p=0.04). There were more adverse events in the surgical shunt cohort (119 vs. 36, p<0.01), although the proportion of patients who experienced ≥1 adverse outcome
was not di erent (67.3% vs 50%, p=0.08). The surgical cohort had a greater incidence of mechanical ventilation requirement ≥7 days (p=0.02), wound infection (p=0.01), unplanned cardiac catheteriza- tion (p=0.05), surgical exploration (p=0.04), and low cardiac output syndrome (p=0.02). The incidence of venous or arterial thrombosis in the PDA stent cohort was relatively low (6.8% & 11.4 %, respec- tively). CONCLUSION: Percutaneous stenting of the PDA is an e ec- tive strategy for stabilization of ductal dependent pulmonary blood ow. While there were no signi cant di erences in early and overall mortality between cohorts, PDA stenting was associated with signi - cantly less morbidity and need for re-intervention.
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INFERIOR VENA CAVA COMPLETE OCCLUSION
AFTER LIVER TRANSPLANT TREATED WITH RADIOFREQUENCY PERFORATION AND STENTING IN A PEDIATRIC PATIENT.
Francisco Gonzalez Barlatay, Fernando Alvarez, Michel Lallier, Joaquim Miro
Hôpital Sainte-Justine. Université de Montréal., Montréal/ Quebec, Canada
We present a 15 month old boy with biliary atresia, who underwent liver transplantation. Surgery was complicated by a bowel perforation and thrombosis of the hepatic artery. Four weeks after the incident he was retransplanted. A thrombosis at the inferior vena cava anasto- mosis was diagnosed by ultrasound in the immediate post-surgical period. Five months after surgery an increase in serum aminotrans- ferases (8 x normal values) and gamma-glutamyl trasferases (2 x normal values) was observed. A liver biopsy showed signs of hepatic vein out ow obstruction. A cavography showed the complete occlu- sion of the inferior vena cava with partial decompression towards the azygos vein system. A 16.9 mm distance between superior and inferior stumps of the IVC was measured. After multidisciplinary discussion, the patient was brought to the catheterisation laboratory, where a radiofrequency needle (Baylis medical, Toronto, Canada) was advanced via the inferior stump, reaching the right atrial stump of IVC. The guidewire was snared and exteriorized by the right jugu- lar vein. On that guidewire rail, a 28 mm covered CP stent (NuMed, Hopkinton, USA) was deployed using a 10 mm x 3 cm BIB balloon (NuMed). The initial clinical response was very encouraging, with ascites signi cantly reduced and normalisation of laboratory tests. The patient needed balloon redilations, due to caudal stenosis of the stent, at two and four months post-procedure. One year after the procedure the stent is still permeable and without signi cant gradi- ent. The patient is still under enoxaparin and aspirin. Liver function is normal.
Conclusion: Percutaneous approach of this rare complication was the alternative to avoid a third liver transplant in our patient. The good results and the feasibility of the technique make it a very encouraging option in this group of patients.
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THE EFFECT ON SOMATIC GROWTH OF SURGICAL AND TRANSCATHETER TREATMENT OF SECUNDUM ATRIAL SEPTAL DEFECTS
Meghan Chlebowski1, Hongying Dai2, Stephen Kaine1
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts