Page 35 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
262
1Children’s Mercy Hospital, Department of Cardiology, Kansas City, Missouri, USA
2Children’s Mercy Hospital, Department of Biostatistics, Kansas City, Missouri, USA
3University of Missouri - Kansas City, Kansas City, Missouri, USA
Objective: To evaluate the e ect of secundum ASD closure on somatic growth, we conducted a single center, retrospective review of patients presenting for surgical or transcatheter closure during two distinct time periods.
Background: Natural history studies suggest an association between atrial septal defect (ASD) and growth retardation with inconsistent improvement following defect closure. Limited data exist regard- ing the e ect of ASD closure on growth in the era of transcatheter therapy.
Methods: Four hundred patients with isolated ASD were divided into three cohorts: early surgical (January 1997-January 2002, N = 138), contemporary surgical (January 2006-January 2015, N = 142), and transcatheter closure (January 2006-January 2015, N= 120). Data collected at treatment and all follow up encounters included demo- graphics; height, weight, and body mass index (BMI) percentiles; hemodynamics at catheterization; and presence of any comorbidity a ecting growth.
Results: Age at repair di ered between groups (p < 0.0001) with a median age of 2.5 years in the early surgical, 5 years in the contempo- rary surgical and 6 years in the transcatheter cohorts. For all cohorts, there was no statistically signi cant change in height or weight per- centiles during two years of follow-up after ASD closure. There was a statistically, but not clinically, signi cant change in BMI percentile for the contemporary surgical cohort. In the transcatheter cohort, mean Qp:Qs was 1.65 +/- 0.54. Bivariate analysis did not show a negative correlation for any growth index demonstrating no association of greater Qp:Qs with decreased somatic growth. Subgroup analysis for patients in any cohort having an initial growth percentile <5th percen- tile demonstrated a signi cant change in weight and BMI percentiles in the rst two years after closure (p < 0.0004).
Conclusion: We found no signi cant change in weight and height percentiles during two years follow-up after ASD closure. Only patients with initial weight and BMI <5th percentile had improved growth after treatment. The advent of catheter device therapy shifted the institutional practice to later age at repair for both surgical and transcatheter cohorts. Concerns over poor growth should not be an indication for early ASD repair except in children with existing signif- icant growth failure.
#0054
EXCIMER LASER THERAPY FOR NEONATAL CONGENITAL HEART DEFECTS WITH CRITICAL OBSTRUCTION: A SINGLE INSTITUTIONAL EXPERIENCE.
Howard Weber
Penn State Hershey Childrens Hospital, Hershey, USA
Interventional procedures for neonatal congenital heart defects with critical obstruction have evolved over the past 25 years with variable
results. The excimer laser catheter (Spectranetics, Corporation) is an over the wire system that is available in 4 diameters (0.9mm; 1.2mm; 1.5mm and 2.0mm) and creates a distinct circumferential ori ce equivalent to the catheter diameter at the site of intervention.
Methods: Since 2001, we have utilized the Excimer laser system, with or without a guide catheter, for the treatment of neonatal congenital heart defects with critical obstruction vs other various established methods including surgical intervention.
Results: Ten neonates with pulmonary valve atresia/critical steno- sis and intact ventricular septum, 4 neonates with hypoplastic left heart syndrome and intact atrial septum, 1 premature neonate with an occluded right pulmonary artery secondary to thrombus and 1 Fontan ba e with failing physiology underwent successful perfora- tion and additional intervention using the excimer laser system (vid- eos of the technique would be provided for oral presentation). All laser perforations were successfully performed utilizing uoros- copy with or without transesophageal echocardiographic imaging. In the case of pulmonary valve atresia and HLHS, only the 0.9mm diameter laser was utilized which facilitated without di culty, the ability to dilate the valve or atrial septum with a single large diame- ter Mini-Tyshak balloon thereby avoiding the need for a gradational approach. The single neonate with an acutely occluded right pulmo- nary artery underwent serial laser dilation with all 4 diameter laser catheters prior to conventional balloon angioplasty. There was a single inadvertent perforation of the RV out ow tract which sealed spontaneously and no other complications were reported secondary to the laser procedure.
Conclusion: Excimer laser therapy is an excellent alternative therapy for the treatment of neonatal congenital heart disease with critical obstruction. The creation of a distinct 1mm or greater ori ce at the site of intervention, facilitates the utilization of a single diameter bal- loon dilation catheter, thereby avoiding a gradational approach and reducing uoroscopy exposure.
#0055
3D ROTATIONAL ANGIOGRAPHY (3DRA) GUIDANCE OF NON-TRADITIONAL ASCENDING AORTA STENTING
Rodrigo Rios, Nasser Moiduddin, Kanishka Ratnayaka, Howaida El-Said, John Moore
Rady Children’s Hospital, University of California - San Diego, San Diego, CA, USA
Introduction: Ascending aorta narrowing is traditionally addressed by surgical intervention. We present a case series in which acquired narrowing of the ascending aorta was addressed successfully via 3D Rotational Angiography (3DRA) guided transcatheter stent placement.
Method: 3DRA was utilized for a roadmap. Balloon sizing was used for stent delivery balloon selection. Apnea and hypotension induced by rapid ventricular pacing aided stent positioning and delivery. Precise positioning was essential to avoid complications such as aortic valve/ coronary artery compromise or brachiocephalic branch vessel jailing.
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306