Page 38 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
Conclusion: VSD closure using nitocclud PFM coil is safe and e ec- tive in selected patients. However, we report hemolysis in a patient with residual shunts as well as delayed onset complete heart block in another patient which needs careful follow up and prompt management.
#0060
PRELIMINARY EXPERIENCE WITH THE USE OF THE AMPLATZER VASCULAR PLUG IV (AVP IV) FOR PERCUTANEOUS CLOSURE OF THE SMALL PATENT DUCTUS ARTERIOSUS
Rodrigo Costa1, Marcelo Ribeiro1, Luis Otavio Campanha2, Rafael Medina1, Paulo Calamita1, Jonathan Lombardi1, Valmir Fontes1, Carlos Pedra1
1Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil, 2Hospital do Coracao, Sao Paulo, Brazil
Introduction: Percutaneous occlusion of the small patent ductus arteriosus (PDA) with controlled or uncontrolled release coils can be fraught with residual shunting, mal position and embolization of the device. Although the Amplatzer Vacular Plug IV has been designed to close unwanted vascular structures using low pro le catheters, its use for closure of the PDA has not been reported.
Objective: In this preliminary experience, we report the outcomes after the use of this device to close small PDAs in children.
Material and Methods: This is an observational, prospective, longitu- dinal study with a single cohort of pediatric patients (pts) who under- went percutaneous closure of the small PDA with the AVP IV. Data collection was performed retrospectively through analysis of records. Closure was performed through the retrograde approach using 4 Fr right Judkins diagnostic catheters under general anesthesia. Size of the device was at least twice the size of the minimal diameter of the PDA. Transthoracic echocardiography (TTE) was employed to assess short-term follow up outcomes.
Results: Between 9/15 and 7/16 11 pts underwent closure. Median age and weight was 64.9 (14.1 to 745) months and 20 (7 to 78) kgs, respectively. The mean minimal diameter of the PDA at the pulmo- nary end was 1.3 ± 0.6 mm and 6.6 ± 2.5 mm at the aortic ampulla mouth. No patient had pulmonary arterial hypertension. The most frequently used device diameter was 4 mm, with a mean of 4.7 ± 1.3 mm. One pt had undergone a previous unsuccessful attempt at clo- sure with a Gianturco coil, which was removed due to malposition inside the aortic ampulla. Technical success and immediate closure was observed in all patients with no complications. Median uoros- copy time was 3 minutes. During a mean follow up of 6 months, TTE showed closure in all patients with no aortic or left pulmonary artery stenosis.
Conclusion: Percutaneous closure of the small PDA with the AVP IV was feasible and simple from the technical standpoint, safe and e ec- tive. Its low pro le and possibility of recapture and reposition are the main advantages. Further studies with larger number of pts including infants are warranted.
#0061
PRELIMINARY EXPERIENCE WITH THE HYBRID APPROACH TO MANAGE PATIENTS WITH PULMONARY ATRESIA, VENTRICULAR SEPTAL DEFECTS AND MULTIPLE AORTO-PULMONARY COLLATERALS
Jonathan Lombardi, Paulo Calamita, Rafael Medina, Rodrigo Costa, Marcelo Ribeiro, Patricia Marques, Marcelo Jatene, Carlos Pedra
Hospital do Coracao, Sao Paulo, Brazil
Introduction: Pulmonary atresia with ventricular septal defect and multiple aorto-pulmonary collaterals (PA/VSD MAPCAS) has a broad variety of clinical and anatomic presentation. Surgical repair gener- ally requires a RV to PA conduit with unifocalization of pulmonary blood ow and closure of MAPCAS. Catheter closure of such vessels before surgery may occasionally result in signi cant desaturation. On the other hand, intra-op ligation of these vessels may be challenging due to their location and friability. Therefore we hypothesized that a hybrid management of patients with this disease could minimize the need of repeat interventions and optimize outcomes.
Objective: To report immediate outcomes after a novel hybrid approach of patients with PA/VSD and MAPCAS.
Material and Methods: This is a prospective, longitudinal, observa- tional study with a single cohort of pediatric patients with PA/VSD and MAPCAS. Data was collected retrospectively with analysis of charts. Patients underwent cardiac catheterization and angio CT to assess pulmonary arteries (PAs) and collaterals before the hybrid approach. Patients were taken to a dedicated hybrid room and a median ster- notomy was performed under general anesthesia. Before the initi- ation of CPB, signi cant collaterals were closed through an arterial approach via cut-down using a variety of devices, mainly Amplatzer vascular plugs. Surgical repair included BTT shunts or a RV-PA conduit and recruitment of collaterals with anastomosis to the pulmonary arteries (PAs). The decision to close the VSD was dependent on the size and distribution of the PAs. An exit angio after cessation of CPB was performed if judged appropriate and further interventions were carried out if needed.
Results: Between 01/10 and 8/16, 7 patients with PA/VSD, MAPCAS and small PAs underwent the hybrid approach at a median age and weight of 17.7 (6-102) months and 9.8 (4.2-19.8) kgs, respectively. Two patients had undergone previous palliations including modi ed BTT shunts and unifocalization procedures. All collaterals were success- fully closed before CPB. Six pts had a RV-PA conduit and 1 had a BTT shunt. Mean CPB, anoxic and surgical time was 139.1±37.3, 89.2±23.2 and 494.6±105.2 minutes, respectively. In one patient, PA stenting through the RV-PA conduit was required after exit angio. Pre and post Sats were 77.7±6.6 e 86.6±6.5 % (p< 0.01), respectively. Median ICU, ventilator and vasoactive meds time was 6 days (5-98), 2 days (1-15) and 5 days (0-18), respectively. One patient underwent early post-op catheter closure of a collateral due to signi cant residual shunting and 2 patients underwent early balloon/stenting angioplasty of the PA. Median in-hospital period was 29 days (7-155). There were no deaths or vascular complications.
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts