Page 39 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
266
Conclusions: The hybrid approach for pts with PA/VSD, MAPCAS and small PAs is a promising new therapeutic modality. Although this approach was feasible and safe in our hands, repeat procedures were still common in the early post-op period. A more aggressive attitude towards intra-op rehabilitation of the PAs after CPB may be required as experience evolves.
#0062
CATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS IN ADULT PATIENTS USING AN OUTPATIENT PROTOCOL
Basil(Vasileios) Thanopoulos1, Petros Dardas1, Vlassis Ninios1, George Giannakoulas2, Dan Deleanou3
1”Agios Loukas” Hospital, Thessaloniki,, Greece
2Ahepa”University Hospital, Thessaloniki, Greece
3Ares Medical Center, Bucharest, Romania
Introduction: Transcatheter closure is the treatment of choice for the majority of patients with a patent ductus arteriosus (PDA). However, the standard technique of this procedure uses an arterial access and requires immobilization of the patients for 24 hours and may be associated with arterial complications. The aim of this study was to report experience with catheter closure of PDA in 68 consecutive adult patients the Cocoon PDA occluder on outpatient basis using an exclusive venous approach.
Methods: The age of the patients ranged from 16-72 (median 36 years) and the weight from 52-74 Kg (median 64 Kg). The anatomy and size of PDA were de ned by transvenous retrograde aortography using a Pigtail or a Berman catheter. The PDA occluder was implanted through an 8-9 F delivery sheath (DS). The procedure was guided using hand injections of contrast media through the DS and 2D and color Doppler echocardiography from suprasternal and parasternal long and short axis, respectively.
Results: The PDA occluders were permanently implanted in 65/68 of the 68 patients. The mean PDA diameter (at the pulmonary end) was 3.8±0.9 mm (range, 1.2 to 9.8 mm). The mean device diameter was 6 ± 3 mm (range 4 to 12 mm). Complete echocardiographic closure of the ductus at 1-month follow-up was observed in all 65 patients (100%). Eight minor groin venous hematomas were the only complications of the procedure. The hospital stay of the patients ranged from 6-8 hours.
Conclusions: Exclusive transvenous PDA occlusion using combined angiographic and echocardiographic guidance is an e ective and safe method that prevents the arterial complications of the standard approach. In addition, in adult patients, this technique, may be used on outpatient basis resulting in reduce hospital cost.
#0063
PERSISTENT PLEURAL EFFUSION, PULMONARY STENOSIS, FAILED FONTAN CIRCULATION. “HEADACHE” SOLVED IN THE CATH LAB.
Alberto Zarate Fuentes2, Liborio Solano Fiesco1, Iñaki Navarro Castellanos2, Julio Erdemenger Orellana1
1Childrens Hospital of Mexico, Mexico City, Mexico
2General Hospital “Adolfo Lopez Mateos”, Mexico City, Mexico
A 6 year old girl with a history of double discordance, narrow bulboven- tricular foramen and hypoplastic right ventricle, had been surgically palliated at one year to ensure systemic ow to the aorta, through Aortopulmonary window with main pulmonary artery banding to reduce the ow and pressure to the lungs and guarantee the systemic output. At 4 years catheterization and later Glenn performed, it was decided to keep intentionally the anterograde ow through the pul- monary artery. At 6 years was completed the cavopulmonary deriva- tion, Cath hemodynamic parameters: (Main Pulmonary Artery: 13/10, mean:10mmHg, Left Ventricle: 80/8 mmhg, Index Pulmonary Vascular Resistance 1.2 Wood Units, pulmonary branches normal Z score). She underwent extracardiac Fontan with fenestration, at the same time the main pulmonary artery was ligated. The immediate outcome was satisfactory. Almost to completed the second week post-surgical the right pleural drainage increase. Echocardiogram reveal anterograde ow through the pulmonary artery and stenosis at the con uence of the pulmonary artery and proximal third of the left branch. She stayed hospitalized for 10 weeks, high right lung drainage persists even though medical therapy was optimized and local procedures were conducted. Cath ndings were: the proximal third of the left branch was 6 mm (Z-4.4) and the distal branch was 10.6 mm (Z -0.17). We realize that both superior and inferior vena cava had selective ow to the right pulmonary branch. Fenestration was not evident. Hemodynamic ndings: Superior and inferior vena cava mean pres- sure 20mmHg, and distal prebranching left artery 15mmHg. End dias- tole ventricular pressure was 9 mmHg. PROCEDURE: A test occlusion in the pulmonary artery using a noncompliant balloon (simulating delivered covered stent) and simultaneously angiography in ascend- ing aorta to con rm the occlusion of the anterograde ow through the aorto-pulmonary window was carried out, and we assess the free drainage of the superior and inferior vena cava. By using a 12Fr Mullins long sheet we implanted a CP StentTM covered 10 Zigs of 39 mm, mounted on 12x40 mm POWERFLEX®Pro balloon, and later stent redilation to 14 mm with MAXI LDTM balloon, without complication. Post angiography result was evaluated, nding homogeneous ow in both pulmonary branches and the Fontan pressure was the same throughout the system, the accessory pulmonary ow was totally blocked. Three days later, the pleural drainage was minimum and she was discharge 10 days after the intervention.
Conclusion: There are numerous causes that can complicate a patient with Fontan circulation, persistent pleural e usion is one of the most common, it´s imperative to perform catheterization early in patients with failed Fontan. Nowadays we should seek for the procedure that brings the better outcome and with less morbidity and mortality to our patients such as the case we discussed, in which discharge was possible 1 week later, after a long hospital stay.
#0064
PERCUTANEOUS AORTIC PARAVALVULAR LEAK CLOSURE USING AMPLATZER VASCULAR PLUG III Manfred Hermanni1, Federico Borges2, Victor Julio Bellera1, Elka M Marcano1, Victor Ortega1, Antonio Guzman1, Ernesto Fonseca1, Franco Lotta1
1Centro Policlinico La Viña, Valencia, Venezuela
2Hospital De Niños J.M. De Los Rios, Caracas, Venezuela
Paravalvular leak (PVL) is a relatively common complication of valve replacement surgery. Although most PVLs are small and
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306