Page 40 - Journal of Structural Heart Disease Volume 2, Issue 6

267
Meeting Abstracts
asymptomatic, 2% to 5% are clinically relevant and associated with major complications, such as heart failure, hemolytic anemia, arrhythmias, and infective endocarditis, surgical reoperation is effective however associated with morbidity and mortality espe- cially in high risk patients. To date percutaneous PVLs closure has probed high efficacy, with different device or occluders, the most used is amplatzer vascular plug III. We report a 40 year male with aortic bivalve, and severe aortic regurgitation who underwent 2 years ago aortic valve replacement with magna ease bioprothesic aortic valve, after surgery developed heart failure, arrhythmia. Echocardiography showed severe aortic paravalvular leak, Under general anesthesia, transesophageal echocardiography guidance (TEE) trough right femoral artery cardiac cath was performed to close the leak, angiography and TEE evidenced a leak on left coronary sinus, measures long axis 12 mm, short axis 4 mm. AL 2 catheter and hydrophilic wire was used to cross the leak, With exchanged wire in left ventricle an amplatzer vascular plug III 14x3 mm was delivered, placed in the leak and release, control angiog- raphy and TEE showed good position and minimal residual shunt, the patient was discharged next day. On follow up 8 months the patient refers clinical improvement, is not receiving anthyarritmyc or diuiretic. Echocardiography normal left ventricular function, mild LV dilation, and mild residual PVL. We report a successful Amplatzer vascular plug III aortic PVL closure with good clinical improvement, and mild peri device residual leak.
Key words: Amplatzer vascular plug III • aortic paravalvular leak • percutaneous
#0065
CLOSURE OF LARGE AND LONG TUBULAR PATENT DUCTUS ARTERIOSUS IN INFANTILE AGE GROUP USING THE AMPLATZER® VASCULAR PLUG II
Shreepal Jain1, Kshitij Seth2, Robin Pinto3, Bharat Dalvi4
1Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India 2Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India 3Holy Family Hospital, Mumbai, Maharashtra, India
4Glenmark Cardiac Center, Mumbai, Maharashtra, India
Objective: To evaluate the safety and e cacy of the Amplatzer® Vascular Plug II (AVPII) in closing large and long tubular Patent ductus arteriosus (PDA) in infants and young children.
Background: Large and long tubular PDA’s in young infants (Figure 1a & 2a) are not amenable for closure with the conventional duct occlud- ers and necessitate surgical closure. Previous case series and reports have described use of AVPII for closure of such PDAs in premies or for smaller sized ducts in younger infants. We describe the use of AVPII for closure of such large and long PDAs in young infants (Fig 1b & 2b).
Methods: Data of patients undergoing transcatheter PDA closure between May 2015 & August 2016 were retrospectively reviewed. Transthoracic echocardiography (TTE) was done in all cases to con- rm the diagnosis as well as to characterize the PDA in terms of size at pulmonary (PA) and aortic end, shape, length and gradient across the PDA and size of aortic isthmus and left pulmonary artery. Procedural steps, complications and results were recorded.
Results: Ten patients (5 females) underwent transcatheter PDA clo- sure. The mean age was 7.3 + 4.7 months and mean weight was 5.4 + 1.5 kg. All patients had shortness of breath and 9 of ten had evidence of failure to thrive. The PDA measured a mean of 5.1 + 1.0 mm at the PA end with an average length of 10.4 + 2.8 mm. All patients had evidence of large shunt with the mean aortic pulse pressure being 55.4 + 8.9 mm Hg. The mean di erence between the aortic and pul- monary systolic pressure heads was 16.2 + 9.6 mm Hg suggestive of minimally restricted ducts. The AVPII size ranged from 6 to 10 mm. The mean device to PDA size ratio was 141 + 9.5%. The device was deployed from the venous side in all cases and deployed completely within the duct. Successful occlusion of the PDA was achieved in 8 out of 10 cases (80%) with no evidence of aortic or left pulmonary artery obstruction. In one case the device embolized after release and the child was shifted for surgical device retrieval and PDA closure. In another case, the device was felt to be unstable after deployment and hence was not released. The child was sent for surgical PDA ligation electively. The average device length to PDA length ratio in both the cases was 102.5% compared to an average of 59.1% in those where the procedure was successful. At a mean follow up of 10.1 months (range 1-15 months), all patients were doing well with no evidence of any residual shunt on TTE. The LPA and the aortic isthmic ows were laminar with no evidence of obstruction
Conclusion: We report successful use of AVPII for closure of large, long and tubular PDAs with signi cant pulmonary arterial hypertension in young infants. The device tends to retain its position after intraductal deploy- ment even in the absence of a retention disc by virtue of ductal walls o ering the support to stabilize the device. Inadequate ductal length can result in the device getting unstable and may lead to embolization.
#0066
LEAFLET MORPHOLOGY VARIATION OF THE MELODY TRANSCATHETER PULMONARY VALVE: EFFECT ON PERFORMANCE AND OUTCOME
Brian Boe, Aimee Armstrong, Darren Berman, Joanne Chisolm, Sharon Cheatham, John Cheatham
Nationwide Children’s Hospital, Columbus, OH, USA
Background: The Melody® Transcatheter Pulmonary Valve (TPV) is con- structed using a harvested bovine jugular venous valve, which is rig- orously tested for competency prior to commercial release. Natural anatomic lea et variations are seen in the TPV when viewed en face. These valve morphologies have not been described, nor evaluated in the TPV.
Methods: A TPV morphology classi cation system was devised after reviewing 1/3 of the available photographic images of implanted TPVs at our institution. All images were blindly reviewed by implanters and TPVs were classi ed based on the consensus of the reviewers. The TPV outcomes (echocardiographic function and complications) were compared based on lea et morphology. Complications included endocarditis, stent fracture, TPV replacement (surgical or transcath- eter), and patient death.
Results: A total of 62 TPVs were categorized into the following lea et morphology types: A -symmetric trilea et (47%); B-asymmetric tri- lea et with a single small lea et (32%); C-asymmetric trilea et with a single large lea et (16%); D-rudimentary lea et with near bicuspid
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts