Page 43 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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Mean PDA diameter was 2.48±0.5mm. Mean Qp/Qs was 1.7±0.2. Morphology of PDA: 5of them were conical, 3of them were tubular. In all patients ADOII-AS device were used for PDA closure (Table1). Steps of percutaneous PDA closure procedure was shown by Figure1. In all patients, we have done closure by venous route. We did not ever used arterial route in 4 patients. There were no major complications reported. Left pulmonary arterial stenosis was detected in 2 patients which were all resolved in 6 months duration.
Conclusion: Interventional catheterization procedures are more com- monly used, in the recent years. The advantages of percutaneous PDA closure include a high success rate, shorter length of hospital stay, reduced blood loss, low morbidity rate, and no traumatic scars. Since the length of hospital stay decreases with catheterization, it is much more cost-e ective than surgery. We want to emphasize that in experienced centers percutaneous closure of PDA can be an alternative to surgery even in the extremely low birth weight babies.
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INTENTIONAL LACERATION OF THE ANTERIOR MITRAL LEAFLET TO PREVENT LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION (LAMPOON) DURING TRANSCATHETER MITRAL VALVE IMPLANTATION: PRE-CLINICAL FINDINGS
Ja ar Khan1, Toby Rogers1, Adam Greenbaum2,
Vasilis Babaliaros3, Marcus Chen1, Robert Lederman1 1NHLBI, Bethesda, USA
2Henry Ford Hospital, Detroit, USA
3Emory, Atlanta, USA
Background: Left ventricular out ow tract (LVOT) obstruction is a life-threatening complication of transcatheter mitral valve implan- tation (TMVR), caused by septal displacement of the anterior mitral lea et (AML). We propose a novel transcatheter resection of the AML.
Methods: LAMPOON was developed in vivo in swine, guided by biplane X-ray uoroscopy and intracardiac echocardiography. Two transfemoral coronary guiding catheters were advanced retrograde through the aortic valve, either side of the AML. The ‘LVOT catheter’ directed an electri ed guidewire across the center and base of the AML towards a snare directed by the ‘left atrial catheter’. The snared externalized guidewire loop was electri ed, lacerating the AML along the centerline from base to tip.
Results: The AML was successfully lacerated in all (n=8) swine. Benchtop analysis demonstrated an increase in neo-LVOT with some residual obstruction (65% ± 10% vs. 31 ± 18% patency, p<0.01). Mean blood pressure fell (54 ± 6 to 30 ± 4mm Hg, p<0.01) due to acute mitral regurgitation from LAMPOON, but remained steady until planned euthanasia. There was no collateral tissue injury on necropsy.
Conclusions: Using simple catheter electrosurgery techniques, we mimicked surgical chord-sparing AML resection prior to TMVR. We recommend pre-positioning the transcatheter heart valve to minimize time between laceration and TMVR, though laceration may be better tolerated in patients with chronic mitral valve disease. Applied cautiously, this technique may enable TMVR in high risk surgical patients with prohibitive risk of LVOT obstruction.
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POST-IMPLANTATION MODIFICATION OF ENDOVASCULAR STENTS IN THE TREATMENT OF COMPLEX CONGENITAL AND ACQUIRED VASCULAR STENOSES
Bryan Goldstein, Wendy Whiteside, Russel Hirsch, Konstantin Averin, Gruschen Veldtman
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Background: Optimal treatment of complex congenital and acquired vascular stenoses may bene t from post-implantation modi cation of standard endovascular stents. Utilization of open-cell design stents allows for side-hole creation with dilation of stent struts to minimize impact on adjacent vessels and/or treat adjacent stenotic lesions. We sought to describe our experience with this technique.
Methods: Single-center retrospective review at a large congenital heart center from 2011 – 2016. Cases with endovascular stent place- ment followed by side-hole creation with or without additional stent implantation, or with side-hole modi cation of an existing implant, were included. Demographic and procedural details were collected.
Results: Twenty catheterization procedures in 19 patients met inclu- sion criteria. Cases were performed in 55% female patients with a median age of 12.8 (IQR 4.2, 25.4) years and a mean weight of 45.1 ± 33.3 kg. Indications for stent angioplasty included: complex RVOT and branch pulmonary artery (PA) stenosis (45%), lobar PA stenosis (30%), aortic coarctation (15%), atrio-pulmonary Fontan connection steno- sis (10%), and systemic venous stenosis (10%). During 18 procedures a new stent was placed, while an existing implant was modi ed in 2 procedures. Three types of open-cell stents were modi ed following implantation: ev3 IntraStent® LD Mega (45%), ev3 IntraStent® LD Max (35%) and Cook Formula 418 (30%). A lobar (45%) or branch (30%) PA were the most commonly jailed vessels, followed by left subcla- vian artery (15%), right internal jugular vein (5%) and hepatic vein (5%). Indications for side-hole dilation included: relief of side-branch stenosis caused by primary stent implant (25%), avoidance of stent material (struts) crossing an important side-branch (50%) and relief of pre-existing side-branch vascular stenosis (25%). Side strut angio- plasty was performed to a variety of diameters (4 mm – 24 mm) using high pressure or ultra-high pressure angioplasty balloons. In 4 cases, a second stent was placed through the newly generated side-hole. Median procedure time was 211.5 (123.5, 272.5) min and mean uoroscopy time was 56.2 ± 23.8 min. There were no local vascular injuries related to post-implant stent modi cation but 1 patient did have a self-limited access site complication.
Conclusion: Post-implant modi cation of endovascular stents via side strut dilation is safe, feasible and may improve outcomes in the de n- itive treatment of complex vascular lesions.
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PERCUTANEOUS CLOSURE OF POSTMYOCARDIAL INFARCTION VENTRICULAR SEPTAL DEFECTS Adrian Sanchez, Jose Antonio Garcia, Carlos Zabal,
Aldo Campos, Guillermo Aristizabal, Carlos Guerrero, Hector Gonzalez, Juan Pablo Sandoval
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306