Page 52 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
Materials and Methods: descriptive and retrospective analysis based on the review of clinical records of patients (p) with transcatheter VSD closure during the period between May 2010 and March 2016 at Pedro de Elizalde Children’s Hospital. 51 procedures were performed in 47p. Median age was 7 years old (range 0,33 to 15y). Median weight was 26 Kg (range 4,3-83Kg); 5 procedures were done in p less than 10Kg. Sex distribution was: 28 females and 19 males.
Results: 43 procedures were successful (84,3%). 44 VSDs closed in 43 procedures. Regarding the type of VSD: 3p had residual POP VSD, the rest were native. 2p had multiple VSDs: 1p had 2 VSDs closed in the same procedure, the other needed 3 di erent procedures. Concerning VSD location within the septum: 20 were PM VSDs with aneurysm (46,5%); Musc: 11 infundibular (25,5%), 6 midmuscu- lar (13,9%), 3 apical (6,9%) and 3 POP (6,9%). Respecting the size of the VSD: Median diameter of left ori ce was 9.3mm, right ori ce 4.7mm, and median length of 7.12mm. 12 VSDs had more than one right ori ce. In regard to the relation with adjacent structures: PM VSDs had aneurysm from the septal lea et of the tricuspid valve, 1p had mild prolapse of the right coronary cusp with partial occlusion of the VSD. 7p presented with prolapse of noncoronary cusp and 2 with right coronary cusp (1 musc infundibular, 1 POP of doubly com- mitted VSD and the rest PM VSD). 3p revealed left ventricular-right auricular shunt, but only one more than mild (moderate). With refer- ence to complications: 3p evidenced major complications (6,9%): 1p tricuspid stenosis (PFM); 1p hematuria with decrease in blood count (PFM); 1p, <10kg with musc infundibular VSD and no aortic prolapse or insu ciency pre procedure, had severe aortic insu ciency imme- diately post procedure (Amplatzer) and died. Minor complications: 11p arrhythmia, 3p needed corticosteroid treatment (2 Lifetech 1 Amplatzer); 1p device embolization to right pulmonary branch, res- cue was achieved with successful re-implantation (Lifetech); 2p tran- sient hematuria (PFM); 1p coil fracture (PFM), 2p moderate tricuspid insu ciency (PFM), 1p mild to moderate aortic insu ciency (PFM).
Discussion: Echocardiography was part of the learning curve and allowed to de ne fundamental aspects for the correct device selection as VSD ana- tomic characteristics and its relation with adjacent structures. It’s a complementary tool to guide the procedure and provides direct view in key situations as arteriovenous loop, progress, deployment and release of the device, among others. It’s essential to assess the correct implantation and stability of the device. It identi es complication during and post pro- cedure and allows decision-making. Transcatheter VSD closure is a less invasive alternative and may become the gold-standard treatment for per- imembranous and muscular VSDs in patients with adequate criteria, and echocardiography is crucial to de ne this population.
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CONGENITAL CORONARY ARTERY FISTULA: PRESENTATION IN FETUS AND TRANS-CATHETER CLOSURE AFTER BIRTH
Varun Aggarwal, Venkatachalam Mulukutla,
Athar Qureshi, Henri Justino
Texas Children’s Hospital, Houston, TX, USA
Congenital coronary artery stula is a rare coronary anomaly. Most commonly, such stulae drain into the right side of the heart or the pul- monary artery. Most children with these stulae are asymptomatic and patients with coronary stulae are usually diagnosed in adulthood (with
symptoms like fatigue, dyspnea, angina and congestive heart failure). We describe two patients who had congenital coronary artery stula to ventricle which was diagnosed in-utero and con rmed after deliv- ery. One of them had congestive heart failure and the other developed ST-T segment abnormalities in the infero-lateral leads concerning for coronary steal and potential myocardial ischemia. We hereby describe trans-catheter management of the large coronary to ventricle stula. To the best of our knowledge, this is also the rst description of left anterior descending and circum ex coronary ostial atresia in the setting of a large left main coronary artery to left ventricle stula presenting in a newborn. We aim to describe the anatomy, trans-catheter closure and potential therapeutic options with concomitant limitations.
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EARLY RESULTS ON THE BEIJING MED-ZENITH PT VALVE FOR PULMONARY REGURGITATION IN THE OVINE MODEL
Sharon Cheatham1, Elizabeth Clark1, Chris Breuer1, Joanne Chisolm1, Qingliang Zhou2, Jian Meng2, Kan Hor1, Andrew Yates1, John Cheatham1
1Nationwide Children’s Hospital, Columbus, OH, USA
2Beijing Med-Zenith Medical Scienti c Co., Beijing, China
Approximately 22% of all congenital heart disease (CHD) patients have anomalies of the right ventricular out ow tract (RVOT). 77% of these patients have severe pulmonary regurgitation (PR) after surgical repair. Restoring pulmonary valve function is imperative to maintain- ing RV function. In the past, surgical pulmonary valve replacement was the only option in these patients. The success of the Melody TPV in patients with a dysfunctional RV-PA conduit is well known. We describe the early animal results of the Med Zenith PT Valve (MZPTV), designed for the native RVOT with severe PR.
Methods: The MZPTV is composed of a symmetric nitinol frame with a porcine pericardial covering and a porcine pericardial valve inside. There are 3 valve sizes and 5 frame dimensions that are delivered through a 21 French transcatheter system. The MZPTV was implanted from the right internal jugular vein (RIJV) in 6 lambs from Nov 2015-Feb 2016: 20mm valve (n=4), 23mm (n=1), 26mm (n=1). Early experience resulted in signi cant ventricular arrhythmias during device delivery that precluded safe implantation. Therefore, a pre-treatment antiar- rhythmic protocol was initiated prior to the interventional procedure.
Results: All lambs were followed for 6 months post implant. There was no device-associated morbidity or mortality. No signi cant PR and only 1 small paravalve leak (PVL) was noted from the MPA. 4/6 had a variable PVL from the RVOT that was felt to be secondary to an inadequate device size, which was con rmed at necropsy. There was variable tricuspid regurgitation noted in 2/6 that was associated with the delivery catheter from the RIJV.
Necropsy: Smooth neotissue was overlaying the stent & valve lea ets. There was no evidence of endocarditis or thrombosis on TPV lea ets. A small area of endomyocardial brosis was noted in the RVOT and was attributed to the delivery catheter. Two animals had a torn tricus- pid valve lea et.
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts