Page 53 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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Conclusions: The MZPTV can be delivered in a safe and e ective man- ner in the ovine model. Care must be taken to pre- treat ventricular arrhythmias that may be unique to the animal model and delivery site. The MZPTV remains competent and without signi cant throm- bosis or infection after 6 months. PVL from the MPA is rare, while a more appropriate chosen MZPTV frame may solve PVL from the RVOT. Modi cation of the loading and delivery systems are underway and a clinical trial for the MZPTV is planned in China for 2017.
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OUTCOMES OF PERCUTANEOUS PULMONARY VALVE IMPLANTATION – CLEVELAND CLINIC EXPERIENCE Patcharapog Suntharos1, Julia Simkowski2, Lourdes Prieto1 1Cleveland Clinic Children’s, Cleveland, OH, USA
2Case Western Reserve University, Cleveland, OH, USA
Background: Percutaneous pulmonary valve implantation (PPVI) has become a standard procedure performed in selected patients who have right ventricular to pulmonary artery conduit dysfunction. This procedure has been expanded to include patient with native pulmo- nary valve regurgitation as a result of previous surgical procedure. The aim of this study is to review our institutional experience and outcome since starting the PPVI program in 2010.
Method: Cleveland Clinic Children’s Cardiac Catheterization Database was retrospectively reviewed. All patients who underwent PPVI from 6/1/2010 to 12/31/2015 were included. Patients’demographic and cardiac diagnosis were recorded. Clinical symptoms before and after PPVI were compared. Cardiac catheterization procedure and complications were also reviewed.
Results: Seventy-nine patients underwent PPVI during the study period with a median age of 30 years at the time of procedure (range 8 to 79 years), and 42 (53%) were male. Median follow-up time was 2.7 years (range 4 months to 6 years). The most common diagnosis was tetral- ogy of Fallot (49%), followed by pulmonary stenosis (24%). Majority of the patients (92%) received the Melody® Valve. The procedure was per- formed in RV to PA conduit in 50 (64%) patients. Eleven patients (14%) had post-procedural complications, all were considered minor. Two patients (2.5%) subsequently required balloon dilation of percutaneous valve for evidence of valve obstruction. Two patients (2.5%) required second PPVI, one for obstruction and one for regurgitation. No surgical re-interventions were performed in our cohort. Three patients (3.8%) developed endocarditis, all were Melody® Valve which successfully treated with long term intravenous antibiotic. Two patients died from non-PPVI related cause. Of the 78 patients for whom change in New York Heart Association Functional Classi cation could be determined, 30 (38%) had a decrease in classi cation and 48 (62%) were unchanged.
Conclusion: PPVI provides good mid-term outcome in our cohort. Similar to other studies, there was an incidence of Melody® Valve endocarditis which responded to medical management.
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TRANSCATHETER LEFT ATRIAL APPENDAGE CLOSURE USING INTRACARDIAC ECHOCARDIOGRAPHIC GUIDANCE. MULTICENTER EXPERIENCE.
Daniel Aguirre1, Gabriel Maluenda1, Cristian Pincetti3,
Luis Perez2, Eduardo Lecanelier2, Carlos Deck4
1Hospital San Borja Arriaran & Clínica Alemana, Santiago, Chile 2Hospital Regional Dr. Guillermo Grant Benavente, Concepción, Chile 3Hospital Regional Temuco, Temuco, Chile
4Hospital Dipreca, Santiago, Chile
Most of the cases of left atrial appendage (LAA) occlusion are performed under general anesthesia using transesophageal echocardiography (TEE) guidance. ICE-guided LAA occlusion experience is limited and has been typically performed from the right atrium, pulmonary artery or coronary sinus where complete visualization of the LAA anatomy is often suboptimal. We report the feasibility, e cacy and safety of LAA occlusion using ICE guidance from the left atrium (LA).
Methods: Twenty-two patients with non-valvar atrial brillation, sig- ni cant risk for stroke, and long-term contraindication to anticoagu- lation underwent LAA closure with the Amplatzer AmuletTM (St Jude Medical, Inc, St Paul, MN) device under mild sedation and ICE guid- ance from the left atrium. The ICE catheter and device delivery sheaths were advanced into the LA through a single transseptal puncture in all cases. Baseline patient characteristics, procedural data, e ective- ness of ICE imaging, quality of occlusion, and complications were prospectively recorded. Clinical and TEE follow-up were done one to three months after the procedure. Procedural success was de ned as the implantation of the closure device at the intended delivery site with adequate (grade 3 or more by angiography and ICE).
Results: Procedural success was achieved in all patients (100%). Mean age was 75±8.6 years. Previous ischaemic stroke was recorded in 9 patients (42.9%). Median CHADS2 and HASBLED scores were 3.8 (2;6) and 3.6 (4;6) respectively. Indication for LAA closure was bleeding in 5 (23.8%), ischaemic stroke under therapeutic anticoagulation in 6 (28.6%) and high bleeding risk in 1 patient(s) (2.7%). Conscious seda- tion was performed using midazolam and/or fentanyl as needed. The amplatzer AmuletTM device were used in all patients. Median hospital stay was 1 day. There was no procedural stroke, pericardial e usion or device embolization. No ICE or transseptal related compli- cation was noted. At the time of writing, during the follow-up period, there were no cardioembolic events. One month after TEE showed complete LAA exclusion with no residual peri-device ow. In all cases, ICE provided adequate procedural guidance, closure assessment and LAA and device visualization, including their relation with adjacent structures.
Conclusions: Initial experience suggests LAA occlusion with the Amplatzer Amulet device using ICE guidance from the left atrium is feasible, reproducible, and safe.
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SURGERY ASSOCIATED VASCULAR INJURY MAY MIMIC RESTRICTIVE SYSTEMIC-TO-PULMONARY SHUNT PHYSIOLOGY AND IS AMENABLE TO TRANSCATHETER INTERVENTION
Pieter Verhoeven, Russel Hirsch, Konstantin Averin, Wendy Whiteside, Bryan Goldstein
Cincinnati Children’s Hospital, Cincinnati, OH, USA
Background: Restrictive systemic-to-pulmonary (SP) shunt physiol- ogy, typically due to anatomic shunt stenosis and/or thrombosis, is a
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306