Page 56 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
vegetation in the Melody TPV on echo. Three of these 5 pts had poor out- comes: Two presented in septic shock, one was immunocompromised and died while the other underwent surgical valve replacement due to severe residual RVOT obstruction. A second death occurred in an afebrile pt with terminal heart failure who presented with multi-organ failure and IE. The other 9 pts were treated medically and none had residual RVOT obstruction after completing antibiotics. One pt developed Strep Mitis IE 2 years after TPV implantation and 5 months later had a second IE epi- sode due to MSSA. TEE was negative both times. Most common organ- isms isolated were MSSA in 4 (33%) pts and Strep Mitis in 3 (25%).
Conclusion: At our institution, IE occurred in 14% of pts after Melody TPV implantation. No speci c risk factors were identi ed. TPV dys- function was present in 67% of cases with mortality occurring in 2 high-risk pts. One pt had their TPV explanted while the rest were successfully treated medically. Multicenter studies are needed to better understand and identify predictors of IE in this population.
#0102
PERCUTANEOUS CLOSURE OF PARAVALVULAR LEAK AND VALVE-IN-VALVE IMPLANTATION IN AORTIC REGURGITATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT
Vasutakarn Chongthammakun, Mauricio Cohen
Division of Cardiology, University of Miami Miller School of Medicine, Miami, FL, USA
Paravalvular leak (PVL) is a common complication in transcatheter aortic valve replacement (TAVR) especially when significant cal- cification of the native valve is present resulting in underexpan- sion of the transcatheter valve. We present a case of a 91-year-old female patient with severe aortic stenosis who underwent right transfemoral TAVR with a 20-mm Edwards Sapien 3 Valve. After the valve was deployed, transaortic gradient normalized; how- ever, aortography revealed severe aortic insufficiency. Elevated left ventricular end-diastolic pressure (LVEDP) and equalization of LVEDP and diastolic aortic pressure were noted on pressure tracings. Transesophageal echocardiography (TEE) demonstrated severe central and paravalvular regurgitation in the region of the non-coronary cusp. Balloon post-dilation of the transcatheter valve did not result in improvement of aortic insufficiency. The decision was then made to close the leak. Two Amplatzer Vascular Plug-II devices were used, which successfully closed the PVL. The degree of paravalvular regurgitation substantially decreased on subsequent TEE. Given central aortic regurgitation remained pres- ent, a second 20-mm Edwards Sapien 3 Valve was implanted in a valve-in-valve fashion. Final aortography and TEE showed res- olution of aortic insufficiency. PVL is a known predictor of worse outcome post-TAVR and percutaneous closure of PVL should be considered as it has been shown to improve symptoms, minimize risks of hemolysis requiring blood transfusion, and is associated with improved long-term mortality.
#0103
THE SHORT-TERM RESULT OF INTRAOPERATIVE BALLOON PULMONARY VALVULOPLASTY IN VALVE- SPARING REPAIR OF TETRALOGY OF FALLOT
Sangyun Lee, Seongho Kim, Soick Jang, Soojin Park, Changha Lee Sejong General Hospital, Bucheon-si, Geynggi-do, Republic of Korea
Introduction: Progressive pulmonary valve regurgitation is a signi cant morbidity after surgical correction of tetralogy of Fallot. This study reviewed a single institution’s experience with valve- sparing repair and investigated the role of intraoperative balloon valvuloplasty.
Methods: A retrospective chart review identi ed 7 patients who underwent valve sparing repair of tetralogy of Fallot by intraopera- tive balloon pulmonary valvuloplasty. We evaluated the pulmonary valve function by echocardiography in immediate post-operative and short-term later.
Results: Among 7 patients, the number of male were 3 and median age was 136 days old. The median annulus diameter of pulmonary valve was 6.8mm (Z score -2.4) and Z score of pulmonary valve annu- lus was from -2.0 to -3.7. The high pressure balloon of various size were used from 8 to 12 mm and median ratio of annulus to balloon was 1.29. In immediate post-operative period, most patients had below moderate pulmonary regurgitation and stenosis. Median fol- low up duration from TOF repair was 22 months and most patients had mild or moderate pulmonary stenosis and regurgitation. We had 1 mortality case and she expired by endocrinology problem as adre- nal dysfunction after operation.
Conclusions: In our results, the intraoperative balloon pulmonary val- vuloplasty in valve-sparing repair of TOF showed feasible outcomes and long term follow up was required for more explainable results.
#0104
USING A CORE TEAM TO IMPROVE PATIENT CARE DELIVERY FOR ASD/PFO CLOSURES IN AN ADULT CARDIAC CATHETERIZATION LABORATORY.
Ami Vaughn
Houston Methodist Hospital, Houston, TX, USA
Background: A knowledge deficit exists at this institution in the cardiac catheterization laboratory in regards to the treatment of Adult Congenital Heart Disease (ACHD). Limited exposure to congenital cases results in a learning curve for the nursing staff and radiology technologists assisting in the procedures. Due to improvements in treatment as children, more patients are living longer, so the need for specialized adult congenital heart care has dramatically increased and will continue to do so for the foresee- able future. With the addition of Houston’s only board certified Adult Congenital Heart specialist, the caseload of ACHD patients has increased at this institution.
Method: This institution’s cardiac catheterization laboratory has recently implemented a core team of people that assist in these congenital heart procedures as well as brie ng with the cardiologist prior to case start. Additionally, the physician meets with our clini- cal manager to discuss the cases coming up the following week and ensure availability of supplies that will be needed for the cases. For these purposes, we have only retrospectively assessed time to case start and total in room time in the lab for the ASD/PFO closures at this institution from 2014 to present.
Results: We reviewed the case times for ASD/PFO closures from 2014 (13), 2015 (7) and 2016 (16), speci cally looking at time in
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts