Page 57 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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room prior to case start and total time in room for each ASD closure. Median in room to case start times in minutes for 2014, 2015 and 2016 are 32.8, 32.8, and 23.1 respectively. Total in room time in min- utes for the same is 145.8, 149.8, and 134.4. Since implementation, the team times are 18.3 minutes from in room to case start and 99 minutes total in room time.
Conclusion: While our results are preliminary, these ndings suggest the team approach improves the quality of care of ACHD patients while undergoing cardiac catheterization and percutaneous interventions.
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LOWER LIMB REGIONAL OXYGENATION MONITORING USING NEAR INFRARED SPECTROSCOPY DURING CARDIAC CATHETERIZATION OF INFANTS.
Rodrigo Rios, Rohit Loomba, Susan Foerster, Todd Gudausky, Rebecca Russell
Children’s Hospital of Wisconsin, Milwaukee, WI, USA
Introduction: Limb ischemia secondary to femoral arterial injury is a rare but potentially catastrophic complication of cardiac catheteriza- tion in infants. Early detection or prevention of compromised lower extremity perfusion is ideal. Near-infrared Spectroscopy (NIRS) is a well-established non-invasive method of monitoring regional oxygen saturation. The purpose of this study was to characterize intra-oper- ative values and postoperative values of NIRS in infants undergoing cardiac catheterization involving femoral vascular access. A second- ary aim was to determine if values were predictive of arterial femoral thrombus after such intervention.
Methods: Bilateral lower extremity NIRS monitoring was performed during cardiac catheterization. All infants (< 1 years old) 6kg in weight or less that underwent cardiac catheterization with femoral vascular access were eligible. Demographic and procedural data was col- lected. Lower extremity NIRS data was blinded as to not a ect the course of the catheterizations.
Results: Data was collected for 16 consecutive infants undergoing cardiac catheterization with femoral vascular access. Cardiac diagno- sis and purpose of catheterization varied between patients. Of these catheterizations, 9 were interventional. The mean lower extremity arterial-venous oxygen saturation di erence (LEAVD) in the accessed leg was 21 immediately prior to catheterization, 45 immediately after sheath insertion, 52 immediately prior to sheath removal, and then 30 at the time of discharge. LEAVD at any time point was not predic- tive of femoral arterial thrombus.
Conclusion: Lower extremity NIRS monitoring demonstrates a widening of LEAVD during catheterization with femoral vascular access. Data on additional infants is required to determine if lower extremity NIRS monitoring in infants undergoing cardiac catheteriza- tion could be a useful and non-invasive method for early detection and potential prevention of femoral artery compromise.
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FROM START TO FINISH: THE PHYSICS BEHIND IMPLEMENTING A RADIATION DOSE REPORTING SYSTEM IN THE PEDIATRIC CARDIAC CATHETERIZATION LAB
Emily L. Marshall, James C. Fudge, Dhanashree Rajderkar, David Borrego, Wesley E. Bolch
University of Florida, Gainesville, FL, USA
Objective: This study focuses on the creation and implementation of a reporting system of patient radiation doses in a large institution pediatric cardiac catheterization laboratory.
Background: In 2015 the Journal of Pediatrics released a study assessing long-term outcome in children with congenital heart dis- ease (CHD) (Razzaghi 2015). The study utilized the National Health Interview Survey’s 1997-2011 data which indicates that 85% of chil- dren born with CHD in the US today will survive into adulthood, thus requiring multiple cardiac interventions before management is achieved. With increasing improvements in pediatric patients’ long- term outcome, the need for in-clinic patient dose tracking emerged.
Methods: The researcher’s institution developed a library of pediatric computational phantoms to represent patients of varying gender, age, height, and weight. These human models were created based on the statistics of the current US population. The uoroscopy unit at the institution produces a log le for each patient’s procedure. These log les are created to track machine motion and output, they include numerous exposure parameters per irradiation event such as: energy, table position, lter, source angle, and the kerma-area product (KAP) meter value. The uoroscopy unit was calibrated to accurately create a model of the machine in Monte Carlo computer simulation space. Calibrations included: eld isocenter determination, beam half-value layers, and KAP meter calibration. Utilizing the radiation transport code Monte Carlo N-Particle, a simulation of the procedure is possi- ble using the log les, modelled uoroscopy unit, and the phantoms.
Results: Patient phantoms selected based on height and weight per- formed within 15-30% of their patient-speci c modelled counterparts. Isocentric positioning of phantoms when compared to image aligned simulations cited in- eld organ relative errors between 0.5-20%. Attenuation through the procedure table and pad was matched in the computer model to the clinical beam within 1.5-4%. To date, the labo- ratory has successfully completed dose reconstructions for 40 patients.
Conclusion: Implementation of an e ective organ dose reporting sys- tem in a large institution catheterization lab has proven successful. Clinical accessibility of organ dose reports will enable physicians to continue improving pediatric patient long-term outcome.
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RADIATION-FREE MRI HEART
CATHETERIZATION IN CHILDREN
Kanishka Ratnayaka1, Joshua P. Kanter2,
Anthony Z. Faranesh3, Elena K. Grant2, Laura J. Olivieri2, Russell R. Cross2, Ileen F. Cronin2, Karin S. Hamann2, Adrienne E. Campbell-Washburn3, Kendall J. O’Brien3, Toby Rogers3, Michael S. Hansen3, Robert J. Lederman3
1Rady Children’s Hospital, San Diego, CA, USA
2Children’s National Health System, Washington, DC, USA 3National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306