Page 58 - Journal of Structural Heart Disease Volume 2, Issue 6

285
Meeting Abstracts
Background: Children with heart disease may require repeated X-Ray cardiac catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiac MRI is radiation-free and o ers information about structure, function, and perfusion but not hemodynamics. We aim to perform radiation-free diagnostic right heart catheterization entirely using MRI guidance in an unselected cohort of pediatric patients.
Methods and Results: We performed 45 MRI guided comprehensive transfemoral right heart catheterizations in 35 pediatric (12.7 ± 4.8 years) subjects referred for clinically indicated cardiac catheterization (post-heart transplant 37%, shunt 31%, cardiomyopathy 14%, pulmo- nary hypertension 12%, valvular heart disease 3%, other 3%) during an sixteen month period (3/2015 – 8/2016). Radiation-free MRI right heart catheterization attempts were all successful using passive cath- eters. In two subjects with septal defects, right and left heart catheter- ization was performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.8 ± 5) previous X-Ray cardiac catheterizations. Retained thoracic surgical or transcatheter implants (40%) did not preclude successful MRI heart catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in six procedures, multiple hemodynamic conditions were tested.
Conclusions: Comprehensive MRI guided right heart catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac catheterizations may bene t most from radiation sparing. This is a step toward wholly MRI guided diagnostic (right and left heart) cardiac catheterization and future MRI guided cardiac intervention.
#0108
UPDATE ON UGANDA HEART INSTITUTE 5 YEAR PROSPECTIVE PLAN TOWARD INDEPENDENT PEDIATRIC CARDIAC CATHETERIZATION
Sulaiman Lubega1, Twalib Aliku1, Peter Lwabi1,
Sanjay V. Daluvoy2, Craig A. Sable3, Shakeel Qureshi4, Krishna Kumar5, Kanishka Ratnayaka6
1Uganda Heart Institute, Kampala, Uganda
2Duke Global Health Institute, Durham, NC, USA
3Children’s National Health System, Washington, DC, USA 4Evelina London Children’s Hospital, London, UK
5Amrita Institute of Medical Science and Research, Kochi, India 6Rady Children’s Hospital, San Diego, CA, USA
Background: Population statistics estimate 10,000 children are born each year with congenital heart disease in Uganda. Over the past decade, Uganda Heart Institute has developed a cardiovascular surgi- cal program. A complementary cardiac catheterization program was started in February 2012 with the aim of developing independent operation after ve years of mentorship.
Methods: A biplane X-ray cardiac catheterization lab was built adjacent to a new cardiovascular operating room. Uganda Heart Institute physicians, nurses, and technologists began training with government and non-governmental organization support toward
independent operation. Innovative prospective ve-year indepen- dence plan includes visiting in-country clinical service and training trips, encouraging autonomy through targeted case selection (diag- nostic, balloon pulmonary valvuloplasty, patent ductus arteriosus device closure), out-of-country training fellowships, and weekly tele- medicine case discussion/mentorship sessions.
Results: Since inception, Uganda Heart Institute has performed 245 congenital heart disease catheterization procedures [diagnostic (85); balloon pulmonary valvuloplasty (37); patent ductus arterio- sus device closure (102); other (21)]. The number and percentage of independent Uganda Heart Institute procedures (no international provider presence) has steadily grown from 0, 0% (2012); 3, 7.8% (2013); 17, 29.8 % (2014); 55, 77.5% (2015) to 53, 82.8% (Jan-Sept 2016). In-country clinical service and training trips have been con- ducted by ve organizations [total n = 10; World Children’s Initiative (4), Gift of Life/Chain of Hope (5)] traveling with physicians, nurses, and technologists. Two Uganda Heart Institute catheterization opera- tors were trained at Amrita Institute of Medical Science and Research for 5 months observing and participating in 226 procedures. Weekly telemedicine conferences (n = 51 months) have facilitated dialogue and education covering clinical case selection, planning, and review. Challenges include inventory procurement, domestic hardware sup- port, and expert support sta (anesthesia, intensive care) shortage.
Conclusions: Through mentoring, Uganda Heart Institute is progress- ing toward the goal of 100 annual independent cases by 2017 ve years after program inception.
#0109
AMPLATZER VASCULAR PLUG II DEVICE TO OCCLUDE DIFFERENT TYPES OF PATENT DUCTUS ARTERIOSUS IN PEDIATRIC PATIENTS
Alper Guzeltas1, Ibrahim Cansaran Tanidir1,
Mehmet Akin Topkarci2, Gulhan Tunca Sahin1, Murat Sahin1 1Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center Department of Pediatric Cardiology, Istanbul, Turkey
2Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center Department of Pediatric Anesthesia, Istanbul, Turkey
Objective: To evaluate the outcome of the Amplatzer Vascular Plug II (AVP-II) for closure of the patent ductus arteriosus (PDA) in children.
Methods: All patients undergoing transcatheter closure of PDA with AVP-II from June 2013 to November 2016 were retrospectively evaluated. In one patient device had to remove due to pulmonary hypertensive crisis. this patient excluded from study. Clinical, angio- graphic, and echocardiographic data were analyzed.
Results: Thirty ve procedures were performed in 34 patients. Median age was 30 months (6–202 months) with median weight 13 kg (4.2–63). The morphological PDA classi cation was Type A in 14/34 (41%), Type B in 2/34 (6%), Type C in 15/34 (44%), and Type E in 3/34 (9%). The median minimum PDA diameter, maximum and length was 3.5 mm (1.5-8.3 mm), 8.2 mm (2.2-21 mm), and 13.1 mm (8.2-21 mm) respectively. The implanted device sizes were: 6 mm in 4/35 (11%), 8 mm in 14/35 (40%), 10 mm in 15/35 (43%) and 14 mm in 2/35 (6%) procedures. The implanted device was mean of
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts