Page 59 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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3.0 ± 1.2 times the ductus narrowest diameter and mean of 1.3 ± 0.75 times the ductus largest diameter in successful procedures. The median procedure and uoroscopy time was 30 minutes (15-60 minutes) and 6,5 minutes (2.8-20.3 minutes). In four patients closure was performed from the arterial side. All procedures except one 100% ‘in-lab’ and 100% closure on post-procedural echocardiogram was achieved. No left pulmonary artery stenosis and aortic obstruc- tion observed with a median follow-up duration of 12 months (1-40 months).
Complications: In one patient 8 mm device was embolized in to the pulmonary artery due to ductal spasm which caused underestima- tion of the duct and on the next day 8mm device was retrieved and a 10 mm device was implanted.
Conclusions: The AVP II seems to be an e ective and safe device for PDA closure in children. It is particularly useful in type A and C ductus with adequate length and in small infants where it eliminated the risk of device related aortic obstruction.
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CARDIAC CATHETERIZATION IN PAEDIATRIC PATIENTS DURING EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT
Alper Guzeltas, Ibrahim Cansaran Tanidir, Taner Kasar, Erkut Ozturk
Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center Department of Pediatric Cardiology, Istanbul, Turkey
Background: Extracorporeal membrane oxygenation (ECMO) is a lifesaving intervention for pediatric patients with respiratory and/or cardiovascular failure. Cardiac catheterization while on ECMO was ini- tially reserved for left atrial decompression with the balloon or blade atrial septostomy procedure, indications for ECMO support have evolved particularly by the time. Nowadays it is suggested that early catheterization after initiation of extracorporeal membrane oxygen- ation support in children is associated with improved survival.
Methods: Between January 2012 and October 2016, 98 patients (5.2% of the surgery patients) needed ECMO support after cardiac surgery. Diagnostic or interventional cardiac catheterization was performed in (16.3%) 16 of these 98 patients.
Results: The diagnostic catheterization was performed in 7 of the patients while invasive procedures were performed in 9 of the patients. In patients with antegrade ow, ECMO cannulas were clipped before the injections for higher quality. Median age was 6.7 months (3.3–60 months) with median weight 7.0 kg (3.7–16 kg). The median duration from ECMO support institution to catheterization procedure was 3 days (1-11 days).
4/7 patients underwent surgical palliation after diagnostic catheter- ization. Left pulmonary arterial (LPA) balloon angioplasty was per- formed in 1/9, LPA stenting in 2/9, RPA stenting in 1/9, RVOT stenting in 1/9, both LPA and RVOT stentin in 1/9, both LPA and mBT shunt stenting in 1/9, both LPA and RPA balloon angioplasty in 1/9, both RPA and LPA stenting was performed in 1/9 of the patients during interventional catheterization procedure. During RVOT stenting AV block occurred and during procedure ECMO ow increased due to hypotension. In one patient ECMO tubing disconnected from the arterial line. Twelve patients were successfully weaned from ECMO
after the procedure while 4 patients died under ECMO support during the ICU stay.
Conclusion: If the patients cannot be weaned from ECMO support due to hemodynamic instability, catheter angiography should be performed urgently. We think that for better and high quality views in patients with antegrade ow, who cannot be weaned from ECMO support, ECMO cannulas can be clipped just before the injections.
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A LIFE SAVING INTERVENTION IN CRITICALLY ILL CHILDREN WITH OBSTRUCTED SUPRACARDIAC TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION: VERTICAL VEIN STENTING
Alper Guzeltas, Ibrahim Cansaran Tanidir, Erkut Ozturk Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center Department of Pediatric Cardiology, Istanbul, Turkey
Background: Obstructed total anomalous pulmonary venous con- nection (TAPVC) and duct dependent pulmonary ow are two cardiac pathologies which need urgent surgical intervention in pedi- atric cardiovascular surgery. Obstructed TAPVC has still high risk of surgical burden. Surgical mortality rate is high especially when the patients clinical condition is worse, in which preoperative stabiliza- tion by temporarily relieving the obstruction may improve outcomes in this population.
Methods: Between June 2014 and September 2016, 5 patients under- went urgent cardiac catheterization to relieve the obstruction in the vertical vein.
Results: All patients’ clinical condition was worse and intubated on the day of diagnosis. Interventional cardiac catheterization was performed within the rst 24 hours after the admission. Four of the patients were newborn. Two out of ve patients had isolated suprac- ardiac obstructive TAPVC where as others had additionally right atrial isomerism, unbalanced complete atrioventricular septal defect, pul- monary stenosis in addition to and pulmonary venous hypertension in echocardiography. One of them had also duct dependent pulmo- nary ow.
Either 6mm or 7mm stent implantation could be achieved in all patients. In the patient with supracardiac TAPVC draining into two dif- ferent parts of the SVC stenting could be performed only for one side.
Two of the patients with isolated TAPVC was operated and other one is in the waiting list.
One of the newborn patient with heterotaxy syndrome and duct dependent pulmonary ow underwent PDA stenting 5 days after the rst intervention. This patient had Glenn operation and TAPVC repair when he was 6-month-old.
Remaining one patients with heterotaxy syndrome were died within two days after the procedure.
Conclusion: Stenting of the vertical vein might be an e ective ther- apy to acutely stabilize a sick neonate with obstructed supracardiac TAPVC. Catheter intervention can be considered as part of the preop- erative cardiovascular stabilization strategy for high-risk infants with obstructed supracardiac TAPVC.
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306