Page 66 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
of the device occurred obstructing complete ow into the LPA. Initial attempts to snare and retrieve the device were unsuccessful. We then decided to restore LPA patency by stenting the vessel. In order to do so, after persistent manoeuvring we were able to pass a coronary wire into the distal portion of the LPA. Sequential coronary (1.5, 2.5 and 4mm) and conventional 4 and 7mm balloons were used to dilate and most importantly allow positioning of a long sheath. A PG1910 stent was successfully deployed achieving enough displacement of the occluder to restore LPA ow. In addition, adequate PDA occlusion was not a ected by stent placement. Post-intervention, mean pul- monary artery pressure dropped to 25mmHg. There was no gradient between distal LPA and the pulmonary trunk or between ascending and descending aorta. The patient was discharged uneventfully the following morning.
#0125
PATENT DUCTUS ARTERIOSUS STENTING IN NEONATES: 10 YEAR SINGLE- CENTER EXPERIENCE. Carlos Guerrero, Carlos Zabal, Jose Antonio Garcia-Montes, Aldo Campos, Adrian Sanchez, Guillermo Aristizabal, Juan Pablo Sandoval
National Institute of Cardiology Mexico City, Mexico City, Mexico
Background: Current conventional management of patients with duc- tal-dependent pulmonary blood ow consists of a surgically created aortopulmonary shunt (i.e. BT shunt). Experience has shown morbid- ity and mortality are higher when surgical shunts are performed in the neonatal period. Stenting of the patent ductus arteriosus (PDA) has become an accepted, e ective and reasonably safe alternative in selected patients with ductal-dependent pulmonary circulation. We sought to report our experience with PDA stenting in neonates with ductal dependent pulmonary blood ow over the last decade.
Methods: Single center, retrospective review including all neonates with ductal-dependent pulmonary blood ow that underwent PDA stenting as an alternative to a surgical shunt between 2005 to 2015 at the National Institute of Cardiology Mexico City. Demographic, clinical, and interventional aspects of the procedure were reviewed. Procedure-related and early (<30 day) mortality were also included for analysis.
Results: PDA stenting was performed in 49 neonates (n=29 female). Median age and weight at intervention was 10 (range 1-30) and 3 (1.6-4kg) respectively. Clinical diagnosis included: n=22(46%) pul- monary atresia (PA) intact ventricular septum or critical pulmonary stenosis; n=10(20%) right atrial isomerism-PA; n=6(12%) PA with ventricular septal defect; 6(12%) single-ventricle physiology-PA associated with single ventricle physiology and other n=5 (10%) (i.e tetralogy of Fallot, transposition of great arteries-subPS). PDA stent- ing was performed through retrograde approach (via femoral artery) in n=27(55%) cases; antegrade (venous) approach in 12(25%) and (in more recent years) via carotid cut-down in n=10(20%). PDA stenting was performed using di erent diameter bare metal coronary stents: 3mm(n=2), 3.5mm (n=29(59%)), 4mm(n=17(34%)) and 5mm(n=1). In six(12%) patients an additional stent was required to span the entire length of the ductus. O2 sats ranged preoperatively from 55± 20 to 89 ± 15 % post intervention (p< 0.0001). Six (12%) patients required an additional BT shunt due to persistence and/or recurrence of cyanosis.
Procedure-related mortality occurred in 4 (8%) patients, 2 of which occurred within the initial 5 years of establishing PDA stenting as an alternative to BT shunt in our institution. Early mortality (< 30 days) was 28%.
Conclusion: PDA stenting is a reasonably e ective alternative to sur- gical shunts to maintain pulmonary blood ow and increase systemic oxygenation in selected patients. In our series, procedure related mortality has decreased as we have increased our curve of experi- ence regarding this complex technique albeit early (<30 day) mortal- ity remains high in the neonatal period as demonstrated in our series.
#0126
TRANSCATHETER DEVICE OCCLUSION OF LARGE (AND HYPERTENSIVE) PATENT DUCTUS ARTERIOSUS USING THE CERATM PDA OCCLUDER
Aldo Campos, José García-Montes, Carlos Zabal, Adrian Sánchez, Guillermo Aristizabal, Carlos Guerrero, Juan Pablo Sandoval
National Institute of Cardiology “Ignacio Chavez”, Mexico, City, Mexico
Background: Transcatheter device occlusion of large patent ductus arteriosus (PDA) is no simple task. Traditionally, non conventional double-disk devices (atrial and ventricular septal occluders) have been used provided they are available in large diameters albeit their shape is not speci cally designed to accommodate into most of the frequently encountered PDA morphologies. In this setting, the CeraTM PDA occluder (Lifetech, Scienti c) is similar to the standard Amplatzer Duct Occluder but has a broader range of diameters (up to a maxi- mum of 24mm) making it an attractive device to close large defects.
Methods: Single centre, retrospective analysis of 39 consecutive patients (female N=27, 69%) with large PDA that underwent closure using the CeraTM PDA occluder between May 2012 and November 2015. Standard implantation technique was performed in all cases. Careful hemodynamic assessment was mandatory. Vasorreactivity test (100% O2 and/or Iloprost) and/or temporary PDA balloon occlusion was per- formed if moderate to severe pulmonary arterial hypertension was present and closure considered if pulmonary vascular resistance was ≤ 6 Wood units. Continuous variables were expressed as median and range or mean and standard deviation were appropriate, while cate- gorical data were expressed as numbers and percentages. Paired t-test was used for pre-post intervention hemodynamic observations.
Results: Median pulmonary and aortic end diameters were 10(6.8-12.7) and 17.5(10-27) respectively. Mean pulmonary systolic artery pressure (PSAP) was 69±21mmHg with a Qp:Qs ratio of 3.6 ±1.7 to 1. Successful closure was achieved in 38 (97%) cases. Mean PSAP decreased to 47±14mmHg (p<0.001). Device embolization occurred in 2(5%) cases. The rst patient had the original device snared and retrieved uneventfully followed by successful deployment of a larger device. The other patient required surgical retrieval of the device and PDA closure. Follow-up was available in all patients with a median follow-up of 24(9,61) months. Currently, 30(79%) patients have completed 1-year follow-up. In this group, mean PSAP was 37±13mmHg on echo. No signi cant left pulmo- nary artery obstruction (≥10mmHg) has been encountered.
Conclusion: The CeraTM PDA occluder is safe and e ective for closure of large and hypertensive defects.
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts