Page 67 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
294
#0127
RELIEF OF PULMONARY VEIN STENOSIS VIA HYBRID APPROACH IN A PATIENT WITH HETEROTAXY, FUNCTIONAL SINGLE VENTRICLE, AND FONTAN PALLIATION
Gregory Fleming, Kevin Hill, Jake Jaquiss
Duke University, Durham, NC, USA
Pulmonary vein obstruction is poorly tolerated in patients with Fontan palliation and total anomalous pulmonary venous return (TAPVR). A 19 year old male with heterotaxy and single ventricle, bilateral superior vena cavae (SVC) and TAPVR to the SVC- right atrium (RA) junction who was had previously undergone extracardiac non-fenestrated Fontan was transferred to our institution after being admitted with cyanosis and chronic pleural e usions. Diagnostic cardiac catheterization revealed multiple veno-atrial collaterals, elevated Fontan pressures at 30mmHg, and elevated pulmonary capillary wedge pressures (PCWP) of 24mmhg compared to end dia- stolic pressure of 9mmHg. Transesophageal echocardiography (TEE) showed pulmonary vein stenosis localized to the entrance of the pul- monary venous con uence to the SVC. Due to the perceived di culty of an intervention from the femoral vein approach, a hybrid approach was performed in a single plane hybrid operating room. The right atrium was exposed through a repeat median sternotomy incision and a pledgetted pursetring suture was placed in the anterior wall. A 14 French short sheath was inserted into the RA, and using TEE and uoroscopic guidance, a wire was easily manipulated across the pul- monary vein con uence into the right lower pulmonary vein. Balloon compliance testing was performed with a 16mm x 3cm Tyshak II bal- loon demonstrating a discrete waist that resolved easily with in a- tion but returned upon de ation. A 26mm EV3 Mega LD stent was hand crimped on a 20mm Numed BIB balloon and deployed across the stenosis. There was unobstructed ow and no signi cant gradi- ent by TEE or catheter pullback pressure following stent deployment. The patient recovered well from the procedure. All chest tubes were removed by postoperative day (POD) 8, and he was discharged home on POD 12 with oxygen saturations in the low 90’s in room air. This case demonstrates the utility of hybrid procedures in treating com- plex obstructions in high risk single ventricle patients.
#0128
ELECTIVE PALLIATION WITH SERIAL CATHETER- BASED INTERVENTIONS AS A BRIDGE TO SURGICAL REPAIR IN PREMATURE INFANTS WITH OBSTRUCTED TOTAL ANOMALOUS PULMONARY VENOUS RETURN Gregory Fleming, Kevin Hill, Andrew Dodgen
Duke University, Durham, NC, USA
Premature infants born with obstructed total anomalous pulmonary venous return (TAPVR) are often not considered candidates for surgery and therefore pose a signi cant treatment dilemma. We describe the course of two premature infants with obstructed TAPVR who were palliated with serial catheter based interventions. Case One: A 1.9kg infant, born at 32 weeks gestational age, was diagnosed with infra- diaphragmatic TAPVR and mild obstruction at the level of the ductus venosus. Although he could be stabilized initially with aggressive respiratory support, serial echocardiograms demonstrated increasing obstruction. On day of life (DOL) 10, stenting of his ductus venosus was
performed by a right internal jugular vein approach with two 4mm Medtronic Integrity stents. He was extubated after the procedure and remained stable for several weeks. He developed progressive hypox- emia and pulmonary edema associated with increasing gradient across the stents by echocardiogram. The stents were dilated with a 5mm Bard Dorado balloon with relief of the gradient and this allowed for stabilization until he underwent surgical repair at DOL 60 and a weight of 2.8kg. He had an uneventful postoperative course and was ultimately discharged home. Case Two: A 1.4kg infant, born at 30 weeks gestation developed respiratory distress in the immediate post-natal period and was diagnosed with supra-cardiac TAPVR draining to the left innominate vein. Due to progressive obstruction, stenting of his vertical vein was performed at DOL 41 with a 4mm Medtronic Integrity stent through femoral vein approach with relief of the gradient. He developed progressive obstruction across his stent, and he was taken back to the catheterization lab where a 5mm Cook Formula stent was placedwithinthepreviousstentandpostdilatedwitha6mmSterling balloon providing relief of the gradient. This allowed stabilization to surgical repair at DOL 79 and a weight of 2.9kg. He had an uneventful postoperative course and was ultimately discharged home. Serial cath- eter-based palliative interventions in premature infants with TAPVR should be considered as a management option that allows them to achieve an acceptable weight and maturity for surgical repair.
#0129
PERCUTANEOUS PULMONARY VALVE REPLACEMENT USING THE SELF-EXPANDABLE VENUS P-VALVE®. INITIAL CLINICAL EXPERIENCE IN LATAM.
Francisco Garay1, Alejandro Peirone2, Carlos Pedra3, Alejandro Contreras2, Daniel Springmuller1, Rodrigo Costa3, Adolfo Ferrero2, Ziyad Hijazi4, Qi-Ling Cao4
1Ponti cal Catholic University of Chile, Santiago, Chile
2Private University Hospital of Cordoba, Cordoba, Argentina 3Instituto Dante Pazzanese of Cardiology, Sao Paulo, Brazil
4Sidra Medical and Research Center, Doha, Qatar
Background: Percutaneous pulmonary valve replacement (PPVR) with balloon expandable valves is limited to patients with RV-PA conduits and bioprosthetic valves. In LATAM, most patients with TOF are operated with transannular patches and have enlarged right ventricular out ow tracts (RVOT ), being not suitable for the available technology. We report the early outcomes after using a new device to restore pulmonary competence.
Methods: The Venus P-Valve® (Venus MedTech, Shanghai, China) is a self-expanding nitinol stent with a tri-lea et porcine pericardium valve with ared ends for anchoring at pulmonary artery bifurcation and RVOT. Pts with severe PR after transannular patch repair were selected under a pre-established study protocol. Demographics, pre-proce- dural, intra-procedural and short-term follow-up data were reviewed.
Results: Since March 2016, 5 pts (4 females) underwent PPVR with the Venus P-Valve®. Mean age, weight and height were 17 years (13-25), 61.6 kgs (49-80) and 1.57 mts (1.51-1.63), respectively. All were in NYHA functional class II and had severe PR. By surface echocardiog- raphy, they had a mean annulus diameter of 23.5 mm (19-26) and a mean RVOT diameter of 40.2 mm (34-43). By MRI, mean RVEDV index was 151.4 ml/m2 (142-179), PR fraction was 46.4 % (29-58) and RV ejection fraction was 47 % (42-53). Successful implantation was achieved in all with a mean uoroscopy time of 26.6 min (23.7-29.4).
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306