Page 68 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
Implanted valve diameters were 26 (n=1), 28 (n=1), 30 (n=2) and 32 mm (n=1). Four valves were 30 mm in length and one was 25 mm. No pt had a significant RVOT gradient or PR after the procedure. Mean length of stay was 3 days (1-5). Two pts had low-grade fever after the implantation with negative blood cultures. In a mean follow-up of 3.4 months (1-5) PR is grade 0 in all pts, mean Doppler systolic peak gra- dient across the valve was 15.8 mm Hg (14-19), 1 pt developed a sus- tained ventricular tachycardia 18 days after implantation requiring cardioversion and anti-arrhythmic medication and there was 1 case of stent strut fracture on fluoroscopy with normal valve function.
Conclusions: PPVR using the Venus P-Valve® in pts with enlarged RVOT was feasible, safe and e ective in this preliminary experience. Immediate pulmonary competence was seen. Further follow-up studies are needed to evaluate the long-term valve performance.
#0130
TRANSCATHETER CLOSURE OF A RUPTURED SINUS OF VALSALVA ANEURYSM, IMMEDIATE AND FOLLOW-UP RESULTS.
Iñaki Navarro, Alberto Zárate, Liborio Solano,
Julio Erdmenger, Alexis Arévalo
Hospital Infantil de Mexico, Ciudad de Mexico, Mexico
This pathology is rare and di cult to see in pediatric population. In our pediatric National Insitute of Health (Hospital Infantil de México Federico Gómez) according to the Archive of Biostatistics and dis- cussed with the doctors assigned to the service (personal communi- cation) we have not found any cases reported in the hospital at least since 1980 to 2015.
Most of these cases in the world are usually close by open heart surgery with extracorporeal circulation pump, which is why the importance of presenting the clinical case.
We present the case of a patient 10 years old, in which the initial malformation was a membranous ventricular septal defect (VSD) 12 x 17mm (1.9 cm2 / ASC) with an aortic ring 12mm, discharged appar- ently without complications.
Four years later of the closure of VSD, it was found in the outpatient clinic: weight and height in the 50 percentile, with a new murmur, Ross functional class II.
The echocardiogram showed a systole-diastolic ow of non-coronary sinus of Valsalva into the right ventricle with a gradient of 70 mmHg.
In the Cath Lab: pulmonary arterial pressure 48/13 mmHg mean of 28 against the aortic 98/50 mean of 70 mm Hg, mixed venous saturation of 75% and in the right ventricle of 85%, saturation was in the left cavities stable at 96%. With a pulmonary vascular resistance of 3.58 uW and systemic vascular resistance 17.43 uW, with QP / QS = 1.9: 1
With the previous information and the angiographies: We decided to closure the defect with a PDA Amplatzer® 10/8 device, using an arteriovenous loop.
One day after the closure there was mild residual ow, after 6 months the residual ow disappear and the patient is asymptomatic with a Ross functional class I.
As the medium-term evolution of the uncorrected defect, patients have a very bad prognosis. Previously there was only the possibility of closure by surgery, but now the closure in the cath lab is a reality.
#0131
COMPREHENSIVE ASSESSMENT OF CORONARY ARTERY COMPRESSION DURING TRANSCATHETER PULMONARY VALVE PLACEMENT: THE ROLE
OF DYNAMIC PROJECTION CORONARY ARTERY ASSESSMENT
Jenny Zablah1, Michael Ross1, Neil Wilson1, Gareth Morgan1, Joseph Kay1, Thomas Fagan2
1University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, USA
2University of Tennessee Health Science Center, Memphis, USA
Background: Coronary Artery (CA) compression is a known devastat- ing complication of Transcatheter Pulmonary Valve Placement (TPVP). Fixed Projection Imaging (FPI) is limited in visualizing the complex relative anatomy of the CAs and the Right Ventricular Out ow Tract (RVOT). We have developed a strategy involving selective CA angi- ography during conduit dilation for CA compression testing (CACT) using Dynamic Projection Coronary Artery Assessment (DPCAA) (3-dimensional rotational angiography, CA Swing angiography, or manual rotation CA angiography). We sought to compare these DPCAA to FPI in the setting of CACT prior to TPVR.
Methods: Retrospective study from subjects who have undergone CACT during from 2010 to 2015. Demographic, echocardiographic, hemodynamic and angiographic data were reviewed. Patients who underwent selective CA angiography during CACT were included for comparison. Comparison of the number of angiograms needed for CACT was performed between those who underwent FPI to those with DPCAA.
Results: There were 132 subjects with intent for TPVP. 102 subjects met inclusion criteria with a median age of 22 years (IQR: 14.3 – 29), weight of 60.5kg. (IQR: 51.4-72.1), with 36% female gender. The indication for TPVP was: pulmonary stenosis 30(29%), pulmonary insu ciency 22(22%), and mixed pulmonary stenosis/pulmonary insu ciency 50(49%). Nine subjects (9%) were found to have coro- nary artery compression precluding TPVP. Sixty-one subjects under- went selective coronary artery assessment. Of these, 16 subjects (15%) underwent DPCAA. There was a signi cant decrease in the number angiograms needed in patients who underwent DPCAA vs. FPI (3.60 vs. 4.74 angiograms, p-Value: <0.01).
Conclusion: Dynamic Projection Coronary Artery Assessment can aid in decreasing the number of angiograms needed to diagnose coronary artery compression during Transcatheter Pulmonary Valve Placement.
#0132
FEASIBILITY AND INITIAL OUTCOME OF TRANSCATHETER CLOSURE OF PERIMEMBRANOUS VENTRICULAR SEPTAL DEFECT WITH DIFFERENT DEVICES
Manish Shrestha Shrestha1, Worakan Promphan1,
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts