Page 69 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
296
Thanarat Layangool1, Supaporn Roymanee2, Kanjarut Wongwaitawe2, Pimpak Prachasilchai1, Tawatchai Kirawittaya1, Chaisit Sangtawesin1, Panthip Pattarakunwiwat1
1Bangkok, Bangkok, Thailand
2Prince of Songkla University, Songkla, Thailand
Background: Transcatheter closure of perimembranous ventricu- lar septal defect (pmVSD) remains controversial due to its asso- ciation with higher incidence of complete heart block (CHB). Various devices are being developed to minimize the proce- dure-related complications. The aim of this study is to analyse the feasibility of closing pmVSD with different devices by a percuta- neous approach and determining the initial six-month outcome of the procedure.
Methods: A retrospective longitudinal cohort study was conducted in all consecutive patients who underwent transcatheter closure of pmVSD from September 2009 to March 2015 in two major cardiac centers in Thailand. The enrolled subjects were followed up for six months with electrocardiogram and transthoracic echocardiogram.
Results: 146 patients underwent transcatheter closure of pmVSD. The median age at intervention was 7.5 years (ranging from 9 months to 28 years). Seventy-five patients (51.4%) were male. The median weight at intervention was 22.5 kg (ranging from 6.4 to 100 kg). Thirteen different devices were used to occlude pmVSD. Transcatheter pmVSD closure was successfully performed in 142 cases (97.2%). There were two cases (1.4%) of new onset signifi- cant aortic regurgitation (AR) and one case of CHB (0.7%). During a six-month follow-up, there was no mortality although 21 patients had minor adverse events. At immediate follow-up, 32% had mild to moderate residual shunt and 20% had trivial to mild AR. At 6-month follow-up, 11% had mild residual shunt and 14% had trivial to mild AR.
Conclusion: With proper case selection, good expertise and judicious use of various devices with respect to anatomic details of pmVSD, transcatheter closure is feasible with promising outcomes.
Key words: complete heart block • device • perimembranous VSD • and transcatheter closure
#0133
PERCUTANEOUS COIL CLOSURE OF LARGE LEFT CORONARY ARTERY FISTULA IN A 48 Y.O. WITH NORMALIZATION OF SEVERELY DEPRESSED LV WALL MOTION.
Mary Porisch, Thomas Summitt
Methodist Children’s Hospital, San Antonio, TX, USA
Introduction: Coronary artery stulas are a rare cardiac defect with an incidence of 0.002% and account for 0.2-0.4% of all congenital heart defects. They most commonly arise from the left anterior descending or right coronary artery with the majority of stulas draining to the right-sided heart structures. Small case series report approximately 4% drain to the left ventricle. The majority of stulas are small and
asymptomatic. We could not nd in a review of the literature whether patients presenting with severe depression of the LV wall motion could be reversible after closure. We describe a case where the EF normalized on ECHO the following day and is normal on follow up to 6 months.
Methods: A 48 y.o. male presented with dyspnea; exertional fatigue and exercise intolerance and was found to be in atrial fibrillation and had an EF of 25%. He was placed on a life vest; Eliquis (Bristol-Myers Sqibb) and limited activity restrictions. His atrial fibrillation was rate controlled with no improvement in his EF. He therefore had a cardiac cath, which demonstrated a mod- erate sized tortuous coronary artery fistula arising off of the distal LAD, which appeared to be draining to the LV. He was therefore referred for percutaneous closure.
Selective left coronary artery injections revealed a very tortuous stula o the LAD measuring 5 x 3.9mm coursing across the RV apex with an intramural course with drainage to the LV with nar- rowing to 3.5mm. Balloon test occlusion was performed without ST segment changes. The stula was then closed with a 6mm × 20 cm Interlock-18 Coil (Boston Scienti c), followed by a 5mm × 8 cm Interlock-18 Coil with complete occlusion. His Eliquis was continued.
Results: Pre-cath ECHO EF was 25%. Post-cath ECHO EF the follow- ing day was 64%. The patient’s symptoms have resolved and patient is now able to exercise again. He had a routine screening cath per- formed 4 months after the procedure which demonstrated complete closure; no proximal extension of thrombus and improved lling of proximal branch vessels of the LAD.
Conclusion: This is only a single case report. However, our experi- ence would suggest that poor LV wall motion secondary to a cor- onary artery stula may be reversed with closure even in the adult patient with presumed long standing shunting. In addition, per- cutaneous coil occlusion is a possible, safe treatment option even when draining the LV. Long term anticoagulation strategies are not well established.
#0134
HYBRID APPROACH TO PREMATURE INFANTS WITH COMPLEX CONGENITAL HEART DISEASE OF JEHOVAH’S WITNESS PARENTS PURSUING BLOODLESS TREATMENT OPTIONS.
Thomas Summitt, Mary Porisch
Methodist Children’s Hospital, San Antonio, TX, USA
Introduction: There are very few programs that o er intervention and there are limited options for neonates born with complex congenital heart disease whose parents are Jehovah’s Witness and are pursuing bloodless options. We present two patients that underwent a percu- taneous intervention in the neonatal period with subsequent blood- less full surgical repair after one year of age.
Methods/Results: Case #1: 4 month former 32 weeker with birth weight of 1.8kg infant with pulmonary atresia, VSD, hypoplastic con uent branch PAs and stenotic MAPCAs with O2 sats of 68%. She was referred for possible percutaneous intervention. She underwent
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306