Page 70 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
perforation of the 3.5 mm pulmonary valve into a 1.8mm MPA and placement of a 4mm Formula 418 Stent (Cook Medical) in the RVOT and MPA with con uent branch PAS measuring 1.5mm each. Her O2 sats increased to 88%. She underwent a second cath at 8 months of age to redilate the RVOT stent to 5mm. She underwent a successful bloodless repair at 14 months of age with RV-PA homograph/VSD closure.
Case #2: 36 weeker with birth weight of 2.4kg with Hypoplastic Aortic Arch and VSD. Patient underwent placement of a 4mm X 8mm Rebel Stent (Boston Scienti c) in the PDA and placement of branch PA stents at 2 weeks of life. He had the stent redilated at 6 months of age to 5mm. He underwent a successful bloodless arch repair and VSD closure at 17 months of age.
Conclusion: Both patients had 2 caths and one full repair on bypass without receiving any blood products. This percutaneous hybrid approach provides a safe alternative and allows patients to delay the rst surgery until after a year of life and at least 9 kg to be able to undergo a bloodless surgical repair.
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BALLOON-EXPANDABLE COVERED STENT IMPLANTATION FOR TREATMENT OF A TRAUMATIC PEDIATRIC PULMONARY ARTERY PSEUDOANEURYSM Vincent Palmieri, M. Elisabeth Heal, Shahryar M. Chowdhury, Varsha M. Bandisode
Medical University of South Carolina, Charleston, SC, USA
Traumatic pseudo-aneurysms of the aorta are well described con- sequences of motor vehicle collisions in adults, but pseudo-an- eurysms of the pulmonary arteries are more often attributed to infectious etiologies, such as necrotizing pneumonia, bacterial endocarditis, tuberculosis, aspergillus, or vasculitis. Traumatic pseu- do-aneurysms in the pediatric population are extremely rare, and often require a novel approach with considerations for continued somatic growth of the vessel and minimally invasive techniques. Here, we detail the case of an 8-year-old male passenger in a motor vehicle collision, whose trauma led to the formation of a pulmo- nary artery pseudoaneurysm. Given the poor candidacy for open surgical repair, an endovascular approach was performed using the NuMed Cheatham Platinum (CP) covered balloon-expandable stent (NuMed, Inc., Hopkinton, New York). The advantage of the use of a balloon expandable CP covered stent in the pediatric setting is the stent’s ability for further dilation on subsequent evaluations if necessary and with somatic growth. The rst CP covered stent was placed over the distal pseudo-aneurysm in the left pulmonary artery (LPA), and a second CP covered stent was coupled to the rst stent extending into the main pulmonary artery (MPA) and “ ow- ered” to obtain apposition to the MPA wall without dilating the LPA. Subsequent CT imaging demonstrated stable stent placement without evidence of complication or a distal lling defect.
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15 YEARS OF EXPERIENCE WITH PERCUTANEOUS TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECTS IN PATIENTS LESS THAN 12 YEARS OLD, MEXICO CITY.
Iñaki Navarro, Alberto Zárate, Liborio Solano, Julio Erdmenger, Alexis Arévalo
Hospital Infantil de México, Mexico City, Mexico
The rst transcatheter closure of an Atrial Septal Defect (ASD) in our NIH was in 2000, at the beginning all patients under 12 years were operated for the closure of the ASD. The objective of our report is to present the evolution in this group of patients, the change of the indications of transcatheter closure (TC) vs surgery, the percent- age of success cases, and the risk factors for complications in this group of patients. We examined the outcome variables through analysis of the record les, comparing the patients who underwent catheterism to those who underwent open surgery for the closure of the ASD.
We present a total of 44 patients under 12 years from 2000 to 2015. The proportion of TC/Surgery for closure of ASD changed signi - cantly during the years, and the most representative years are 2006 when we closed 13 ASD by surgery vs 2 by TC, and 2014 with a total of 12 ASD closed by TC vs 2 by surgery.
Total of 44 patients, 10 (23%) cases were classi ed as complex, 97% had a successful closure. In the rst 24 hours they present mild ow thru the device in 10 patients (27%) and moderate in 1 patient (2.7%), at 6 months 100% had had a total closure of the defect. A total of 3 cases had complications (6.8%) of which 2 were rhythm disorders (4.4%), 1 case the device embolized (2.2%). Patients <20kg were more likely to had a complex ASD.
Percutaneous closure of atrial septal defect is a safe procedure in patients under 12 years. This study demonstrates the natural evolu- tion in the expertise to perform a procedure, as cases solved by per- cutaneous closure of the ASD in 2015 would have underwent surgical closure in 2000. We still need to acquire experience in our center for percutaneous closure in patients under 4 years old (16 kg).
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RISK FACTORS FOR REINTERVENTION IN CHILDREN UNDERGOING TRANSCATHETER ATRIAL SEPTAL INTERVENTIONS FOR ATRIAL DECOMPRESSION AND MIXING
Bhavesh Patel, Holly Bauser-Heaton, Yinn Khurn Ooi,
Dennis Kim, Robert Vincent, Christopher Petit
Emory University, Atlanta, GA, USA
Objectives: Catheter-based atrial septal interventions (ASI) to cre- ate or enlarge atrial septal defects (ASD) are performed for left atrial decompression (LAD), right atrial decompression (RAD) or to enhance atrial level mixing or streaming in infants and children. Occasionally, reintervention (RI) is necessary due to restriction of the ASD. The goal of our study was to identify risk factors for RI based on patient factors and technical approaches.
Methods: A retrospective chart review was performed on all patients that underwent ASI between 2005-15, including: balloon atrial sep- tostomy (BAS), septal stent, or static balloon dilation (SBD). Infants with transposition of the great arteries were excluded. Data collected
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts