Page 71 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
298
included pre- and post-intervention septal gradient. The primary endpoint was RI on the ASD - surgical or catheter-based.
Results: 84 patients underwent creation (n=17, 20%) or enlargement (n=67, 80%) of an ASD at median age of 45 days (IQR 7-109) for mix- ing or streaming (n=26, 31%), LAD (n=47, 56%), and RAD (n=11, 13%). Among the cohort, 56 (67%) had BAS, 12 (14%) had SBD, and 16 (19%) had septal stent. The median baseline septal gradient was 5.5 mmHg (IQR 2-12.8) and decreased to 1 mmHg (IQR 0.8-2) after ASI (p < 0.001). There was no di erence in gradient reduction by method of ASI. There were 53 (63%) single ventricle (SV) patients, of whom ASD creation was performed for mixing or streaming in 12 (23%), LAD in 32 (60%), and RAD in 9 (17%). 14 patients (17%) had cardiomyopathy requiring LAD following extra-corporeal membranous oxygenation. Baseline gradient in patients requiring RAD was lower (median 3.5 mmHg, IQR 0.3-8.3) compared to patients who required LAD (median 9.5 mmHg, IQR 5-18.25, p= 0.002). Of the 84 patients, 34 (40%) required RI, 31/34 had SV, and 26/34 had RI as a part of a scheduled surgery. There was no signi cant di erence in risk of RI (p = 0.34) or time to RI (p = 0.42) with regards to method of initial ASI. However, patients with SV (RR 6.0, p = 0.001) and patients that did not have cardiomyopathy (RR 6.6, p = 0.004) were more likely to require RI.
Conclusions: ASI is acutely e ective for mixing or streaming, RAD, and LAD, albeit with a high rate of RI. Method of ASI does not appear to a ect risk of RI, while patients with SV are at greater risk of RI fol- lowing ASI and patients with cardiomyopathy are at lower risk of RI following ASI.
#0138
THE INTRA-PROCEDURAL CARE OF THE LYMPHATIC PATIENT
Stephanie Piacentino, Erin Hengy
CHOP, Philadelphoa, PA, USA
Purpose: To describe the care of the patient during a lymphatic case. To describe the responsibilities of the nurse/Tech during a lymphatic procedure to streamline care.
Method: data was collected through direct experiences during lym- phatic cases.
Results: Because this a new program, Care is ongoing and continues to progress and change to make care of the lymphatic patient cohe- sive and streamlined.
• Pt lays supine on the cath lab table.
• Foley placed
• Skin assessment; protect bony prominences with protective devices
• Raise heels slightly
• No straps
• Arms at the side
• Prep from groins to mid thigh
• Minimal sterile eld... just towels, no tape, sterile sheet
• Ultrasound guided access of groin lymph nodes
• Must take great care to not have needles dislodge
• Remind pt not to move
• Describe MRI tract
• Communicate with MRI team
• Transfer back Cath Lab via track • Re-prep for intervention
• Dress access sites
• Dismiss to ICU
#0139
PERCUTANEOUS RECONSTRUCTION OF INTERRUPTED AORTIC ARCH IN ADOLESCENTS AND ADULTS
Hussein Abdulwahab
Cardiology, Baghdad, Iraq
Percutaneous stenting seems to be an attractive & preferred alter- native to surgical therapy for treatment of severe aortic coarcta- tion in the adolescents & young adults . However such procedures are challenging. In the last 2 years, five of all patients who were referred to our center as a cases of coarctation of aorta were found to have interrupted aortic arch during cardiac catheterization. The clinical examination & CT- angiogram were suggestive of severe coarctation of the aorta. Cardiac angiography showed an interrupted aortic arch, just distal to the origin of the left subcla- vian artery with a gap ranging from 5 – 8 mm between the proxi- mal & distal segments.
Patients & Methods: Right axillary & femoral arterial access were obtained. Antegrade & retrograde aortograms were done in diago- nally apposite projections to analyze the relation between proximal & distal segments. A straight end hole catheter was crossed in the dis- tal segment & another pigtail or straight end hole catheter was rmly engaged in the oor of the proximal segment to perform an angiogram to visualize both segments simultaneously. In some cases BMW 0.014 Fr. x 182 mm guide wire can be crossed from the proximal segment to the distal one, then a guide wire 0.021 Fr. or 0.025 Fr. x 150 mm crossed antegradely to enlarge the hole in the membrane. If this method was unsuccessful, the proximal gap was perforated antegradely by a prog- ress guide wire 0.014 x 182 mm or pilot guide wire 100-150 x 182 mm using proximal & distal aortogram as a road map thereafter there are 2 methods to dilate the tiny hole either by in ating a PTCA balloon 4 x 20 mm (sprinter legenb) up to 16 barr or by sequential dilatation of the hole with an incremental sized-dilators until 12- 14 Fr. Cook sheath crosses to the proximal segment where Z-mid or BIB-balloon mounted covered CP- stent progressed over the Amplatz guide wire 0.035 Frx260 mm was in ated at the site of interrupted segment. After stent in a- tion, pressures were taken in the proximal & distal segments with post-stenting aortogram showing good anterograde ow without any complications.
Results: All those patients underwent successful procedures with no residual pressure gradient or procedure- related complications after CP- stenting of the interrupted segment. At 6 months follow up, they were asymptomatic & their blood pressure was controlled.
Conclusion: Although transcatheter reconstruction of interrupted aortic arch is technically di cult & challenging but it is feasible & associated with high success rate . Di erent techniques & tricks posi- tively in uence the outcome.
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306