Page 72 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
#0141
IS A LEFT-SIDED HEMIAZYGOS CONTINUATION
OF THE INFERIOR CAVAL VEIN AND MESOCARDIA
A CONTRAINDICATION FOR A PERCUTANEUS PULMONARY VALVE IMPLANTATION? A CASE DESCRIPTION.
Marinos Kantzis1, Majed Kanaan1, Christof Happel3, Deniz Kececioglou1, Nikolaus Haas2
1Centre for Congenital Heart Disease- Heart and Diabetes Centre, North Rhine Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany
2Department of Paediatric Cardiology and Paediatric Intensive Care, Ludwig Maximillians University, Grosshadern Clinic, Munich, Germany
3Department of Pediatric Cardiology and Pediatric Intensive Care, MHH, Hannover, Germany
Introduction: Percutaneous pulmonary valve implantation (PPVI) is today an establishedintervention. In the majority of the cases is pre- ferred the trans femoral approach and only in special circumstances is used the right trans jugular approach.
Methods: We describe PPVI by a 14 year old female with tetralogy of Fallot, mesocardia and Hemiazygos continuation of the inferior caval vein, left sided superior caval vein (LSVC) draining in the coronary sinus. At 4 months of age underwent for a ventricular septal defect closure, with homograft insertion from the right ventricle to the pulmonary artery, patch augmentation of the left pulmonary artery (LPA) and creation of an atrial communication (ASD). Thereafter she underwent numerous catheterizations due to a stenosis of the LPA and at the age of 5 she underwent device closure of the ASD.
At the age of 12 due to a Homograft stenosis she underwent for a balloon dilatation and one year later for a stent implantation (covered CP 8Z34 of NuMED Inc. over a 20mm Z MED II Balloon of NuMED Inc.) in the Homograft as a preparation for a future PPVI. Prior to the PPVI she underwent a second stent implantation into the LPA (AndraStent XL 30mm from Andramed over 15 mm Z MED II Balloon) and in the Homograft distal to the rst one (AndraStent XXL 39 mm over a Z MED II Balloon 22 mm). Finally, a 22 mm Melody® Valve was implanted through the Hemiazygos vein.
A pre formed extra sti guide wire (Lunderquist, Cook Medical inc.) was placed through the Hemiazygos -LSVC in the LPA and formed a “U” type root. The large delivery sheath of the Melody Ensemble kept a smooth undistorted shape, in order to deliver the valve. The valve was positioned precise in the landing zone.
The procedure was performed under deep sedation according to our standard protocol. The duration of the procedure was 172 min and the radiation time was 24.9 min.
Discussion: Reports in the literature support the root of jugu- lar vein as feasible and safe for PPVI. There are no reports as far to our best knowledge of literature, which describe a PVVI through a Hemiazygos- LSVC- CS pathway.
The “U” type con guration, which is the same con guration as for the access from the right superior caval vein was crucial in order
to deliver the Ensemble in the proper position. To achieve this, the extra sti exchange wire had to be manually shaped according to the underlying anatomy to enable a smooth and safe placement of the long sheaths and delivery system. This con guration provided us the proper support and accessibility for all prior interventions as for the PPVI. The duration of the procedure and the radiation time was comparable to those reported in the literature.
Conclusion: Based on this unique experience, PPVI is possible even in patients with unusual anatomy. Establishing a “U” shape form of the guide wire according to the underlying anatomy is a helpful tool to enable a safe positioning of the valve.
Background: Patients with functional aortic interruption of the descending thoracic aorta at the isthmus due to severe coarctation are extremely rare and frequently solve by surgery.
Case presentation: We describe case with radial access (sti guide) because the impossibility to reach the ascending aorta from the fem- oral arteries. After that we use an a arterio-arterial loop with the help of a Snare catheter, and a successful percutaneous reconstruction using a covered stent (CP).
Conclusions: This report is an attempt to highlight the role of mini- mal invasive approach in the management of a severe coarctation of the aorta and the utility of use the radial access in pediatric patients to avoid morbidity and mortality associated with more invasive procedures.
#0143
VALEO STENT IMPLANTATION FOR RECURRENT AORTIC ARCH OBSTRUCTION FOLLOWING THE NORWOOD OR DAMUS-KAYE-STANSEL PROCEDURE. Brian McCrossan1, Lars Nolke1, Paul Oslizlok1, Damien Kenny1, Gloria Crispino2, Kevin Walsh1, Colin McMahon1
1Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland 2National Clinical Research Centre, Dublin, Ireland
Background: Stent implantation for recoarctation of the aorta follow- ing Norwood or Damus-Kaye-Stansel (DKS) procedure is well estab- lished as an e ective treatment.
Methods: Evaluate the prevalence and outcome of stent implan- tation for recoarctation in children following Norwood or DKS procedure over the last decade at a single national cardi- ology centre. In particular we sought to assess the performance of the Valeo stent (Bard Peripheral Vascular, Tempe AZ) in this setting.
Results: Of 114 children who underwent Norwood procedure or DKS between January 2003 and March 2013, 80 patients survived the peri-opeative period. Of these fteen children underwent stent implantation for recoarctation. A Valeo stent was employed in 11 children, a Palmaz Genesis stent in 2 patients, a MultiLink stent in one child, and a Jo stent/covered stent in one child. The only pre- dictive factor of need for stent placement was previous angioplasty (p valve<0.01, Chi square 11.5). Eight of these patients had previous balloon angioplasty.
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts