Page 73 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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The Valeo stent was inserted at a median age = 3.8months (IQR 3.8 – 10.2 months). The median reduction in aortic arch gradient was 24mmHg (IQR =14.5- 29mmHg) [p<0.01]. The median increase in aortic diameter = 3.1mm (IQR 2.7 – 4.2mm) [p<0.01] and the median increase in coarctation index = 0.40 (IQR = 0.33 – 0.46) [p<0.01]. There were no procedural deaths but stent migration occurred in one child. One patient (1/11) died during follow-up due to poor systemic ven- tricular function. Six patients required redilation of the stent with no complications.
Conclusions: The prevalence of stent placement for recoarctation following Norwood/DKS operation was 15 %. Recoarctation was suc- cessfully addressed by percutaneous insertion of a Valeo stent. Due to its low pro le and facilitiy to re-dilate to much larger diameters, the Valeo stent is a useful addition to the interventionalist’s armamentar- ium and in particular for relief of recoarctation of aorta in univentric- ular infants.
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RELIEF OF OBSTRUCTED NATIVE PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTIONS WITH FORMULA STENT IMPLANTATION
Brian McCrossan, Barry O’Callaghan, Kevin Walsh
Our Lady’s Children’s Hospital, Dublin, Ireland
Background: Transcatheter relief of total anomalous pulmonary venous connections (TAPVC) has been employed to stabilise patients pre-operatively. There are a number of encouraging case reports of stent implantation for obstructed TAPVC as an initial intervention but none relating to partial APVC (PAPVC).
Report: Ex 32 week gestation infant unable to wean o ventilatory and inotropic support. Echocardiography demonstrated PAPVC of the left upper pulmonary vein to the innominate vein, a small secun- dum atrial septal defect with bidirectional shunting, mild right heart dilatation, moderate right ventricular hypertrophy but well preserved biventricular systolic function (left ventricular ejection fraction = 86%). There was moderate pulmonary regurgitation and mild tricus- pid regurgitation. The development of left sided pulmonary oedema occasioned a CT angiogram which suggested vertical vein stenosis with no apparent extrinsic compression.
At eight weeks (weight 3.3kg) cardiac catheterisation was performed which con rmed 3⁄4 systemic pulmonary arterial pressures and a severe discrete stenosis in the vertical vein receiving the left upper and part of the left lower lobe pulmonary veins (Figure 1). The peak pressure gradient across the stenosis= 9mmHg.
A premounted Formula 414, 6mmx12mm (Cook Medical, Bloomington, IN) stent was placed across the stenosis, over a 0.014” Asahi Grand Slam wire (Abbot, Illinois, USA).and in ated to 22 ATM. There was excellent angiographic relief of the stenosis with a 1mmHg pressure gradient across the stent. The procedure was well tolerated.
Conclusion: Obstructed PAPVC may potentiate pulmonary hyperten- sion necessitating intervention. Endovascular stent implantation for obstructed supracardiac PAPVC is technically straight-forward, but the stenosis is often resistant, and may provide e ective relief of the stenosis with reduction in pulmonary artery pressure.
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IMPLANTATION OF THE EDWARDS SAPIEN 3 TRANSCATHETER HEART VALVE IN REGURGITANT NON-CONDUIT RIGHT VENTRICULAR OUTFLOW TRACTS: IMMEDIATE RESULTS.
Shabana Shahanavaz, Toby Rockefeller, David Balzer Washington University in St Louis, St Louis/MO, USA
Background: Pulmonary valve replacement (PVR) is indicated in patients with signi cant pulmonary regurgitation (PR). While once an exclusively surgical procedure, many patients now have PVR accom- plished using transcatheter techniques with excellent early outcomes. Current literature is limited to the Melody valve and the Edwards SAPIEN XT. We aim to evaluate the procedural and immediate post-pro- cedural results of PVR with the newest generation Edwards SAPIEN 3 valve in regurgitant non-conduit RV out ow tracts (RVOT).
Methods: After receiving IRB approval, a retrospective review of all transcatheter pulmonary valve replacements performed in our insti- tution was conducted. We included all patients receiving SAPIEN 3 valves in regurgitant non-conduit RVOTs and excluded all others. Pre- procedural data included patient demographics, anatomy, surgical history, and baseline assessment of tricuspid insu ciency, PR and RV size/function. Procedural data included access site(s), baseline RV pressure, RVOT gradient, RVOT dimension, subsequent stented diam- eter, and nal RVOT dimensions with assessment of any residual valve gradient or regurgitation.
Results: The SAPIEN 3 valve was implanted in 12 patients with non-conduit RVOTs between July 2015 and October 2016. Mean body weight was 61 kg (31-100). Successful valve deployment was achieved in all 12 patients (10 via transfemoral approach, 2 via Hybrid surgical approach). All patients had free PR on baseline assessment without signi cant RVOT stenosis. Mean RV pressure at baseline was 30 mmHg (24-37) with minimal RVOT pressure gradient (0-7). Mean RVOT dimension during balloon sizing was 28 x 27 mm. Pre-stenting was performed in 10 (77%), and 8 of those 10 underwent staged intervention. All of the 12 patients received 29mm valves. Rapid ven- tricular pacing was utilized during valve deployment in all 11 patients undergoing percutaneous delivery. There were no procedural com- plications. Immediate results demonstrated excellent resolution of PR (trace in 10, none in 2) with minimal residual pressure gradient on pullback measurements or follow-up echocardiography. Tricuspid regurgitation was unchanged. Median length of stay was 1.5 days (1-6 days).
Conclusions: The SAPIEN 3 valve is well suited for use in regurgitant non-conduit RVOTs demonstrating excellent immediate results, but additional studies are needed to make meaningful comparisons to the historical outcomes with surgical PVR.
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TRANSCATHETER CLOSURE OF MEMBRANOUS AND MUSCULAR OUTFLOW VSD’S USING A RETROGRADE ARTERIAL APPROACH.
Ross Foley1, Damien Kenny1, Colin Mc Mahon1, Orla Franklin1, Terence Prendiville1, David Coleman1, Ivan Casserly2,
Kevin Walsh1
1Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
2Mater Misericordiae University Hospital, Dublin, Ireland
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306