Page 77 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
304
implementation of this practice demonstrates similar early recogni- tion of inadequate ETT position, this simple practice may be recom- mended as the standard for all laboratories.
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RADIAL ARTERIAL ACCESS FOR CARDIAC CATHETERIZATION: CASE REPORT
Daniel Gruenstein, Melissa Webb, S Nathan, Brojendra Agarwala
University of Chicago, Chicago, IL, USA
Background: Alternative access for percutaneous interventions is becoming more common for pediatric patients with di cult access. The smallest reported child receiving radial access for cardiac cathe- terization is 39 kg and youngest 12.1 years.
Methods: A 7 year old child with Tetralogy of Fallot, pulmonary atre- sia, and MAPCAS status post RV-PA conduit and pulmonary artery unifocalization required conduit stenting due to severe right ven- tricle hypertension and conduit gradient. He had bilateral femoral artery occlusion from previous cardiac catheterizations. Left radial artery access was used for left heart catheterization and conduit bal- loon-occlusion testing for coronary compression angiograms. Post- procedural testing showed no vascular injury a patent and intact radial artery.
Conclusion: Successful radial arterial catheterization is possible with- out complication in the smaller and younger patients than previously reported. This approach for may provide safe opportunities complete procedures in patients with di cult access. The speci c techniques and tips discussed in this case may help operators perform radial arterial catheterization for small pediatric patients.
#0153
ADVANCED TECHNIQUES FOR PERCUTANEOUS PULMONARY VALVE REPLACEMENT USING THE MELODY VALVE.
François Godart, Ali Houijeh, Marie-Paule Guillaume, Pauline Gras, Olivia Domanski
Cardiac Hospital, Lille, France
Percutaneous pulmonary valve replacement (PPVR) with the Melody valve (Medtronic) may be challenging in patients with unfavourable RVOT. Di erent advanced techniques have been proposed to over- come this problem: jailing and/or Russian dolls techniques or the folded valve techniques.
From March 2015 to October 2016, 11 patients (5F/6M) with a mean age of 19 ± 10 years (11-45 years) underwent these procedures. Initial pathology included tetralogy of Fallot (n=7), transposition of the great vessels (n=2), pulmonary valve stenosis (n=1), and aortic valve stenos (n=1). These patients had undergone a median of 2 pre- vious surgical repairs. The RVOT had been previously repaired with a transannular patch and 1 patient had homograft. The indications for pulmonary valve replacement were: signi cant pulmonary regur- gitation (n=7) and a mixed lesion (n=4). All patients had before the
procedure, MRI study and CT scan to delineate the exact morphology of the RVOT. Before implantation, balloon dilatation of the RVOT with control aortography to obviate any coronary artery compression was performed in all. Prestenting was realized in all with LD max stent (Ev3).
A 22-mm Melody valve was implanted in 9 patients, a 20-mm valve in 2 (9/11 under left ventricular pacing). The folding techniques were employed in 8 patients, the PA branch jailing in 7, and the Russian dolls technique in 3. The folding technique on both extremities of the stent (n=1) and only on distal end (n=7) was performed because of short pulmonary artery trunk with early PA bifurcation. These tech- niques were combined in 6 patients. RVOT dilated up to 25-26 mm in diameter could be thus corrected by PPVR with a 22 mm Melody using these techniques.
During follow-up (1 to 19 months), no patient had reintervention. No endocarditis was observed.
These advanced techniques using the Melody valve can extend the clas- sical indications for PPVR beyond the revalvulation of conduit. Patched RVOT up to 25-26 mm in diameter can be repaired. These initial results are promising but more experience and longer follow-up are mandatory.
#0154
IS THE NEW OCCLUTECH PDA OCCLUDER A GOOD ALTERNATIVE FOR TRANSCATHETER CLOSURE OF PDA?
François Godart, Ali Houeijeh
Pediatric Cardiology, Lille, France
Purpose: One tertiary centre experience with the new Occlutech PDA occluder for arterial duct occlusion.
Methods: From March 2013 to October 2016, 29 patients (20 females and 9 males) underwent percutaneous arterial duct closure with the new Occlutech PDA occluder. All patients had signi cant L-to-R shunt with enlarged left ventricle.
At implantation, the median age was 26 months and median weight was 12kg (4.1 to 57 kg). The procedure was realized under local anaes- thesia in the majority of patients. Size of the duct was 2.94 ± 0.85 mm on angiography. According to PDA Krichenko classi cation, ducts were: type A (n=21), type E (n=7) and B (n=1). The systolic pulmo- nary artery pressure was 42 ± 15 mm Hg. Implantation succeeded in all. Closure was performed by the standard 4/6 mm occluder (n=14), the standard 5/7 mm occluder (n=9), the standard 6/8 mm occluder (n=4), the standard 8/10 mm occluder (n=1), and the standard 3.5/5 mm (n=1) using a 6 or 7 F delivery sheath. Technique of implantation is similar to that of the Amplatzer Duct Occluder and there is no learn- ing curve with the use of this device. After implantation, trivial shunt was noticed on angiography in 21 patients, 8 had no shunt. The mean radiation dose was 7.2 Gycm2. Neither embolization nor haemolysis was observed. After closure, femoral thrombosis was noticed in 3 patients but resolved completely under heparin therapy. On control Doppler echocardiography, 6 patients had tiny residual shunt after implantation. At the control one month later, shunt was closed in 5 of them; in the remaining one, full occlusion was observed 18 months
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306