Page 78 - Journal of Structural Heart Disease Volume 2, Issue 6

305
Meeting Abstracts
after implantation. No obstruction of the left pulmonary artery or isthmic stenosis was noticed. These results are very similar to those published with the Occlutech device including 171 patients from 4 articles: successful implantation (95.4–100%), full occlusion during follow-up (96-100%); complications were observed in 4 patients: fem- oral thrombosis (n=2) and embolization (n=2).
Conclusions: Transcatheter closure of PDA with the new Occlutech PDA occluder is a safe and e ective. In fact, the results are very simi- lar to that reported with the Amplatzer Duct Occluder. The Occlutech PDA occluder appears as a valuable therapeutic option for transcath- eter occlusion of the arterial duct. Further studies with longer fol- low-up are necessary to con rm these results.
#0155
SUCCESSFUL TRANSCATHETER CLOSURE OF UNROOFED CORONARY SINUS USING COVERED STENTS IN AN ADULT WITH DRAINAGE OF THE CORONARY SINUS TO THE RIGHT VENTRICLE
Bassel Mohammad Nijres1, Damien Kenny2, Suhaib Kazmouz3, Ziyad Hijazi4
1Rush University Children’s Hospital, Chicago, IL, USA
2Our Lady’s Children’s Hospital, Dublin, Ireland
3Rockford Memorial Hospital, Rockford, IL, USA
4Weill Cornell Medicine & Sidra Medical and Research Center, Doha, Qatar
We present a rare case of a 41 year-old female with unroofed coronary sinus who underwent supra-annular tricuspid valve replacement with consequent drainage of the coronary sinus to the right ventricle. It is unclear whether the coronary sinus was unroofed congenitally or iatrogenically (as a result of increased pressure load on the coro- nary sinus). Either way this rare setup resulted in a signi cant central cyanosis as a result of shunting the desaturated blood from the right ventricle to the left atrium. In addition, she was at high risk of devel- oping paradoxical embolism and other complications of chronic cyanosis. This connection was successfully closed via trans-catheter delivery of covered stents and lead to resolution of the cyanosis. Post stenting transesophageal echocardiogram with contrast injection in the coronary sinus revealed no residual communication with the left atrium. Our patient recovered well from the procedure. On follow-up, the patient has normal systemic oxygen saturation with stable car- diac function and improved exercise tolerance.
Catheter-based management of unroofed coronary sinus is still evolving; there is only one case reporting deployment of a covered stent and limited cases reporting successful closure using Amplatzer@ Ductal Occluders. Use of covered stents may be preferable as it restores normal physiologic circulation and eliminates right to left shunting. However, it may be challenging especially in complete unroo ng. Furthermore, it may be more di cult to ensure stent sta- bility and requires extreme caution to avoid obstructing coronary venous drainage into the coronary sinus. This might result in abnor- malities in electrophysiological conduction.
In conclusion, transcatheter occlusion of unroofed coronary sinus, although it is technically di cult, is feasible and provides an alterna- tive to cardiac surgery as a rst line in managing unroofed coronary
sinus. However, extreme caution and experienced interventionists are prerequisites to consider this type of procedure due to technical di culties and possible complications.
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RESULTS OF LD ADVANTATM V12 COVERED STENT TRIAL FOR COARCTATION OF THE AORTA.
Elchanan Bruckheimer1, Carlos Pedra2
1Schneider Children’s Medical Center Israel, Petach Tivka, Israel 2Dante Pazzanese, Sao Paolo, Brazil
Objective: To assess the safety and e ectiveness of the Large Diameter AdvantaTM V12 Covered Stent for treatment of coarctation of the aorta.
Methods: A prospective, multicenter, non-randomized, single arm study. Primary E cacy Endpoint: Signi cant reduction in gradient assessed by echo-Doppler DV (diastolic velocity) and DV/SV (diastolic velocity /systolic velocity) at pre-stent vs. immediately post stent and pre-stent vs. 12 month follow-up. Primary Safety Endpoint; MAE and MAVE occurring within 30 days.
Results: Between 2009 and 2013, 70 patients [43M, 27F] of median age 17.0 yrs [6.0-75.0] and weight 57.4Kg [28.2-120] with coarctation of the aorta were enrolled. Stents were successfully implanted and in all patients. Mean CoA diameter increased from 5.5±3.6 to 13.1±3.2mm [p<0.001]. Mean peak gradient decreased from 35.8±16.0 to 5.4±7.8mmHg [p<0.001]. A Baseline DV/SV was 0.59± 0.17 dropped to 0.34 ± 0.13 [p<0.001] after stenting and was unchanged at 12 month follow-up. DV was 216.3 ± 77.5cm/s dropped to 90.9 ± 46.5cm/s [p<0.001] and was unchanged at 12 months. 61 patients underwent CTA at ~12 months with mean stent diameter maintained at 13.3 ± 2.1mm, 91 ± 0.1% of diameter of the transverse arch.
Complications: Acute MAVE was 1.4% [1 femoral artery occlusion]. MAVE at 12 months was 4.3% including 1 aortic hematoma treated with a second stent, 1 small aneurysm at distal edge of the stent treated with a second stent. At 12 months there was no new wall injury on CT. 3 patients had late [>1 yr] stent infolding requiring re-intervention.
Conclusions: The Large Diameter AdvantaTM V12 Covered Stent is safe and e ective for treatment in coarctation of the aorta. Long term fol- low up to assess aortic wall injury and stent integrity is required.
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PREDICTORS OF PROCEDURAL FAILURE IN PATIENTS UNDERGOING PERCUTANEOUS CLOSURE OF LARGE ATRIAL SEPTAL DEFECTS USING THE AMPLATZER SEPTAL OCCLUDER.
Mounir Riahi
Montreal Heart Institute and St. Paul’s Hospital/University of British Columbia, Montreal/Vancouver, Canada
Aims: Owing to their more complex anatomy. large atrial septal defects can present unique challenges for percutaneous closure. Previous reports observed a much higher procedural failure rate in
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts