Page 35 - Journal of Structural Heart Disease Volume 3, Issue 3

Meeting Abstracts
88
We report a case of AS and concomitant LVOTS treated by balloon aortic valvuloplasty (BAV), TAVR and percutaneous transluminal sep- tal myocardia alcohol ablation(PTSMA) sequentially.
A 84-years-old female presented with severe AS [aortic valve area (AVA) 0.5 cm2, mean gradient 63 mmHg] and LVOTS [peak gradient 166 mmHg,] , hypertension, hyperlipidemia, and heat failure. Her STS-PROM was 4.95% and signi cant frailty was noted. Due to high surgical risk, non-surgical approach was sought.
Medical therapy with cibenzoline and bisoprolol ameliorated LVOTS. However, subsequent BAV using 16 mm retrograde balloon exacer- bated LVOTS with a LVOT gradient from 20 mmHg to 45 mmHg and worsening MR. One month following BAV, transfemoral TAVR using SAPIEN3® 23 mm was performed without any valve related complica- tions. LVOTS was worsened with a pressure gradient from 76 mmHg to 117 mmHg and MR was mildly improved. One week later, elective PTSMA was performed by injecting 0.8 cc of ethanol into the rst sep- tal branch territory with an improved LVOT pressure gradient from 110 mmHg to 20 mmHg and improved MR.
Leaning points: LVOTS can accompany with severe AS. In those cases, single relief of valve resistance could exacerbate adjacent LVOTS hemodynamics. TAVR with concurrent or subsequent PTSMA should be employed for better improvement of obstructive hemodynamics.
COMPARISON BETWEEN BOLUS INTRACORONARY VERSUS BOLUS INTRAVENOUS INJECTION REGIMENS OF EPTIFIBATIDE DURING PRIMARY PCI IN PATIENTS WITH ANTERIOR STEMI
Shaimaa Mostafa1, Mohamed Hassan2, Khaled Elrabat1, Hamza Kabil1, Naema Elmelegy1
1 Egypt, BenhaBenha University Hospital
2 Benha, Egyptational Heart Institute
Background: Epti batide achieve high local concentration via direct intracoronary injection as it promotes clot disaggregation, but it remains unclear if it is of superior bene t than the routine intrave- nous administration.
Aim: The current study aimed to examine the safety and e cacy of intracoronary versus intravenous bolus regimen dose of epti batide during primary PCI.
Patients and Methods: Prospective, controlled, randomized study enrolled 100 patients with acute anterior STEMI eligible for primary PCI equally divided into 2 groups (group A received bolus intracor- onary epti batide and group B received it intravenous) followed by 12h continuous IV infusion. Predictors of myocardial salvage in the form of TIMI ow grade III, myocardial blush grade 3, ST segment resolution and left ventricular systolic function were evaluated with short term follow up for 1 month.
Results: Mean age of the study population was 50.95±8.45years, there was statistically insigni cant di erence between both groups regarding baseline characteristics regarding age (p=0.062), gender (p=0.488) and coronary artery disease risk factors (p>0.05), time
from onset of pain to admission (p=0.86) or door to balloon (p=0.12). Group A achieved statistically signi cant better myocardial blush grade 3 (42% versus 10%, p=0.005), ejection faction 30 days after PPCI (46.11±7.81, versus 40.88±6.26, p=0.005) but statistically insigni cant TIMI ow grade III (p=0.29) and ST resolution (p=0.34). Incidence of in hospital compilations and 30 days after discharge was statistically insigni cant (p>0.05).
Conclusion: Regimen of intracoronary bolus epti batide achieved better myocardial salvage predictors and was as safe as intravvenous bolus during PPCI and at short term follow-up.
PERVENTRICULAR IMPLANTATION OF MELODY VALVE IN 12 KG BABY WITH PULMONARY HYPERTENSION AFTER POTTS SHUNT
Tomasz Mroczek1, Marcin Demkow2, Tomasz Moszura3, Aleksandra Morka4, Janusz Skalski4
1 Jagiellonian University, Department of Cardiac Surgery; Cardiac Surgery; Surgery of Congenital Heart Defects, Krakow, Poland
2 Department of Coronary Artery Disease, The Cardinal Stefan Wyszynski Institute of Cardiology, Warszawa, Poland
3 Department of Cardiology, Polish Mother’s Health Memorial Hospital, Łódź, Poland
4 Department of Pediatric Cardiac Surgery, Jagiellonian University, Krakow, Poland
History and Physical: A baby-girl born with tracheoesophageal s- tula, esophageal atresia and truncus arteriosus communis (TAC) underwent esophageal repair and stula closure when 2 days old and weighing 3 kg. The cardiac procedure was postponed until the 3rd month of age due to pneumonia and sepsis. During the truncus repair, a 12 mm Contegra xenograft (Medtronic Inc, Santa Ana, CA) was implanted to reconstruct the right ventricle out ow tract. When she was 4.5 years old, her weight was only 12 kg and she was admit- ted to the cardiology department because of deteriorating exercise tolerance and poor weight gain.
Imaging: Echocardiography revealed severe right ventricle (RV) dys- function and symptoms of elevated pulmonary pressure. Cardiac catheterization demonstrated suprasystemic pulmonary artery (PA) pressure, pathologic pulmonary arteries pattern and RVEDP 19 mmHg. The Contegra graft was distended to 21 mm in diameter and the PV was incompetent The baby was hospitalized and pharmaco- therapy had to be gradually extended from bosentan and sildena- l to include continuous epoprostenol infusion, milrinon, digoxin, dopamine and oxygen therapy. Such a management did not prevent progressive heart failure with the eventual NT-proBNP level of 21 515 pg/ml. The patient was listed for lung transplantation and 8 mm Potts shunt has been created. The ow of blood in the Potts shunt was right to left in systole (with the di erence between the upper and lower body saturation of 10 to 15%), however left to right in diastole with signi cant pulmonary insu ciency (PI). A conventional surgical pul- monary graft exchange was highly risky in terms of PAH, extremely depressed RV and the Potts shunt. Also percutaneous PV implanta- tion was impossible because of low weight and poor venous access.
Journal of Structural Heart Disease, June 2017
Volume 3, Issue 3:73-95