Page 39 - Journal of Structural Heart Disease Volume 3, Issue 4

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sure monitoring provided a constant assessment of coronary perfusion during the intervention and not just during angiographic balloon testing of the RVOT. As expected, pressures in both the proximal left main and distal LAD coronary arteries equally decreased with obstruction of the RVOT during balloon compli- ance testing, stent implantation, and PPVI, which re- sulted in a temporary decrease in left ventricular pre- load. In addition, both pressures recovered equally upon de ation of the balloons. Coronary artery stent compression would have been identi ed if either of the two following scenarios were present following balloon de ation: (1) a discrepancy between the two pressure waveforms indicating coronary artery ste- nosis or (2) both pressures not returning to baseline values as a result of acute left ventricular dysfunction. Had there been evidence of coronary artery compres- sion, the JL guide catheter positioned in the left main coronary artery would have allowed us to advance the prepped coronary balloon over the pressure wire to re-expand the stent.
Currently, the estimated number of adults with congenital heart disease in the United States is greater than 1 million [13]. As the congenital heart disease patient population ages, there will be an in- creasing number of patients with combined acquired cardiovascular disease in addition to their under- lying congenital heart disease. With technological advancements in transcatheter therapies, a greater proportion of this patient population will receive percutaneous treatment in the catheterization labo-
ratory. The interventional cardiologist must be mind- ful of both types of heart disease in the older patient. This procedure was performed in the congenital car- diac catheterization laboratory given the need for bi- plane imaging during PPVI. Our adult interventional colleagues were prepared to provide any assistance in the event of a coronary intervention. Adult con- genital heart disease programs have bridged the gap between pediatric and adult cardiac care and can often assist in the planning of complicated interven- tional procedures in adult congenital heart disease patients. Close collaboration between congenital and adult interventional cardiology is needed to provide the best care to this patient population.
In conclusion, coronary artery compression is a risk of PPVI and should be routinely evaluated. Continu- ous coronary arterial pressure monitoring via a pres- sure wire can facilitate PPVI in high-risk patients with coronary arterial stents. Given the risk of coronary artery stent compression, these high-risk procedures should be performed with support from adult inter- ventional cardiology.
Con ict of Interest
The authors have no con ict of interest relevant to this publication.
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Journal of Structural Heart Disease, August 2017
Volume 3, Issue 4:119-127