Page 32 - Journal of Structural Heart Disease Volume 4, Issue 3

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Meeting Abstracts
6. ATTACH-&-RAISE TO THE ATRETIC PULMONARY VALVE WITH AN ENDHOLE CATHETER IS A GUARANTEE FOR SUCCESSFUL RADIOFREQUENCY VALVOTOMY IN NEONATES OF PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM
Jeng-Sheng Chang1, Tzu-Yao Chuang2, I-Ching Peng3,
Ping-Yun Chiou3
1 China Medical University Children's Hospital; Pediatric Cardiology; Pediatric Cardiology
2 China Medical University Children's Hospital; Pediatric Cardiology; Pediatric Cardiology
Background: For neonates of pulmonary atresia with intact ventricular septum(PAIVS), Z score of tricuspid annulus is above -4.0, and without severe sinusoidal RV-coronary communication, a transcatheter perforation of the atretic PV appeared to be an optimal initial intervention to pave a way for nal 2 ventricle circulation. However, the hypoplas- tic and tortuous RV out ow tract usually make this proce- dure di cult and risky.
Method: 1999 through 2017, there have been 15 PAIVS neo- nates received radiofrequency valvotomy (RFV) procedure in this Children’s hospital. The procedure began with hot air cooking and hand molding of a 4F JR catheter, usually 1.5 or 2.0 cm of its rst curve, to make it soft and compliant as much as possible. Assisted with a 0.035 Terrumo wire, we advanced it patiently until attached at the atretic PV, and even pointed and raised it. Aftewards, exchanging to an RF wire, and connect to the energy generator to perform RFV. Following a successful RFV, we used monorail catheters to perform balloon pulmonary valvuloplasty.
Result: In the rst year, we failed in 2 cases. Afterwards, all 13 cases were successful. The initial 5 cases required 5-12 attempts of RFV procedure. However, all the later 8 cases were successful within 3 attempts. There was no mortality. We believe the key break through technique was making all possibility to get a rm attachment on the PV by the end-hole catheter.
Conclusion: Attach-&-raise to the atretic pulmonary valve with an endhole catheter is a guarantee for successful RF valvotomy in neonates of PAIVS.
7. SERIAL PULMONARY ARTERY STENTING USING VARIOUS STENTS AND TECHNIQUES IN A YOUNG PATIENT WITH REPAIRED COMMON TRUNCUS ARTERIOSUS
Chun-An Chen1, Yi-Sharng Chen2, Jou-Kou Wang1
1 Department of Cardiology, National Taiwan University Children Hospital
2 Department of Surgery, National Taiwan University Hospital
History and Physical Findings: A female baby with common truncus arteriosus (CTA) type II received surgical repair at her age of 3 days. However, severe bilateral pulmo- nary artery (PA) stenosis developed soon after operation. Balloon dilatation was performed at her age of 2 months but the PA recoiled easily. We implanted bioabsorbable stents (Abbott BVS 3.5x18mm) at bilateral PAs and post-di- lated up to 4.0 mm. Systolic right ventricular (RV) pressure decreased from 71 to 45 mmHg. However, follow-up echo- cardiography showed progressive increase in RV pressure. At her age of 5 months, we repeated cardiac catheteriza- tion and realized the PA diameter remained around 4 mm while bilateral bioabsorbable stent integrity had been dis- rupted. Because hemodynamic instability due to low car- diac output during the procedure, we implanted a metallic stent (Express SD 7x20mm premounted stent) for left PA stenosis using “jail technique”. However, general condition remained unstable after unilateral PA stenting. We then arranged further cardiac catheterization for right PA stent- ing (Express 6 x 18 mm stent) using “Y-stent technique” 3 weeks later. Distal right PA was totally obstructed by an intimal ap after stenting, and rescued by an in ated bal- loon to reattach the ap to the vessel wall. Unfortunately, signi cant stenosis with obstruction was detected at RV out ow tract 6 months later. We sent the patient to sur- gery at her age of 11 months. During operation, the stents were explanted, and the out ow tract and branch PAs were extensively reconstructed. Follow-up echocardiography after redo operation revealed signi cant restenosis at bilat- eral PA junctions. The patient also developed signi cant edema and hepatomegaly since her age of 20 months.
Indication for Intervention: Stenting for bilateral recurrent postoperative PA stenosis
Intervention: Bilateral PA stenting was performed using “kissing stent technique” (2 premounted stents (GENESIS 2910) were in ated simultaneously). The e ect was dra- matic. Systolic RV pressure decreased from 104 to 17 mmHg. Although reperfusion lung edema developed in the following few days after the procedure, the condition was fairly managed by aggressive diuretics treatment and ventilator support. The patient was discharged home 7 days after stenting. Follow-up echocardiography revealed no obstruction across the RV out ow tract and bilateral PAs. The patient experienced much improvement in exer- cise tolerance after the procedure.
Hijazi, Z
2017 CSI Africa Abstracts