Page 35 - Journal of Structural Heart Disease Volume 4, Issue 3

Meeting Abstracts
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21st day after admission. The patient was under general anesthesia. We approached the middle inferoseptal VSR from right femoral artery route by a 6 Fr. JR 4 guiding catheter and a 0.032inch*260cm guidewire. The guide- wire crossed the middle inferoseptal VSR successfully and moved into inferior vena cava. A Snare kit was indwelled from right femoral vein into pulmonary artery. The guide- wire was captured by the Snare kit and then it was exter- nalized into right internal jugular vein. The measured size of VSR was 11.4mm by a 34mm sizing balloon and 12mm by real-time transesophageal echocardiography (TEE). A 10 Fr. delivery system was indwelled from right inter- nal jugular vein into left ventricle by the guidance of the guidewire. Then a 20mm AmplatzerTM P.I. Muscular VSD Occluder was deployed to the middle inferoseptal VSR site successfully. The position was con rmed by the left ven- triculography. (Figure 2A and 2B). His hemodynamic status improved immediately after implantation. TEE on the next day (Figure 2C) and the 12th day (Figure 2D) after inter- vention revealed that the site of implantation was optimal with much decreased interventricular shunt. He was dis- charged uneventfully on the 35th day after admission.
Learning Points of the Procedure: Interventional closure of post-myocardial infarction VSR is an alternative treatment option to surgical repair, with the advantage of immediate shunt reduction to prevent haemodynamic deterioration. A meta-analysis revealed that the successful device implan- tation rate was 89%, the overall inhospital/30-day mortal- ity was 32%, and the major complications included device embolization, ventricular perforation and arrhythmias.1
Reference:
5. Schlotter F, de Waha S, Eitel I, Desch S, Fuernau G, Thiele H.
Interventional post-myocardial infarction ventricular septal defect closure: a systematic review of current evidence. Euro- Intervention. 2016;12:94-102
9. TREATMENT PREFERENCES OF HEMODYNAMICALLY SIGNIFICANT PATENT DUCTUS ARTERIOSUS
IN NEONATES < 2500 GM AT THE ERA OF TRANSCATHETER CLOSURE: WHAT ARE NEONATOLOGISTS' CONSIDERATIONS?
Yu-Hsuan Chien1, Chun-An Chen2, Ming-Tai Lin3, Shu-Chien Huang4, Yih-Sharng Chen5, Ting-An Yen6, Chien-Yi Chen6, Hung-Chieh Chou6, Po-Nien Tsao6, Mei-Huan We2,
Jou-Kou Wang7
1 Shin Kong Wu Ho-Su Memorial Hospital; Department of Pediatrics; Cardiology
2 National Taiwan University Children’s Hospital; Department of Pediatrics; Cardiology
3 Department of Pediatrics, National Taiwan University Children Hospital, Taiwan; Pediatric Interventional Cardiology, Kawasaki Disease ; Pediatric Cardiology
4 National Taiwan University Children’s Hospital; Department of Surgery; Pediatric Cardiac Surgery
5 Department of Surgery, National Taiwan University Children Hospital, Taipei, Taiwan; Surgery; Cardiac Surgery
6 National Taiwan University Children’s Hospital; Department of Pediatrics; Neonatology
Background: Transcatheter closure and surgical ligation of hemodynamically signi cant patent ductus arteriosus (PDA) are both treatments of choice for premature neo- nates when medical treatment fails or are contraindicated. However, factors regarding to which treatment option to be preferentially adopted by neonatologists remain unclear.
Objective: The aim of this study is to evaluate factors which may determine the treatment preference for neonatologist toward hemodynamic signi cant PDA in neonates < 2500 gm.
Methods: The retrospective study was conducted in one level 3 hospital from December 2016 to August 2017. Hemodynamically signi cant PDA in neonates < 2500 gm managed by either transcatheter closure or surgical liga- tion were included.
Results: There were 23 neonates included (8 with tran- scatheter closure, and 15 with surgical ligation). In surgi- cal group, 10 (66.7%) procedures were performed within 8 hours after the decision was made by neonatologists, while all transcatheter closure were performed > 12 hours after decision making. Patients receiving surgical ligation had smaller birth body weight (BW) (median 763 (min.350- max. 1278) v.s. 1170 (680-2120) gm, p<0.05), younger age at procedure (10 (1-24) v.s. 25 (11-41) days, p<0.001), lower BW at procedure (738 (350-1230) v.s. 1318 (718-2190) gm, p<0.05), and less likely to having nished ibuprofen treat- ment ≥ 2 times (13.3% v.s. 87.5%, p<0.05). Besides, PDA associated comorbidity (66.7% v.s. 12.5%, p<0.05) and gen- eral comorbidity (93.3% v.s. 50%, p<0.05) were more prev- alent in patients receiving surgical ligation. Transcatheter closure generally took longer procedure time (69 (37-104) v.s. 26 (10-45) minutes, p<0.001), but the intubation days after procedure were shorter (5 (0-17) v.s. 27 (1-82) days, p<0.05) than surgical group. No procedure failure was noted in both groups. Short-term complications were more common in surgical group. After excluding 8 (53.3%) surgical cases with comorbidities (ongoing infection, pul- monary hypertension requiring inhaled nitric oxide, and acute kidney injury with anuria) which were considered as
Journal of Structural Heart Disease, April 2018
Volume 4, Issue 2:85-113