Page 38 - Journal of Structural Heart Disease Volume 4, Issue 3

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Meeting Abstracts
oxygen, Furosemide, Bosentan and Sildena l she remained severely symptomatic at rest (NYHA functional class IV) with poor quality of life. Due to her refractory right-sided heart failure requiring frequent hospitalization patient underwent atrial septostomy. The septostomy was created with a transeptal puncture then followed by graded dila- tion initiated by a cutting balloon catheter then ended by serial static balloon dilation. This was guided by 3D echo- cardiography. A 10 mm atrial septal defect was created with a drop in RA pressure to 10mmHg and nal oxygen saturation of 80-84% from right to left shunting. There was relief of shortness of breath after 72 hours from the pro- cedure. The patient was maintained on oxygen, Bosentan and Sildena l. At six-month follow-up, patient has shown sustained improvement in 6 minute-walk test and heart failure symptomatology.
This is the rst successfully performed atrial septostomy in an adult in the Philippines as a therapeutic option for severe end stage PAH in a setting where heart-lung trans- plantation is not yet available.
13. A CHALLENGING WATCHMAN LAA CLOSURE CASE
Jiandong Ding
Zhongda Hospital Southeast University; Department of Cardiology; Intervention
History and Physical: A 66-year old woman presenting with nonvalvular Atrial Fibrillation (AF). Hypertension was the only risk factor. She su ered from AF for 20 years and was treated intermittently under anticoagulant therapy
because of abnormal uctuations of INR when taking war- farin. She had a heavy past medical history: cerebral embo- lism that leading to left limb hemiplegia in 2007. In 2008, she su ered from spontaneous cerebral hemorrhage and nally she recovered without any sequela. Anticoagulant therapy was stopped and switched to aspirin, leading to a recurrent ischemic stroke in 2014. Then, the patient was put under dabigatran (110 mg twice a day). CHA2DS2- VASC score was estimated 5 and HAS-BLED score 6.
Imaging:
1) Baseline transesophageal echo rule out thrombus. 2) Baseline transesophageal echo measurements (Fig1).
Indication for Intervention: The patient with AF was at extreme high risk of stroke for many reasons: high CHA2DS2-VASC score, previous stroke on aspirin and was also at high risk of bleeding with the previous occurrence of a cerebral bleeding and high HAS-BLED score. The patient ful lled FDA indication for Watchman:indicated for OAC, not suitable for warfarin, appropriate rationale for non-pharmacologic approach.
Intervention: Under general anesthesia, TEE guidance was performed. Location of the transseptal puncture was selected and con rmed by TEE. A double-curved access sheath was advanced into the left atrium and LAA angi- ography was performed. The max width of LAA ostium was 28mm by LAA angiography. A 33mm Watchman® device was selected for implantation. At rst, the device was too proximal in the LAA and protruded into the left
13. Figure 1.
Hijazi, Z
2017 CSI Africa Abstracts