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

Meeting Abstracts
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atrium, shoulder was 11mm, full implant recapture, then, the device was too distal in the LAA and residual ow in the left atrium, partial retreival and redeployment. Finally, the attachment of the device was checked with a Tug test and the device was deployed. The nal angiogram and TEE showed a well-seated device, with no residual ow, that completely closed the LAA ostium (Fig2, mov1,2).
Learning Points of the Procedure: Coumadin ridge (liga- ment of marshall) separates LAA and LUPV. If coumadin ridge protrudes far into LA, must push probe in and ex to see LAA without acoustic artifact.
When original sizing is done (outpatient TEE or CT), patient is often NPO, so LAA may be small. LAA may expand with hydration during watchman implant, needs remeasuring after volume load.
Attempt to cover all proximal trabeculations as trabecu- lated areas increase risk of thrombus formation.
Avoidance of pericardial tamponade: Echo guided trans- septal puncture, pigtail catheter in front of sheath, slow deployment of device.
Avoid embolization: proper position and size of device.
Avoid periprocedural stroke: Adequate anticoagulation (ACT > 220), proper de-airing
14. SUCCESSFUL STENTING OF OBSTRUCTED GLENN CIRCULATION ON DAY 5 POSTOPERATIVE DAY IN A 8-MONTHS-OLD GIRL
Madhu Bangalore Gangadhara1, Nicholas Hayes2,
Trevor Richens3
1 University Hospitals Southampton NHS Trust; Southampton General Hospital; Department of Paediatric Cardiology
2 Southampton University Hospital; Consultant Cardiologist; Child Cardiology
3 Southampton General Hospital; Interventional Congenital Cardiology; Child Cardiology
History and Physical: Superior vena cava (SVC) stenosis can be a rare but signi cant complication in patients under- going Cavo-pulmonary anastomosis. Rarely hemodynam- ically signi cant obstruction can lead to SVC syndrome which carries a signi cant morbidity for these patients. Treatment options for SVC stenosis include surgical relief or catheter-based interventions, including balloon dilation or endovascular stent implantation.
Eight months old girl with Tricuspid atresia, large unrestric- tive VSD and severe subpulmonary stenosis underwent a Superior Cavopulmonary anastomosis, BT shunt takedown, Atrial septectomy and augmentation of right pulmonary artery. Unfortunately, postoperatively she continued to have low saturations with high central venous pressures. On further assessment clinically and echocardiographi- cally, signi cant Glenn obstruction was strongly suspected.
Indication for Intervention: Diagnostic catheter on day 5 postoperative period suggested mean SVC pressures of 27 mm Hg with marked arterial waveform. Angiography sug- gested the Glenn anastomosis was compressed anteriorly probably by the aorta, as was the proximal left pulmonary artery.
Intervention: Following urgent MDT review she went back to the catheter lab next day and stent implantation was successfully performed into the left pulmonary artery using a 7 x 12 mm Cook Formula stent in ated to about 6mm and an 8 x 12 Cook Formula stent placed across the Glenn anastomosis. The nal result of this was a signi cant fall in her mean SVC pressure to 17mmHg with good ow seen through both stents.
Learning Points of the Procedure:
• Superior vena cava obstruction can be successfully re-
lieved by transcatheter stent implantation in patients post Superior Cavopulmonary anastomosis as early as day 5 postoperative period.
• Technical success and e cacy in relieving associated symptoms are high.
References:
1. Rocchini AP, Cho KJ, Byrum C, Heidelberger K. Transluminal an-
gioplasty of superior vena cava obstruction in a 15-month-old child. Chest. 1982; 82:506–508. [PubMed: 6214380]
2. Tzifa A, Marshall AC, McElhinney DB, Lock JE, Geggel RL. En- dovascular treatment for superior vena cava occlusion or ob- struction in a pediatric and young adult population: A 22-year experience. J Am Coll Cardiol. 2007; 49:1003–1009. [PubMed: 17336725]
3. Morchi GS, Pietra B, Boucek MM, Chan KC. Interventional car- diac catheterization procedures in pediatric cardiac transplant patients: Transplant surgery is not the end of the road. Cathe- ter Cardiovasc Interv. 2008; 72:831–836. [PubMed: 18798241]
4. Stan ll R, Nykanen DG, Osorio S, Whalen R, Burke RP, Zahn EM. Stent implantation is e ective treatment of vascular stenosis in young infants with congenital heart disease: Acute implan- tation and long-term follow-up results. Catheter Cardiovasc Interv. 2008; 71:831–841. [PubMed: 18412081
Journal of Structural Heart Disease, April 2018
Volume 4, Issue 2:85-113