Page 47 - Journal of Structural Heart Disease Volume 4, Issue 3

Meeting Abstracts
104
History and Physical: 24 years old pregnant woman was referred to us because of large right fetal heart. Fifteen days ago she was given intravenous paracetamol and obstetri- cian suspected from ductus constriction.
Imaging: Transthoracic echocardiography after birth revealed: large right atrium,13mm Atrial Septal Defect. Tricuspid regurgitation velocity was 3.7m/s. Interestingly large ductal ow was detected. Because of her intrauterine history we have thought that pulmonary hypertension had worsened her situation. Despite anti-congestive treatment she got worse and Patent Ductus Arteriosus was occluded with 5x2 ADOII-AS. After Patent Ductus Arteriosus closure, nothing had changed her state. Then Transthoracic echo- cardiography was repeated: tunnel between aorta and right atrium was detected.
Indication for Intervention: Aorta-Right Atrium tunnel is a rare congenital lesion with an unknown etiology. Owing to the possible complications like risk of emboli, spontaneous rupture thrombosis, aneurysm formation, infective endo- carditis, pulmonary vascular disease, coronary failure, aor- tic insu ciency, and calci cation on the wall of the tunnel etc., it should be closed after certain diagnosis Treatment options are surgery and transcatheter closure.
Intervention: Ori ce of tunnel was occluded with 5x6 ADOII-AS from retrograde side (Figure 1). After closure she got better, extubated and inotropic support was terminated.
Learning Points of the Procedure: Aorta-Right atrium tun- nels should be closed even the patients are asymptomatic Our case is di erent because of enlarged Right Atrium and atypical location of tunnel ori ce.
26. TRANSCATHETER CLOSURE WITH DEVICE IN PATIENTS WITH LARGE PATENT DUCTUS ARTERIOSUS AND MODERATE TO SEVERE PULMONARY HYPERTENSION IS EFFECTIVE AND SAFE
Radityo Prakoso
National Cardiovascular Center Harapan Kita; Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia; Pediatric Cardiology
Background: Transcatheter closure has become a preferred procedure as compared to surgical ligation for the patent ductus arteriosus (PDA). However in large PDA with mod- erate to severe pulmonary hypertension, the procedure poses a challenge and the data remains scarce. This study
aims to evaluate the e cacy and complications of this procedure.
Methods: Retrospective study has been conducted from January 2013 until September 2017 in National Cardiovascular Center Harapan Kita, Jakarta-Indonesia. The inclusion criteria were PDA with diameter ≥8mm with recorded moderate to severe pulmonary hypertension (mPAP ≥ 40mmHg by right heart catheterization). From 515 patients who underwent transcatheter closure during this period, 34 patients ful lled the inclusion criteria. The results after procedure were observed clinically and by echocardiography.
Results: Median age was 19 years old (3-47 years old), median duct size was 9.8 (8.0-20)mm and mean mPAP (mean pulmonary artery pressure) was 58.5 ± 8.0 mmHg. Median ow ratio (FR) before pulmonary vasodilator test was 1.8 (0.5-21) and median pulmonary artery resistance index (PARi) was 4.8 (0.7-20). Fifteen patients with PARI ≥4 WU.m2 underwent pulmonary vasodilator test with median FR pre vasodilator test was 1.3 (0.5-3.3) increased to 4.3 (1-22), p=0.001; mean PARI before vasodilator test was 9.6 improved to 0.9 (0.1-6), p=0.001; with mean mPAP decreased from 62.2±8.7 to 40.5±17.8 (p=0.004) accord- ingly after device closure. There was no cardiac death. During study, there was one case of device dislodge which underwent uneventful surgical ligation afterwards. Initial residual PDA before discharge was 60.6% which all com- prises of minimum centrally residual. Upon follow up from one week to four months, no residual PDA was detected. A patient developed AV stula after the procedure and underwent uneventful surgical ligation afterwards. The median length of stay in hospital was three days.
Conclusions: Transcatheter closure with device in large PDA with moderate to severe pulmonary hypertension was e ective and safe provided that the PARi after vasodi- lator test was less than 8 WU.m2.
27. A COMPARISON OF DUCTAL STENTING AND BLALOCK TAUSSIG SHUNT IN DUCT DEPENDENT LESIONS: A SYSTEMATIC REVIEW
Radityo Prakoso1, Prissilia Prasetyo2
1 National Cardiovascular Center Harapan Kita; Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia; Pediatric Cardiology
2 University of Indonesia; Faculty of Medicine; General Practitioner
Journal of Structural Heart Disease, April 2018
Volume 4, Issue 2:85-113