Page 52 - Journal of Structural Heart Disease Volume 4, Issue 3

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Meeting Abstracts
Indication For Intervention: Because his pulmonary arter- ies were already acceptably dilated with pulmonary artery stenting, we decided to create interatrial fenestration, using PALMATZ P3008ETM stent (Cordis, Switzerland) this time.
Intervention: Procedure was guided under intracar- diac echocardiography. Because of slipping of the tip of Brockenbrough needle, we directed the needle by snare guide wire for tip to enface the Fontan tract wall. Once we punctured the tract, we advanced 0.035 sti guidewire. Over the guidewire, we advanced the distal half of pre- mounted 8mm-PALMAZ stent through the inter-atrial sep- tum. Covering proximal half of the stent with long sheath, we dilated distal half of the stent without dilating proximal part of stent. Then, we further pull back the long sheath and exposed entire stent. After pulling back the balloon until the tip of the balloon at the middle of stent, we dilated proximal part of the stent tightly holding the middle part of stent with snare guidewire to make it dumbbell shape. Finally, we further dilated the middle part of stent with 5 and 6 mm balloon and the patient SpO2 decreased from 93% to 86% resulting in increase of cardiac index.
Learning Points of the Procedure: Staged uncovering of the stent by long sheath and tight holding of stent by snare wire can make ideal dumbbell shaped stent for fenestra- tion of Fontan tract.
33. DUCTAL STENTING IN CONGENITAL HEART DISEASE WITH DUCT DEPEDENT PULMONARY BLOOD FLOW : A FOUR YEARS EXPERIENCE FROM NATIAL REFFERAL CENTRE IN INDONESIA
Ruswandiani Sukarya1, Radityo Prakoso2
1 Universitas Indonesia/ National Cardiovascular Center Harapan Kita; Cardiology; Cardiology Resident
2 National Cardiovascular Center Harapan Kita; Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia; Pediatric Cardiology
Introduction: Cyanotic congenital heart disease with duct-dependent pulmonary blood ow is a life threaten- ing condition and often require early intervention. Blalock Taussig (BT) shunt remains the treatment of choice, but it is associated with high morbidity and mortality. Ductal stenting is becoming an alternative to maintain pulmonary blood ow as it is less invasive. However, this challenging procedure is not widely available in Indonesia.
Objective: This study aims to present our early experience with the short-term outcomes and safety of ductal stent- ing procedure.
Methods: We studied 14 patients who underwent ductal stenting in National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia between October 2013 until Mei 2017.
Results: Indications were pulmonal atresia (n=13) and pul- monal atresia- tricuspid atresia (n=1). Median age at the procedure was 21 days (7-227 days) and median weight at the procedure was 3350 gram (2800-7200 gram). Femoral artery access was used in all procedure. Five procedure used uneventfully antegrade technique. Types of PDA were type A(n=5), C(n=5), E(n=3), and D (n=1). Stent implanta- tion was succesful in 57% of the cases. All procedure used Bare Metal Stent as a device with vary diameter and length 2,5-4 mm x 8-15mm. A signi cant improvement in mean arterial oxygen saturations after stent placement was observed from previously 43.12% to 84.25% (p<0.05). There was no cardiac death during the procedure. Complications after the procedure were thrombosis (n=2), bleeding (n=3), and stent dislodged (n=2. Three deaths after the proce- dure were due to bleeding and stent dislodged. Due to thrombosis, only one patient underwent ballon dilatation, and done successfully. Due to stent dislodge, one patient died and other was succesfull for re-stenting. During fol- low up, one patient underwent radiofrequency ablation and balloon pulmonary valvuloplasty and one patient had Blalock-Taussig shunt operation. There was non signi cant reduction in pulse oxygen saturation six months after the procedure (7-22%;p>0.05)
Conclusion: Stent implantation of ductus arteriosus can be a good alternative for initial palliation in cyanotic congen- ital heart disease with duct depedent pulmonary blood ow.
34. A CASE OF MULTIPLE SECUNDUM ATRIAL SEPTAL DEFECT TREATED WITH TWO FIGULLA FLEX
Shuhei Tanaka, Hiroshi Ueno, Nobuyuki Fukuda,
Koichiro Kinugawa
Toyama University Hospital; Cardiovascular Center; Cardiologist
A case was a 75-years-old female. She was diagnosed with paroxysmal atrial brillation (PAF) and sinus arrest by Holter electrocardiography. Transthoracic echocardiog- raphy revealed atrial septal defect (ASD) and right heart overload (Qp/Qs 2.9). She was scheduled to ASD closure after 6 months treated catheter ablation for PAF. In trans- esophageal echocardiography, two ASDs were con rmed.
Hijazi, Z
2017 CSI Africa Abstracts