Page 105 - Journal of Structural Heart Disease Volume 5, Issue 4

167
Meeting Abstracts
same session. Two patients had moderate tricuspid regur- gitation related with the procedure. There were no deaths during a median follow-up of 14(2-47) months. Valve func- tion was preserved in all patients during follow-up.
Conclusion: The Edwards SAPIEN-XT and S3 valves may be an alternative method for tPVR in patients with native and dilated RVOT.
136. ASSESSMENT OF RIGHT VENTRICULAR TO PULMONARY ARTERIAL COUPLING DURING TRANSCATHETER PULMONARY VALVE REPLACEMENT Britton Keeshan, Sofia Charania, Jeremy Asnes, Paul Heerdt Yale School of Medicine, New Haven, USA
Background: Severe pulmonary insufficiency leads to progressive right ventricular (RV) dilation and dysfunc- tion with optimal timing of transcatheter pulmonary valve replacement (TPVR) remaining unclear. The degree of RV dysfunction, manifest as decreased ejection fraction (RVEF) on cardiac MRI (CMR), has been used to guide decision making. The right ventricular-pulmonary arterial (RV:PA) coupling index is the ratio of contractility/afterload— expressed as load-independent ventricular end-systolic elastance (Ees)/pulmonary arterial elastance (Ea)—and is a comprehensive index of RV adaptation to abnormal load- ing conditions. RV:PA coupling (Ees/Ea) has been shown to have prognostic significance in patients with pulmo- nary arterial hypertension (PAH) and recent data suggest that Ees/Ea is impaired in patients who have undergone surgical repair of Tetralogy of Fallot. While Ees/Ea has tra- ditionally been assessed using CMR, novel techniques for measuring Ees/Ea with right ventricular pressure (RVP) waveforms have been reported. We sought to determine how the Ees/Ea was affected by TPVR using RVP tracings before and after successful TPVR.
Methods: Data obtained under IRB-approved proto- cols from 21 patients was analyzed including: 14 control patients (7 normal and 7 pulmonary arterial hypertension) that had undergone diagnostic right heart catheterization and 7 patients that had undergone CMR followed by TPVR for pulmonic insufficiency. Digital recordings of RVP wave- forms were used to determine Ees, Ea, and RV:PA coupling index (Ees/Ea) in controls and patients before and after TPVR. Correlation between Ees/Ea and RVEF from CMR was performed to validate methodology.
Results: Ees/Ea at the time of TPVR was significantly cor- related with preoperative RVEF measured by CMR (r2= 0.84, p = 0.009). Data directly measured at time of catheteriza- tion are shown in Table 1. Notably, Ees/Ea is decreased at
baseline in patients undergoing TPVR when compared to normal controls. This is similar to patients with PAH despite a peak RV pressure about half that measured in the PAH cohort. TPVR had little overall hemodynamic effect and did not alter Ees and Ea as individual variables. However, following TPVR Ees/Ea tended to increase in all subjects (Figure 1) and this effect was significant.
Conclusions: RV:PA coupling index is impaired in patients with severe pulmonary insufficiency undergoing TPVR relative to normal controls. Immediately following TPVR, there is a significant increase in Ees/Ea despite only mod- est change in systemic hemodynamics. Further study is needed to determine if assessment of RV:PA coupling index may prove useful in determining optimal timing and efficacy of TPVR in patients with severe pulmonary insufficiency.
137. LYMPHATIC EVALUATION DURING ICMR PROCEDURES IN SINGLE VENTRICLE PATIENTS
Yousef Arar, Tarique Hussain, Vasu Gooty, Riad Abou Zahr, Sheena Pimpalwar, Jennifer Hernandez, Luis Zabala, Joshua S. Greer, Gerald Greil, Surendranath R. Veeram Reddy
UT Southwestern, Dallas, USA
Background: Lymphatic insufficiency evaluation in the single ventricle (SV) circulation remains an area of increas- ingly targeted clinical research. Elevated central venous pressures in post-Fontan patients leads to increased liver lymphatic production and impaired lymphatic drainage. This causes significant lymphatic system leak, resulting in numerous complications such as protein losing enteropa- thy (PLE), chylous effusions, and plastic bronchitis. Recent reports by Dori et al showed that greater MRI-based sever- ity of lymphatic abnormalities (Type 4) in pre-Fontan patients was associated with failure of Fontan completion and a longer postoperative stay.
Objectives: We describe our institutional experience to assess lymphatic burden during real-time interventional cardiac magnetic resonance (iCMR) procedures performed to evaluate pre- and post-Fontan hemodynamics. The grade of lymphatic abnormality was evaluated in all SV patients by T2-weighted MR lymphangiography (T2W- MRL) and an invasive dynamic contrast magnetic reso- nance lymphangiography (DCMRL) in high risk patients.
Methods: Patients underwent an iCMR procedure using dilute gadolinium-filled balloon-tip catheter with the aid of EmeryGlide guidewire (Nano4Imaging Aachen, Germany) for Glenn/Fontan right heart catheterization (RHC) and left heart catheterization (LHC) under real-time MRI
Hijazi, Z
22nd Annual PICS/AICS Meeting