Page 109 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
successful in increasing the minimal luminal diameter with lasting effect and acceptable associated comorbidities.
140. FEMORAL ARTERIAL THROMBOSIS FOLLOWING CARDIAC CATHETERIZATION: A PERFORMANCE IMPROVEMENT PROJECT
Saar Danon, Jennifer Peterson, Mark Redmond, Heather Adame, Christopher Tan
MemorialCare Long Beach Medical Center/Miller Children’s and Women’s Hospital, Long Beach, USA
Objective: Evaluate the outcome of a performance improvement project aimed to reduce femoral arterial thrombosis related to pediatric cardiac catheterization.
Background: Femoral arterial thrombosis is a common complication of pediatric cardiac catheterization, and rates maybeupto30%ininfantslessthan1yearofage.Riskfac- tors include weight less than 5 kg, larger sheath French size, increased sheath length, final activated clotting time less than 250 seconds, and need for arterial sheath exchanges. Treatment of femoral arterial thrombosis requires antico- agulation and results in increased hospital length of stay and cost. From January 1, 2016 through June 30, 2017 our program’s overall rate of femoral arterial thrombosis in pediatric patients was 12.7%, and 19.5% in patients weigh- ing less than 15 kg. The purpose of this project was to reduce the rate of femoral arterial thrombosis in pediatric cardiac catheterization patients to less than 8%.
Methods: All procedures were performed at MemorialCare Long Beach Medical Center/Miller Children’s and Women’s Hospital, an academically affiliated adult and children’s hospital in Southern California. Pediatric cardiac cathe- terizations are performed within a 5-room adult cardiac catheterization laboratory with multiple operators. We identified that all cases of femoral arterial thrombosis occurred in patients weighing less than 15 kg, so the target was adjusted to include only this smaller cohort. Procedure details were reviewed and it was found that patients received a variable dose of heparin ranging from 25-100 units/Kg, sheath removal was often deferred until the acti- vated clotting time (ACT) was less than 200 seconds, and distal perfusion during access site compression was not routinely monitored. Three practice changes were incor- porated. (1) Intraprocedural initial heparin dose minimum of 50 units/kg in all patients where arterial catheterization was performed. (2) Sheath removal policy was modified to allow sheath removal without an ACT threshold. (3) Pulse oximeter waveform monitoring of distal extremity during catheterization site compression, with hand pressure adjustment to maintain hemostasis while also maintaining
a visible pulse oximeter tracing distal to the access site as an indicator for adequate pulsatile distal perfusion.
Results: Following implementation of these changes in July 2017 through March 2019, there have been no cases of clinically significant femoral arterial thrombosis in patients less than 21 years of age, including all patients weighing less than 15 kg leading to a reduction from 12.7% to 0 (p = <0.001). Median initial heparin dose/kg increased from 44 units/kg to 55.1 units/kg (p = 0.003), although the peak and final activated clotting times were not significantly different from pre-to post-practice change. However, fol- lowing these changes, there was a non-statistically signifi- cant increase in minor access site bleeding following these practice changes (8.3% to 10.4%), none of which required treatment.
Conclusions: Performance improvement project lead- ing to practice changes resulted in a dramatic decrease in femoral arterial thrombosis following pediatric cardiac catheterization.
141.PULMONARYARTERIOVENOUSMALFORMATION: A CASE REPORT
Celia Maria Camelo Silva, Nathalie Bravo-Valenzuela, Yan Sasaki, Gustavo Feitosa Santos, Ana Faccinetto, Wallessa Mota, Wagner Granelli Junior, Juliana Taguchi
UNIFESP, São Paulo, Brazil
Background: Pulmonary arteriovenous malformations (PAVMs) can be spontaneous or be part of a hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease, which is an autosomic dominant disorder charac- terized by the development of multiple arteriovenous mal- formations in either the skin, mucous membranes, and/or visceral organs. The PAVMs may either rupture, and lead to life-threatening hemoptysis/hemothorax or be responsible for a right-to-left shunting leading to paradoxical embo- lism, causing stroke or cerebral abscess. PAVM diagnosis is mainly based upon transthoracic contrast echocardiogra- phy and CT scanner examination. The latter also allows the planification of treatments to adopt, which consists of per- cutaneous embolization, having replaced surgery in most of the cases.
Case Report: Infant with 10 months of age previously healthy according to parents, had his first respiratory event at such age. He was hospitalized in a general hospital due to pneumonia. After one day, oxygen saturation worsened, and he needed supplemental oxygen. After a week with antibiotic therapy, patient presented clear improvement of respiratory pattern, but without correlative improvement
Hijazi, Z
22nd Annual PICS/AICS Meeting