Page 110 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
172
of saturation, which was maintained around 65% in ambi- ent air.
CT with contrast scanning was performed and revealed PAVMs in the lower and upper lobe of the lung. On 04/17/2019, he underwent coiling of the fistules in the lower lobe and plugging on fistules located in the upper right lobe, lower right lobe and the right middle.
After a percutaneous procedure, the child presented improvement of the symptoms, with oxygen saturation at 90% in ambient air.
Nowadays our patient maintains follow-up with pedi- atric pneumology, cardiology and neurology teams due to signs of cerebral arteriovenous malformations in agiotomography.
Discussion: Pulmonary arteriovenous malformations are abnormal direct communications between pulmo- nary arteries and pulmonary veins without interposition of a capillary bed. Approximately 80 to 90% of patients presenting with PAVMs eventually present HHT, whereas the remaining are sporadic cases. Conversely, 15 to 35% of HHT patients will present PAVMs. The PAVM consists of three different anatomical components: one or more than one feeding artery(ies), an aneurismal sac and one or more draining vein. Many infants are only diagnosed after a respiratory event with an odd evolution. TTCE and CT scanning is considered the gold standard diagnosis tool as it provides an easy patient screening, a high anatomi- cal resolution, a precise location and type definition of the PAVM. Furthermore, this tool is useful for percutaneous embolization planification and follow-up. It’s important to look for other malformations in other sites such as brain and abdominal. Percutaneous embolotherapy is nowadays preferable in most disease cases. The aim of transcatheter embolization is to occlude all the PAVM feeding arteries by a selective catheterization of pulmonary arteries by using a coaxial system, via a percutaneous femoral approach.
142. AUTOMATED ROBOTIC CONTROL OF VOLUME INTRACARDIAC ECHOCARDIOGRAPHY TO GUIDE CONGENITAL HEART INTERVENTIONS
Zhongyu Li1, Jarrod Collins2, Young-Ho Kim2, Neal S. Kleiman3, Ponraj Chinna Durai2, Tommaso Mansi2, C. Huie Lin3,1
1Houston Methodist Research Institute, Houston, USA. 2Siemens Medical Solutions USA, Inc., Princeton, USA. 3Houston Methodist Hospital, Houston, USA
Background: Intracardiac echocardiography (ICE) is widely used to guide congenital and structural heart inter- ventions. In contrast to tranesophageal echo, ICE does not require general anesthesia and can be performed by the interventionalist. However, manipulation of the ICE cath- eter can divide the attention of the operator. We report the development of an automated robotic ICE catheter controller with the ability to successfully reobtain three defined views in vivo in a porcine model.
Method: A robotic controller was built to control linear translation, axial rotation, and A-P / L-R bending of an Acunav P6 volumetric ICE catheter (Acuson, Mountain View) from joystick or encoded inputs. Initial views of the mitral valve, aortic valve and tricuspid valve were acquired by operator-directed manipulation of the robotic system in vivo porcine model and electronically recorded and encoded. The same views were then re-directed by auto- mated robotic manipulation based upon operator manip- ulation with five trials. Error in robotic reacquisition and reproduction of the same views was evaluated using a nor- malized cross-correlation similarity metric. Catheter pose and position were also recorded using cone-beam CT and EM tracking.
Result: The similarity metric for incorrect views revealed a mean of 43.4%. Evaluation of the automated-robotic reac- quisition of ICE images demonstrated similarity metric of 76.7% for mitral valve view, 88.0% tricuspid valve view and 75.4% aortic valve view. Cone-beam CT revealed minimal differences in catheter pose and position between opera- tor- and automated-robotic control.
Discussion: We report the first successful in vivo auto- mated-robotic view-to-view ICE catheter manipula- tion. Additional work will be required to develop iterative image improvement and stabilization algorithms as well as safety boundaries.
143. MINIMALIST TRANSCATHETER PULMONARY VALVE REPLACEMENT: INITIAL EXPERIENCE
Joseph Venturini, AbdulRahman Dia, Isla Mclelland , Daniel Gruenstein, Janet Friant, Diane Weibeler, Jonathan Paul, John Blair, Atman Shah
University of Chicago, Chicago, USA
Background: As more children with congenital heart dis- ease are treated successfully and survive to adulthood, the number of adults requiring percutaneous approaches to their structural heart disease continues to rise. There is increasing demand for transcatheter pulmonary valve replacement (TPVR) techniques. The minimalist approach
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205