Page 112 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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patients 96 had transannular patched large native RVOT without stenosis, 16 had patched native RVOT with steno- sis and 82 had conduit dysfunction. In patients with con- duits as well as native RVOT with stenosis a Z-Med balloon was used to assess the compression of the coronary arter- ies with simultaneous coronary angiogram. At the begin- ning of our experience, in patients with large native RVOT without stenosis also CC test was performed in 46 patients, after that we have canceled the CCT in these patients.
Results: Mean age and weight of the patients were 15.5 ±6.3 (5-50) years and 48 ±16 (16-99) kg, respectively. There were no cases of coronary compression or abnormal coronary artery anatomy in patients with native RVOT with transannuler patch (with or without stenosis). Among the patients with conduit dysfunction 16 (19.5%) had abnor- mal coronary artery anatomy. CC occurred in five patients (6%) with conduit dysfunction, It involved the left ante- rior descending coronary artery in three and the right coronary artery in two patients. Four of five patients had abnormal coronary anatomy. In sixteen patients with cor- onary anomaly four patients had coronary commression after test (25%). Two patients with tetralogy of Fallot and two patients with transposition of the great arteries and one patient with truncus (patient with normal coronary anatomy) demonstrated compression. Conduit types were Contegra (3) and Labcor (2). Median conduit diameter was 16 (13–19) mm at surgical implantation. CC resolved after deflation the balloon in all cases and patients sent to sur- gery. In 189 cases PPVI was successfully implanted (Sapien valve in 115 and Melody valve in 74). No patient developed CC following stent and/or a valve implantation.
Conclusion: Patients with conduit dysfunction and abnor- mal coronary anatomy tend to be at increased risk of CC, especially in patients with tetralogy of Fallot or transpo- sition of the great arteries. In patients with transannular patched large native RVOT without stenosis, we believe that CCT is not necessary because the stent can barely be implanted without overexpansion. In addition in patients with transannular patched large native RVOT with stenosis we continue CCT because overexpansion is necessary to relieve the stenosis.
146. PERCUTANEOUS CLOSURE OF AN ANOMALOUS PERSISTENT LEVOATRIAL CARDINAL VEIN PRESENTING WITH SYSTEMIC HYPOXEMIA
Nicholas Ghiloni, Robert Cubeddu, Hans Koop, Hardik Bhansali
Cleveland Clinic Florida, Weston, USA
Background: Persistent levoatrial cardinal veins (LACV) represent an uncommon, yet benign form of partial anomalous pulmonary venous communications (PAPVC) between the left atrium or pulmonary veins and a systemic vein (i.e. the innominate vein). We report here an unusual presentation of severe systemic hypoxemia and profound dyspnea in an elderly patient with recurrent pulmonary venous thromboembolism. After a thorough clinical eval- uation, the patient was diagnosed with a large paradoxical right-to-left shunt flow across an LACV that was subse- quently closed percutaneously.
Case: An 87 year old male with chronic venous pulmonary thromboembolisms (PTE) was evaluated for severe unex- plained systemic hypoxemia and dyspnea with aortic oxy- gen saturation of 78% on room air. He required continuous use of supplemental oxygen. Pulmonary work up did not reveal causation for his progressive symptoms. Initial TTE with bubbles injected into the left cubital vein (CV) revealed immediate opacification of both atriums. However, follow up TEE with bubbles injected in the right CV was negative for suspected interatrial septal defect. Subsequent con- trast gated CT scan revealed a LACV extending between the left innominate vein and left upper pulmonary vein (LUPV). Cardiac catheterization demonstrated no oxygen step-up between the SVC and pulmonary arteries. The mean PA pressure was 26 mmHg. The innominate vein was cannulated and venography confirmed the LACV with right-to-left shunt reversal due to elevated PA pressures from PTE. The LACV was occluded with a 12 mm Amplatzer Vascular Plug II. This resulted in immediate normalization of systemic oxygen saturation to 98% with improvement in the symptoms. The patient no longer needed supplemen- tal oxygen.
Discussion: The overall incidence of anomalous pulmo- nary venous communications is 0.4-0.7%. Multiple case reports present this incidental finding with signs and symp- toms related to the degree of shunting and the presence or absence of other cardiopulmonary disease. Furthermore, hemodynamic abnormalities are not expected until 50% or more of the pulmonary blood flow is redirected to the systemic venous system. Typically these patients live normal asymptomatic lives. There are no guidelines or recommendations for the management of anomalous pul- monary venous communications, but those cases that have required definitive treatment have traditionally undergone surgical correction.
Our patient was an unusual presentation of LACV given that he was asymptomatic from this congenital malfor- mation until his 80s when he subsequently developed
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205