Page 113 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
dyspnea. However, he also had significant hypoxemia which contradicts the left to right shunt physiology of usual LACV. In fact, the patient had developed pulmonary arterial hypertension secondary to recurrent pulmonary venous embolism which resulted in increased right atrial pressure that subsequently caused reversal of usual LACV hemodynamic physiology resulting in right-to-left shunt. After percutaneous closure described above, the patient’s dyspnea and hypoxemia resolved.
Conclusion: Levoatrial cardinal veins are rare, but in the setting of pulmonary hypertension and elevated right sided pressures, can result in significant right to left shunt reversal with severe systemic hypoxemia. We demon- strated it is safe and effective to close LACV via transcathe- ter approach compared to traditional surgical approaches.
147. STENT IMPLANTATION FOR AORTIC COARCTA- TION: THE NEED FOR REINTERVENTIONS ON LONG TERM FOLLOW UP
Ahmet Çelebi, Mustafa Orhan Bulut, İlker Kemal Yücel, Emine Hekim Yılmaz
Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery, İstanbul, Turkey
Introduction: Depending on patient size, transcatheter stent implantation has been the first line treatment option for patients with aortic coarctation (CoA). Nevertheless, reinterventions may be needed on follow-up due to reste- nosis, stent fracture or aneurysm formation. We presented our experience in patients with CoA who required a rein- tervention after stent implantation.
Methods: Between 2007 and 2019, 288 patients received a stent implantation for CoA. All patients were followed regularly with echocardiography and multisliced com- puted tomography. Twenty nine patients, who needed a reintervention upon clinical and laboratory findings, were enrolled. Patients with stenosis and/or with a stent fracture received a bare stent, while we preferred covered stents in those with aneurysm formations.
Results: Mean age and weight at the time of reinterven- tions were 13.2 ±5.5 years and 54 ±19 kg, respectively. The mean time to a reintervention was 60 ±32 months follow- ing the initial procedure. Mean weight of patients at the index procedure was 32 ±15 kg. All patients had stent restenosis. Stent redilation was sufficient in four patients with in-stent stenosis due to intimal proliferation, while restenting was needed in 25. Of 25 patients, 13 also had a stenosis at the proximal part of stents, while a stent frac- ture was detected in seven. 16 Andrastents, three bare and
six covered CP stents were used. Covered CP stents were implanted in patients who developed an aneurysm forma- tion after initial CP stent (two covered, 3 bare) implanta- tions. Andrastent implantation to the hypoplastic segment of transverse aortic arch was performed in three. Pressure gradients decreased from 31 ±11 to 3.3±2.2 mmHg.No procedure related complication occured. During the median follow-up of 21 months (2-48), only one patient, who had received a covered CP stent due to aneurysm formation,required a reintervention and a third stent was placed.
Conclusion: Transcatheter stent implantation has evolved as an efficient procedure in patients with CoA. Nevertheless, regular screening with noninvasive imaging modalities for potential complications, such as restenoses, stent fractures and aortic wall injuries, is crucial on follow-up. Restenting can be an effective and safe option, when an indication for reintervention arises.
148. TRANSCATHETER CLOSURE OF MULTIPLE ATRIAL SEPTAL DEFECTS
Ahmet Çelebi, İlker Kemal Yücel, Mustafa Orhan Bulut, Emine
Hekim Yılmaz, Selma Oktay Ergin
Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery, İstanbul, Turkey
Introduction: Atrial septal defects may be multiple in about 10-15 % of the patients.Several different transcathe- ter strategies for treatment of multiple interatrial commu- nications have been described.
Method: During the study period, 1310 patients under- went percutaneous ASD closure at our institution. Among these subjects, 119 (9%) had multiple interatrial commu- nications. Mean age of the patients was 14 ± 10 years and mean weight was 38 ± 22kg. If the tissue separating the defectswas <8 mm, a single device was used. If the dis- tance between the defects was >8 mm, balloon sizing with compliant balloon was performed to the larger defect and distance between the defects evaluated again. If the distance between defects became <8mm, a single device which was identical to the sizing diameter was used. When the tissue separating the defectswas still >8mm following the sizing procedure, with low pressure balloons balloon septoplasty to the larger defect was performed to be able to use a single device. While Multifenestrated/PFO device was preferred for multiple small defects, multiple device was used for the defects well away from each other.
Results: Device implantation was successfully per- formed in all 119 patients. While ninety six case was having
Hijazi, Z
22nd Annual PICS/AICS Meeting