Page 115 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
expedite this process with reduced x-ray and contrast dose as well as allow iterative re-registration during the procedure.
150. SURGICAL IMPLANTATION OF MELODYTM TRAN- SCATHETER PULMONARY VALVE IN THE NATIVE PUL- MONARY VALVE OF A NEONATE
Shireen Mukadam1, Mehmet Gulecyuz2, Dhaval Patel1, Michel Ilbawi1
1Advocate Children's Heart Institute, Oak Lawn, USA. 2Illinois Institute of Pediatric Cardiology, Naperville, USA
Background: Neonatal repair of congenital absence of the pulmonary valve may require placement of a valved con- duit or monocusp valve due to severe pulmonary insuffi- ciency. The natural history of these valves often involves future re-intervention and possibly repeat sternotomy for replacement.
Case: We describe the case of a term newborn male with a prenatal diagnosis of absent pulmonary valve and aor- topulmonary window. He was emergently intubated within the first two hours of life due to respiratory distress, and was noted to have retrognathia with concern for Pierre Robin sequence. Initial postnatal echocardiogram demon- strated severe stenosis and insufficiency of the pulmonary valve, a large type B patent ductus arteriosus, massive hypertrophy of the right ventricle, and dilated pulmonary arteries and ascending aorta. Microarray revealed 15q11.2 deletion syndrome. He was taken to surgery at 6 days of life, and intraoperatively was found to have nearly absent pulmonary valve except for nubbing of dysplastic resid- ual leaflets. Due to significant pulmonary insufficiency, decision was made to implant a competent pulmonary valve using a MelodyTM transcatheter pulmonary valve 20 (Medtronic Inc., Minneapolis, Minnesota). The valve was tested in a saline bath and deployed over a MustangTM 10mmx30mm PTA Balloon Dilatation catheter (Boston Scientific, Marlborough, MA). The valve was immediately implanted by the surgical team, externally sutured into the right ventricular outflow tract with 5-0 Prolene. The outflow tract was then closed with a CardioCel patch. Intraoperative transesophageal echocardiogram showed a well-function- ing MelodyTM valve with no significant stenosis or insuffi- ciency. The valve was noted to extend significantly into the body of the right ventricle at that time. His postoperative course was uncomplicated and he was discharged home at one month of age. At two months follow-up, he had developed mild stenosis of the MelodyTM valve with mod- erate valvar and paravalvar regurgitation. By one year of follow-up, there was persistent mild pulmonary stenosis and moderate regurgitation which had not progressed. His
most recent echocardiogram at 14 months of age demon- strated mild MelodyTM valve stenosis with estimated peak gradient 28 mmHg, mean gradient 14 mmHg. There was moderate regurgitation which was mostly valvar, with mild paravalvar leak. There was mild right ventricular hypertro- phy and a prominent muscle bundle at the right ventricu- lar apex, with qualitatively normal right ventricular systolic function. He has been maintained on daily aspirin, and is an active child who has been demonstrating adequate weight gain. His saturations are 100% on room air. We will likely perform further transcatheter balloon dilation of the valve in the near future.
Conclusion: To our knowledge, this is the first known report of MelodyTM valve implantation in the native right ventricular outflow tract (RVOT) of a neonate. This tech- nique may potentiate future transcatheter intervention for ballooning or valve replacement. Primary transcatheter valve placement in the native RVOT may help minimize the need for additional sternotomies in the future, or eventu- ally allow for a catheter-based approach to initial pulmo- nary valve replacement.
151. LONG-TERM CLINICAL OUTCOMES IN CHILDREN AND ADOLESCENTS WITH TRANSPLANTED RENAL ARTERY STENOSIS
Célia Maria Camelo Silva, Ana Carolina Buso Faccinetto, Gustavo Rocha Feitosa Santos, Attílio Galhardo, Gabriel Kanhouche, Henry Orellana, Manoela Linhares, Juliana Cristina Taguchi, Yan Sasaki, Wagner Granelli Jr, Walessa Pereira Mota, Nathalie Jeanne Magioli Bravo Valenzuela, João Chaker Saba, Hélio Tedesco, José Medina Pestana, Adriano H. P. Barbosa
Federal University of São Paulo, São Paulo, Brazil
Background: Transplanted renal artery stenosis (TRAS) is the main vascular complication of patients undergoing transplantation and may require surgical or percutaneous intervention (PI). The incidence of TRAS in children and adolescents is between 5-9%.
Objective: To evaluate the long-term effects of PI in chil- dren and adolescents with TRAS.
Methods: Retrospective and longitudinal study from a single center. Between January 2007 and December 2014, 38 children and adolescents ≤18 years with suspected of TRAS had been submitted to renal angiography. Two patients had complex stenosis and weren´t angioplasted and thus excluded. Of these, 20 had significant stenosis >50% and had went to PI renal stenting at the same pro- cedure(TRAS+),the remain 16 hadn´t significant stenosis
Hijazi, Z
22nd Annual PICS/AICS Meeting