Page 121 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
vascular access was needed for a plasmapheresis catheter in a kidney transplant recipient.
VBX stents were chosen over bare metal stents due to con- cern for the severity of stenosis and risk for vascular injury in four of the cases. In one patient a VBX stent was chosen in order to exclude pulsatile antegrade flow while simul- taneously treating LPA stenosis in a Fontan patient. In one patient a VBX stent was implanted within coronary stents which had previously been placed to treat critical neonatal coarctation during emergency resuscitation. After place- ment of the VBX stent, the coronary stents were safely unzipped with high-pressure balloon dilation.
VBX stents were delivered through 7 or 8 French sheaths in all cases except one, in which it was delivered through a 14 French sheath which had been placed for another procedure. A single complication occurred in the patient with acquired SVC occlusion; the length of stent required to bridge the occluded segment of SVC was underap- preciated, resulting in a large right hemothorax. This was treated with the placement of two additional VBX stents, which restored flow through the SVC without residual vas- cular leak.
Conclusions: We report the successful implant of VBX stents in five children with congenital or acquired vascu- lar stenoses. Relief of obstruction was achieved in all cases, and a single complication occurred. In vitro bench testing of the VBX stent has demonstrated the possibility of open- ing the side struts and unzipping the stent. The VBX stent is a unique, balloon-expandable covered stent that may hold greater potential for the treatment of vascular stenosis in children.
158. PERCUTANEOUS OCCLUSION OF CORONARY ARTERY FISTULA IN AN INFANT PRESENTING WITH SUDDEN CARDIAC ARREST POST TETRALOGY OF FALLOT REPAIR
Marisha McClean, Konstantin Averin, Darren Freed, Lindsay Ryerson, Andrew Mackie, Cameron Seaman
University of Alberta, Edmonton, Canada
Background: Isolated coronary artery fistulae (CAF) are usually asymptomatic in children. Pre-existing or acquired CAF created by muscle resection may result in inadequate myocardial protection during administration of cardio- plegia and subsequent myocardial dysfunction following repair of Tetralogy of Fallot (TOF).
Case Description/Methods: A 7 day old female infant with TOF underwent urgent central shunt for profound
hypoxaemia. An anomalous left anterior descending (LAD) coronary from the right coronary artery (RCA) prohibited neonatal complete repair. TOF repair with transannular patch and right ventricle muscle bundle resection was performed at 6 months and 6.2 kg. Biventricular dysfunc- tion resulted in cardiac arrest 2 hrs post-operatively and required extracorporeal cardiopulmonary resuscitation. Echocardiogram post arrest showed a CAF to the right ven- tricular outflow tract (RVOT). Cardiac catheterization day 1 post arrest showed an unobstructed left main coronary artery (LMCA), left circumflex (LCx) and RCA ostium giving rise to the LAD. There was a small CAF from the proximal LCx to the RVOT. The RCA was occluded distal to the LAD origin due to compression by the venous extracorporeal membrane oxygenation (ECMO) cannula. Immediately post catheterization, the ECMO cannula position was revised with attempted surgical ligation of the CAF how- ever biventricular dysfunction persisted and she returned to the catheterization laboratory 5 days later due to failure to wean from ECMO.
Results: Femoral venous and arterial access was obtained. Angiography showed persistent LCx CAF, which increased in size with prominent flow into the RVOT and minimal fill- ing of distal LCx. The RCA and LAD were unobstructed. The proximal CAF measured 1.6 mm and narrowed to <0.5 mm. The LMCA was engaged with a 4 Fr RIM catheter; a 0.014” BMW wire and microcatheter were advanced to the distal CAF. The CAF was successfully occluded using 3 x Cook Tornado 0.018” 3-2 mm Embolization Coils with no residual flow and improved distal LCx perfusion. Serial echocardio- grams showed normalization of LV function and improved RV function, with successful decannulation day 2 post CAF occlusion.
Conclusion: Hemodynamically significant CAF may result in impaired myocardial perfusion and ventricular dysfunc- tion following cardiac surgery. This case demonstrates the value of invasive CA imaging for an unexplained arrest post cardiac surgery. It also demonstrates that CAF occlusion can be safely and successfully performed in small children, resulting in increased distal coronary perfusion.
159. TRANSCATHETER TRICUSPID/PULMONARY VALVE-IN-VALVE REPLACEMENT: INITIAL EXPERIENCE USING A BRAZILIAN BIOPROSTHESIS
Giolana Mascarenhas da Cunha, Germana Cerqueira Coimbra, Luiz Junya Kajita, Henrique Ribeiro, José Honório Palma, Raul Arrieta
Heart Institute - University of Sao Paulo Medical School , São Paulo, Brazil
Hijazi, Z
22nd Annual PICS/AICS Meeting