Page 123 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
tricuspid or pulmonary valve dysfunction of congenital or acquired childhood etiology.
Conclusion: In this initial experience, the percutaneous implantation of the Braile Inovare bioprosthesis in the tricuspid and pulmonary position was effective and safe for patients with important dysfunction of the previously surgical implanted bioprosthesis; the use is capable of pro- viding encouraging results with increased functional and structural cardiac improvement.
160. MESENTERIC ISCHEMIA AFTER STENT IMPLAN- TATION IN NATIVE AORTIC COARCTATION
Renata Mattos, Herica Falci, Victor Hugo Oliveira, Luiz Carlos Simões
Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Background: Mesenteric ischemia is well known compli- cation after aortic surgery, but there aren't many reported cases after percutaneous procedures.
Case Report: A 6-year-old boy had clinical and echocar- diographic diagnosis of severe aortic coarctation and persistent ductus arteriosus with moderate left heart enlargement. We opted to implant a covered CP stent for treatment of both lesions at the same time and achieved a good hemodinamic result. He was admitted to the pediat- ric ward just. After about 24 hours he started complaining of abdominal pain and distension. Serial abdominal x-rays and abdominal CT were made. He was examined by the general pediatric surgeon who suspected of mesenteric ischemia. The patient was admitted to the ICU and treated conservatively with fasting and antibiotics. He got better and was discharged after 72 hours.
Discussion: In our hospital, we frequently treat aortic coarctation with stent implantation. In the last 10 years, we had less then 1% complications, all of them related to the vascular access. It was our first mesenteric ischemia during this period. Opposite to post-surgical mesenteric ischemia, which is related to the time of aortic clamping, with per- cutaneous treatment the aortic flow is interrupted for a minimal amount of time. I is known that ischemia leads to progressive tissue damage, but paradoxically the reperfu- sion lesion after flow restoration is even more damaging.
This case showed us that mesenteric ischemia following percutanous aortoplasty, however rare, is potentially fatal if not diagnosed before intestinal perforation. This has lead to a change in our routine post-aortoplasty, with a pro- longed fasting time.
161. OFF-LABEL USE OF A PFO DEVICE FOR OCCLU- SION OF A RESIDUAL LEFT ATRIAL APPENDAGE SHUNT
Renata Mattos
Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Case Report: A 17 year-old boy had obstructive hyper- trophic cardiomyopathy and mitral regurgitation. He had surgical miectomy and mitral valve replacement in March 2017. During the surgery the left atrial appendage (LAA) was excluded.
In November 2018 he was admitted after incidental echo- cardiographic finding of a thrombus in the left atrium and a residual shunt from the LAA. Clinical treatment with enoxaparin and warfarin was started. After thrombus reso- lution, it was decided that the LAA communication should be closed.
The procedure was made in the cath lab under general anesthesia with transesophageal echocardiographic (TEE) guidance. Transeptal puncture was performed with Brockenbrough needle and we managed to assess the LAA with a JR catheter. TEE and radioscopic images confirmed that the communication was a small hole in the surgical patch. We then safely positioned a stiff guide wire inside the LAA to allow us to insert a 7 French long sheath and the Occlutech 16/18 PFO occluder.
Immediately after implant, TEE showed minimal residual shunt through the device.
Because of the mitral prosthetic valve, he still takes warfa- rin. In January 2019 he was again admitted in the hospital for symptomatic atrial fibrilation, which was treated with amiodarone. TEE in this occasion showed the device well positioned with no residual shunt.
Discussion: Closure of surgical residual shunts might be challenging, because the anatomic structures may be distorted and we are dealing with foreign materials. Therefore, planning ahead and pre-procedure imaging is very important. Similarly, good TEE imaging is vital during the procedure.
Since these defects are unique, there are no specific designed devices. Therefore, off-label use of PFO, ASD, VSD, vascular plug and other devices is mandatory.
Hijazi, Z
22nd Annual PICS/AICS Meeting