Page 124 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
186
162. WHEN PERCUTANEOUS TREATMENT IS NOT THE BEST CHOICE: THE ASDS WE DIDN'T CLOSE
Rafael Agostinho, Renata Mattos
Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Background: The study aims to evaluate a phenomenon known in the cath lab during percutaneous occlusion of atrial septal defects (ASD): the crossover for surgery. We evaluated, among the surgical ASD closures performed in our hospital in a given period, the patients who under- went previous catheterization and, if the intention was the percutaneous closure, what was the reason for referring to surgery. We classified according to the type of ASD, the absolute size of the defect and its relation to the body sur- face, as well as the justification that motivated the indica- tion of open surgery.
Methods: We reviewed the hospital records of all the patients referred for percutaneous ASD closure from 2010 to 2017. Patients referred to surgery for defects other than ostium secundum ASD were excluded.
General anesthesia and transesophageal echocardiog- raphy were performed in all patients. Some cases were excluded at this point. After this evaluation we proceeded to the right heart catheterization. If the pulmonary artery pressure and resistance were normal, we evaluated the septal defect with a sizing balloon, which was another stage when some patients were excluded. After position- ing of the device, echocardiographic evaluation of its sta- bility and relationship to adjacent structures was the final stage when some cases were referred to surgery.
Among the cases referred to surgery, we analyzed several factors of the defect, such as the biggest diameter and its rims.
Results: From 2010 to 2017, there were 80 surgeries for isolated ASD repair, among which 18 had been previously referred for percutaneous intervention. In the same period 221 patients were referred for percutanous closure, so the crossover to surgery happened in 8,2% of those 221 cases.
We found that the absence of adequate rims and a high ASD size to body surface area (higher than 30) were the most prevalent factors influencing the decision to abort the percutaneous procedure.
Conclusion: We know that giving up percutaneous closure of some ASDs in the cath lab, after balloon sizing and echo- cardiographic evaluation, is inevitable.
Based on the factors examined in this study, we found that some patients could be referred directly to surgery, thus avoiding one unecessary procedure under general anes- thesia. This approach is specially important in the public health system.
163. DIAGNOSIS OF DIASTOLIC DYSFUNCTION DURING ROUTINE PRE-FONTAN CATHETERIZATION: THERE IS NEVER TOO MUCH INFORMATION
Renata Mattos, Victor Hugo Oliveira, Rafael Agostinho Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Background: The Fontan completion is one of the strate- gies for single ventricle patients. Among several variables that influence the prognosis of these patients, occult dia- stolic dysfunction (ODD) is a key element which is fre- quently undiagnosed. We used a simple volume stress test to access ventricular diastolic function in patients under- going routine catheterization before Fontan surgery.
Methods: Patients who had bidirectional Glenn surgery and were scheduled to undergo Fontan surgery were selected to catheterization under general anesthesia. Besides routine hemodinamic assessment of the pulmo- nary circulation, study of the systemic venous system, ventricle and aorta, and also occasional occlusion of an aortopulmonary colllateral, we performed the volume stress test. This test consists in rapid infusion (over five minutes) of 15ml/kg of saline. Ventricular end diastolic pressure (EDP) was mesured before and five minutes after the infusion. EDP above 15mmHg before or after the test mean that ODD is present.Afterwards we reviewed the hospital records of the patients who had the test and went to Fontan surgery.
Results: From January 2018 to Abril 2019 there were eight pre-Fontan hemodinamic studies including assessment of ODD in the cath lab. Their ages ranged from 10 to 19 years with an average of 13 years old. The average of time since the Glenn surgery was 4 years. Two of them had high pul- monary arterial pressure and therefore didn't go to surgery. Among the six who had surgery, three had basal elevated EDP and the other three expressed DDO after the volume test. Two of them had fenestrated Fontan. Apart from one patient who had post-operative endocarditis, the average length of hospital stay was 29 days and the average tho- racic draining time was 11 days.
Conclusion: Echocardiographic assessment of the single ventricle is challengig. ODD is relevant in these patients, even in those with normal systolic fraction, since it might direct medical therapy towards lusitropic drugs instead
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205