Page 126 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
188
165. CLOSURE OF HEPATIC LESIONS CAUSING CARDIOPULMONARY SYNDROME IN NEONATES. CASE SERIES OF HEPATIC LESIONS PRESENTED WITH CCF AND PAH IN ABSENCE OF HEPATIC FAILURE CLOSED WITH CHEMO AND COIL EMBOLIZATION Sudeep Verma, Gouthami V, Ananta Ram V, Rajamannar K V, Nanda Kishore
Kims Hospital , Hyderabad, India
Introduction: Hepatic lesions causing cardiopulmonary syndrome in absence of live failure and cholestatsis are rarely seen in neonatal age. We are presenting three struc- tural hepatic lesions of different ethology causing cardio- pulmonary syndrome in neonatal age successfully treated with chemo or coil embolization.
CASE 1: HEPATIC TUMOUR WITH CARDIOPULMONARY SYNDROME. Full term neonate developed features of CCF with hepatomegaly (till right iliac fossa) on day one of life. Diagnosed to have Hepatic angioendothelioma, hence started on steroids, beta blocker, inotropic support and diuretics. On day 16 of life developed respiratory failure with CCF and severe PAH. CT scan showed hepatic angio- endothelioma with multiple large intralesional vascu- lar lakes causing high output failure. AFP was elevated in presence of thrombocytopenia and anaemia. In view of intractable cardiac failure, deliberate partial closure of the intralesional lakes was done using ONYX (Ethylene Vinyl Alcohol- Micro therapeutics- Irvene USA) and emboli- zation coils (Cook- Bloomington- USA) through right femoral artery access. Subsequently clinical condition improved and discharged in a stable condition. 12 months follow up showed normal liver function, asymptomatic sta- tus with no cardiomegaly or hepatomegaly.
CASE 2: HEPATIC AVM CAUSING HIGH OUT PUT CARDIAC FAILURE AND PAH. 15 days old IUGR neonate weighing 1.7 kg presented with poor feeding and breathing diffi- culty. Referred for cardiac assessment in view of cardio- megaly. During echocardiography it was detected to have high hepatic venous return. Detailed evaluation revealed large hepatic AVM involving left lobe of the liver. In view of the poor response to medical therapy and increas- ing distress and cardiomegaly, it was decided to close the lesion. After securing right femoral arterial access- hepatic AVM was closed partially using multiple injections of Onyx (Ethylene Vinyl Alcohol- Micro therapeutics- Irvene USA). Baby was discharged on beta blocker and diuretics. 6 months follow up showed good weight gain, asymptom- atic status with normal cardiac size and no PAH. Residual small AVM was left unattended.
CASE 3: INTRAHEPATIC PORTOSYSTEMIC SHUNT TYPE 3 CAUSING PAH AND CARDIOMEGALY. One day old neo- nate presented with respiratory distress soon after birth. Evaluation revealed PAH and cardiomegaly not improving with medical and ventilatory management. Further evalua- tion showed intrahepatic shunt between left portal vein and left hepatic vein connected through an aneurysm(- Type 3 Park). In view of worsening clinical status and persistent PAH closure was done on day 15 of life. After securing right internal jugular vein access, left hepatic vein was hooked and the aneurysm connecting it with the portal vein was closed using multiple V Trek Microplex 18 coils (Terumo Corporation, Japan) and three 0.035 4-4 Embolization coils ( Cook Medical Indiana, USA). Post procedure general condition of the baby improved and discharged in a stable condition. 8 months follow up showed asymptomatic status with no evidence of PAH with normal cardiac size.
Conclusion: Variety of structural hepatic lesions ranges from tumour, AVM or postosystemic shunt can cause car- diopulmonary syndrome in neonates. High index of sus- picion and precise delineation is essential to formulate treatment plan. Such lesions can be treated with multidis- ciplinary approach using variety of embolisation agents.
166. STENTING IN NEAR-ATRETIC COARCTATION OF THE AORTA. ACUTE AND MEDIUM-TERM OUTCOMES IN A LARGE COHORT OF PATIENTS WITH COMPLEX AORTIC ANATOMY
Magaña KG, Guerrero C, García-Montes JA, Zabal-Cerdeira C, Molina-Sánchez T, Romero-Montalvo LA, Moreno-Salas JC, Sandoval JP.
Department of Intervention in Congenital Heart Disease, Ignacio Chavez National Institute of Cardiology, Mexico City.
Background: Endovascular repair has generally become the first-line therapy for most adolescents and adults with discrete coarctation of the aorta with excellent results. However, in situations where the obstruction is progressive and results in a visible lack of continuity at the isthmic level (so-called extreme or near-atretic coarc- tation), interventionists are faced with a challenging and technically demanding high-risk procedure with major potential complications including dissection, aortic rup- ture, massive bleeding and aneurysm formation.
Methods: Retrospective, single-center analysis including all patients who were diagnosed with near-atretic coarcta- tion who underwent percutaneous intervention between March 2004 and March 2019 at the Ignacio Chavez National Institute of Cardiology.
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205