Page 128 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
190
mortality in children. At experienced centers, CDT may be considered as a first-line treatment for patients with acute massive PE. The precise dosage and duration of CDT needs further investigation.
168. NOVEL TECHNIQUE FOR SELECTIVE LYMPHATIC EMBOLIZATION USING AN ANTI-REFLUX SUREFIRE INFUSION CATHETER IN A PATIENT WITH A HISTORY OF HYPOPLASTIC LEFT HEART SYNDROME (HLHS) Sanjay Sinha1,2, Aarti Luhar1, Ashley Prosper1, Takegawa Yoshida1, Paul Finn1, Daniel Levi1, Edward Lee1
1UCLA, Los Angeles, USA. 2UC Irvine, Orange, USA
Objective: Demonstrate a novel technique in selective glue embolization of lymphatic vessels in a patient with congenital heart disease and a chylous leak after heart transplant using an anti-reflux catheter with a dynamic expandable tip.
Background: Lymphatic interventions have become life- saving in those with lymphatic flow disorders. There is a new found understanding that a working lymphatic system is essential in these patients, and selective embolization of target vessels is necessary. Reflux of embolic material during targeted interventions into the thoracic duct caus- ing paradoxical emboli and strokes has been described. This case demonstrates a novel use of a chemotherapeutic delivery catheter, utilizing its retractable anti-reflux “cone” to ensure entirely antegrade delivery of embolic material to sub-selective vessel targets.
Methods: This is a retrospective review of a single case wherein this delivery system was used for the first time to occlude a chylous leak. The patient first underwent a dynamic contrast enhanced lymphangiography (DCMRL) to map his lymphatics and a subsequent heart catheteriza- tion. The thoracic duct was accessed percutaneously from the left supraclavicular area and the Surefire Infusion sys- tem was directed into a branch of the thoracic duct found to be leaking into the pleural space. N-BCA glue was deliv- ered to this area with deployment of the anti-reflux cone. Demographics, procedure details, procedure related com- plications and follow up data were collected and shown.
Results: One patient with a history of HLHS orthotopic heart transplant (OHT) underwent successful treatment of a refractory chylothorax after his second transplant using this technique. Pre-intervention thoracic duct angiography showed no evidence of a cisterna chyli, and the presence of an abnormal network of abdominal lymphatics. Post inter- vention of there was no undesired reflux of glue embolic material. Given the volume of his leak, the decision was
168. Figure 1. Surefire Infusion catheter (A) with an ePTFE cone to prevent reflux of flow. Selective embolization of a vessel with chylous leak (green arrow) is seen with the catheter in place (yellow arrow), without evidence of reflux of n-BCA glue (yellow arrow with asterisks).
made to also conduct a thoracic duct embolization. His pre-procedural chest tube output was an average of 4.3 liters of chylous output per day. This was reduced to less than 600mls by 4 days after the procedure. His chest tubes were removed on post procedural day 12. Subsequent chest x-rays showed no significant re-accumulation of pleural fluid there-after. The patient did, however develop chylous ascites requiring intermittent paracentesis. This was felt to be due to complete thoracic duct embolization reversal of flow to an abdominal lymphatic tract.
Conclusion: Use of a selective anti-reflux catheter can allow direct delivery of embolic material to small branches of the thoracic duct to treat patient with pulmonary lym- phatic perfusion syndrome (PLPS). The catheter can be easily advanced over 0.018 inch wires via conventional per- cutaneous routes. It is essential to attempt selective vessel embolization and avoid complete thoracic duct embo- lization if possible, to avoid complications such as stasis or reversal of lymphatic flow seen in this case as chylous ascites.
169. THE PULMONARY ARTERY STENT (PAS) STUDY-A RETROSPECTIVE STUDY IN COLLABORATION WITH THE FDA AND INDUSTRY: A NEW PATHWAY TO PRE-MARKET APPROVAL FOR PEDIATRIC DEVICES Frank Ing1, Aimee Armstrong2, Jeff Delaney3, Howaida El- Said4, Bryan Goldstein5, Don Hagler6, Ralf Holzer7, Sok-Leng Kang8, Asra Khan9, Daisuki Kobayashi10, Andy Pelech1, Patrick Sullivan11, Andrea Wan8, Thomas Forbes10
1UC Davis Children's Hospital, Sacramento, USA. 2Nationwide Children's Hospital, Columbus, USA. 3University of Nebraska Children's Hospital, Omaha, USA. 4Rady Children's Hospital, San Diego, USA. 5Cincinnati Children's Hospital, Cincinnati, USA. 6Mayo Clinic, Rochester, USA. 7Weill Cornell Medical Center, New
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205