Page 130 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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One year later, repeat cardiac catheterization and partial PDA occlusion was performed.
Procedure: The PDA ampulla measuring 14.2 mm with a minimal diameter of 11.7 mm. The decision was made to use a 14 mm Amplatzer VSD device. It was fenestrated manually by sharp and blunt dissection of the fabric weave. The delivery sheath was positioned in the usual manner across the PDA and a 0.014” GrandSlam wire posi- tioned through the sheath into the descending aorta. The back-end of the GrandSlam was passed through the fen- estration prior to loading the device and advancing it into the sheath. The device was successfully deployed. We were initially unable to pass a 4mm x 15mm Resolute Onxy cor- onary stent across the previously made fenestration. The GrandSlam wire was therefore snared in the descending aorta and a 4-Fr long sheath was inserted into the femoral artery over the GrandSlam. The stent was advanced retro- grade and with using the two long sheaths to stabilize the VSD device, the stent was able to be pushed through the fenestration and deployed successfully. The most recent echocardiogram at approximately 6 months showed good device position and restrictive left to right flow across the stent with mild septal flattening.
Discussion and Conclusion: This represents to our knowl- edge the first reported use of a manually fenestrated, stented Amplatzer muscular VSD device in the ductal posi- tion. Given the intrinsic tendency of nitinol to reassume it’s nominal shape, we felt using a stent to mechanically displace the nitinol and leave a lasting fenestration to be a preferred over simply distracting the fabric weave. Until a fenestrated device is commercially available for implan- tation in the duct, a muscular VSD device serves as good substrate in some cases for deployment and fenestration with a coronary stent.
171. SHORT-TO-MIDTERM OUTCOMES OF SURGICAL VS HYBRID PULMONARY VALVE REPLACEMENT
Lamya Mubayed, Kim Ray, John Bokowski, Joshua Murphy
Rush University Medical Center, Chicago, USA
Introduction: Hybrid pulmonary valve placement (PVR) involving surgical plication of the main pulmonary artery followed by transcatheter PVR is an alternative to sur- gical PVR requiring cardiopulmonary bypass (CPB) for patients with a dilated right ventricular outflow tract (RVOT). Previously reported immediate outcomes of hybrid PVR suggested that the procedure is comparable to surgical PVR with the additional advantage of no cardio- pulmonary bypass (CBP) and lower transfusion rates.
Objective: We sought to examine the short to midterm outcomes of surgical vs hybrid pulmonary valve replace- ment at a tertiary care medical center.
Methods: Retrospective chart review of patients who underwent surgical or hybrid PVR at our center from June 2012 through June 2015.
Results: 8 patients (age 31.5±17.4yr) underwent hybrid PVR during the review period, vs .13 patients (31±18.4yr) with surgical PVR. Follow-up ranged from 1-45 months in the hybrid PVR group and 1-61 months in the surgical PVR group (p=0.11). Pulmonary regurgitation occurred in 33% of the surgical group vs 14% of the hybrid group (p=0.31). Max pressure gradient across the implanted valve was higher than the surgical group (mean 25.4 vs 10.0, p=0.04). Exercise intolerance was in the surgical group was 33% vs 14% in the hybrid group. New onset arrhythmia was seen in one patient in the in the surgical group vs none in the hybrid group (p= 0.34).
Conclusion: Hybrid PVR is a viable option for patients with RVOTs that are too large for standard percutaneous PVR. Despite being higher in the hybrid group, the peak pres- sure gradient across the implanted pulmonary valves was not elevated enough to require further intervention during this study period. Early to mid outcomes from this study are comparable to previously published studies comparing surgical vs standard PVR.
172. MANAGEMENT OF FIRST DEGREE HEART BLOCK AFTER PERCUTANEOUS ATRIAL SEPTAL DEFECT DEVICE CLOSURE-AN ENIGMA!
Sripadh Upadhya
Health City Cayman Islands, Grand Cayman, Cayman Islands
Percutaneous device closure of the Secundum Atrial sep- tal defect (ASD) is a proven therapy for the defect and Heart Block is one of the major, though rare complications especially with the larger devices and particularly with the Amplatzer Septal Occluder (ASO).
3 year old Girl weighing 14kg, diagnosis of 12mm secun- dum ASD, Left to Right shunt with adequate rims with a total septal length of 30mm,ECG revealed sinus rhythm with a PR interval of 0.16 sec. 14 mm ASO was implanted. The rhythm was sinus throughout the procedure with no change in the PR interval. After the device was released, the ECG showed prolonged PR interval of 0.20sec. The echocardiography was done which showed device insitu with no complications.Oral steroid was given as TID dose. Repeat ECG at 4pm showed PR prolongation (0.22sec). Next
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205