Page 131 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
day 24 hourHolter revealed average PR interval of 0.166sec with maximum interval of 0.188sec and minimum interval of 0.146sec. Pt was discharged with 2 days of oral steroids along with Aspirin with an advice of more frequent ECG fol- low up. The ECG at 1 week and 2 week follow up revealed PR interval of 0.16 sec.
Conduction defects may be present in patients with ASDs at baseline, possibly due to hemodynamic changes and the proximity of the AV node in the triangle of Koch to the loca- tion of the defects. This risk of arrhythmias after percuta- neous device closure it is about 1–6%.The onset may be as early as during device deployment even before the device is released to as late as few days to weeks. One of the case reports illustrates late progression of first degree AVB to complete heart block four years after ASD device closure. The etiology of the conduction blocks after ASD device clo- sure has been attributed atleast partly to the inflammation and edema caused around the AV node by the atrial discs. This is one of the bases for the administration of steroids empirically in such cases.However there have been cases in which steroids have not helped and hence the recom- mendations on this issue are not quite clear. Risk factors for development of AVB include hemodynamically signif- icant defect with QP/QS ratio >2.8, larger defects, greater device/height ratio, larger devices, short distance between right atrial disk to tricuspid valve, deficient postero-inferior rim <5 mm, and weight <15 kg.
Transcatheter ASD device closure in small children may be associated with increased complications. Despite ade- quate postero-inferior margin Heart Block may still occur in small children. Heart block is a rare but worrying com- plication of ASD device closure, especially occurring in high-risk patients. Though in most of the cases it is a tran- sient phenomenon resolving either spontaneously or with anti-inflammatory therapy, in some of the case it requires surgical removal of the device and closure of ASD. There are no consensus for the management of first degree and second degree heart block.Decision should be taken case by case basis and close monitoring and surgical back-up are essential requirement for these patients.
173. BALLOON ATRIAL SEPTOSTOMY IS A NEGATIVE PREDICTIVE FACTOR FOR SURVIVAL IN PATIENTS WITH PULMONARY ATRESIA INTACT VENTRICULAR SEPTUM
Nicole Herrick1, Asimina Courelli1, Nicholas Dreger2, Jesse Lee2, Kanishka Ratnayaka2, Laith Alshawabkeh1, John Moore2, Howaida El-Said2
1UC San Diego, San Diego, USA. 2Rady Childrens Hospital San Diego, San Diego, USA
Introduction: Pulmonary atresia with intact ventricular septum (PA/IVS) compromises less than 1% of all con- genital heart disease. Management strategies for PA/IVS are evolving as the role of catheter based intervention is expanding.
Methods: Retrospective review of patients at a large aca- demic center with a diagnosis of PA/IVS from 1988 to 2018. Clinical records, procedural reports and angiograms were reviewed. Here we compare the interventions from the newborn to determine if there is a correlation with ulti- mate surgical anatomy and mortality.
Results: Ninety patients had a diagnosis of PA/IVS, 57.3% were male. RV dependent coronary sinusoids were pres- ent in 47.8%. Seventy-two percent (n=65) were managed surgically in the newborn period; of those 13.3% (n=12) had a preceding balloon atrial septostomy (BAS) and 5.6% (n=5) had a preceding radiofrequency perforation and pulmonary valvuloplasty. Eighty-three percent of patients managed surgically were eventually palliated to single ventricle physiology. Twenty-six percent (n=24) were man- aged exclusively via catheterization based intervention as a newborn; 18.9% (n=17) had primary PDA stenting (accompanied by RF perforation in 2.2%, pulmonary valvu- loplasty in 6.7%, or both in 10%), 5.6% (n=5) had isolated BAS, and 2.2% (n=2) had BAS and PDA stenting. Of those managed with primary PDA stenting, 77.8% (n=14) ulti- mately underwent a bi-ventricular repair. One patient had a transplant in the newborn period. After median 8.0 years follow up (Q1 2.0, Q3 17.25), mortality was 10% (n=9), two patients received a heart transplant. Median age at death was 4.5 months (Q1 0.77, Q3 6.63). Undergoing a BAS in the newborn period was predictive of early mortality (p=0.00, 95% CI 0.27-0.54), even after adjusting for the presence of RV coronary sinusoids. Patients with an isolated BAS had the highest mortality (80%), followed by those who under- went BAS and PDA stenting (50%), and BAS and surgical shunt (33%, chi-squared p=0.00). There was no significant difference in survival for patients with and without RV cor- onary sinusoids (p=0.47). There were no deaths to date in the 17 patients who underwent PDA stenting without BAS.
Conclusions: Patients with PA/IVS who require a BAS at birth, regardless of the presence of RV dependent coronary sinusoids, have a significantly higher mortality, especially in the newborn period. The need for BAS performed in the newborn period may reflect the severity of disease. Given the high mortality in this group, these patients may benefit from consideration for transplantation.
Hijazi, Z
22nd Annual PICS/AICS Meeting