Page 132 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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174. TRANSCATHETER CLOSURE OF CONGENITAL CORONARY ARTERY FISTULA WITH VASCULAR PLUG: INTERMEDIATE OUTCOME AND FOLLOW-UP ANGIOG- RAPHY IN SINGLE CENTER EXPERIENCE
Jakyoung Yoon, Seongho Kim, Soick Jang, Sujin Park, Eunyoung Choi, Jiseok Bang, Jungyun Kim
Sejong general hospital, Bucheon, Korea, Republic of
Background: Congenital coronary artery fistula (CAF) is a rare congenital anomalous connection between the coronary arteries and a cardiac chamber or great vessel. Transcatheter closure of symptomatic CAF has become an alternative to surgical closure but limited data are available in the pediatric population. This study sought to assess clinical and angiographic outcomes in a series of 8 children who underwent successful transcatheter closure of CAF
Method: We retrospectively reviewed medical records of all patients with CAF who underwent transcatheter closure between 2006 and 2019 in infant and children in single heart center. Patients with other complex cardiac lesions and those requiring surgery were excluded.
Results: Eight children (6 girls), with median age 1.77 of years [0.18-8.5] and weighing 10.7 of kg [5.17-24.8] with CAF underwent 9 transcatheter closure procedures with- out significant complication. Coronary artery fistula arose from the right (n=7) and left (n=2) coronary artery and single coronary artery (n=1). Drainage sight was to the superior vena cave or right atrium or right ventricle, left ventricle. The mean Qp/Qs was 1.54±0.28 and all patients showed dilatated left ventricle chamber. Transcatheter closure of the fistula was carried out using an Amplatzer vascular plug II (AVP II) in 7patients and 1 patient who failed coil embolization 7 years prior using the retrograde approach rather than anterograde. Anterograde approach was performed in 2 patients and retrograde approach was performed in 6 patients. Successful closure occurred imme- diately in all patients with no residual flow 6 (75%) and with trivial flow in 2 (25%). A follow-up angiogram was obtained in 7 patients with median time from closure of 1.18 years. Five patients (71%) had prominent regression of proximal dilated coronary artery before fistula. Anti-platelet agent was maintained in 4 and anti-coagulant agent in 3. One patient was taking antiplatelet and anticoagulant agent before follow-up angiography. All patients were alive and doing well with normal resting ECGs and normal both ven- tricular function on echocardiography with no significant complication after a median follow up of 3.32 years.
Conclusion: Transcatheter closure appears to be safe and effective treatment for congenital coronary artery fistula in
pediatric population. AVP II is considered the good treat- ment of option, especially in isolated large CAF in children.
175. PULMONARY VALVE SPARING REPAIR OF TETRALOGY OF FALLOT USING INTRAOPERATIVE BALLOON VALVULOPLASTY: EXPERIENCE IN A SINGLE CARDIAC INSTITUTE
Su-Jin Park, Seong-Ho Kim, So-ick Jang, kyoung Yoon, Eun- Young Choi, Ji-Seok Bang, Chang Ha Lee
Sejong Hospital, Bucheon, Korea, Republic of
Balloon pulmonary valvuloplsaty has been the treatment of choice in patients with pulmonary valve (PV) stenosis. During the inflation of the balloon, valve dilation occurs in a static position, and the transmission of the radial force causes splitting of the fused or incomplete leaflet com- missures along with dilation and stretching of the valve annulus. In Tetralogy of Fallot (ToF) patients, right ventricu- lar outflow tract (RVOT) transannular patch technique still remains the most frequent approach, followed by a trans- atrial approach. However, whenever the use of TAP is nec- essary, progressive PV regurgitation will develop, leading to right ventricular dilation and dysfunction, and eventu- ally leading to impaired functional capacity. To minimize these detrimental prognosis, surgeons have developed dif- ferent techniques to preserve the PV during the initial total correction stage. Since the year of 2013, our cardiac team has adapted the technique to use an intra-operative PV balloon dilatation (IBPV) during TA TOF repair in selected group of patients with milder forms of pulmonary stenosis (PS), consisting of PV annulus Z score between -2~-4. The purpose of this study was to evaluate the short and mid- term results of these patients, treated in a single cardiac institute.
Result: From January of 2013 to April of 2019, total of 12 patients underwent IBPV (Male:Female=6:6). The median age was 4.5 months (2 months to 10months), the median weight was 6.2 kg (5.0 to 9.6 kg), the median PV annulus size was 6.4mm (5.0 to 9.2mm), median z value of PV was -2.7 (-2.0 to -3.9), and the size of balloon used was 6 to 10mm. Echocardiographic data showed mild pulmonary regur- gitation in all 12 patients and moderate PS in 3 patients, and mild PS in 8 patients. One patient underwent percuta- neous pulmonary valvuloplasty and there was 1 mortality unrelated to the procedure (adrenal insufficiency).
Conclusion: The use of balloon angioplasty during TA TOF repair in selected group of patients is a feasible option of treatment. However, meticulous repair of the valve mor- phology after ballooning by the surgeon is mandatory and the selection of the appropriate balloon size is the key to
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205