Page 134 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
196
total, there were 152 reinterventions on these 74 stents. 75 were for somatic growth, 40 for intimal buildup, 19 for adjacent stenosis, and 5 for stent fracture. 12 of the stents were surgically removed at the time of required additional cardiac surgery.
Table 2 summarizes the sub-group of patients with a fol- low-up duration of ≥12 years (27 pts and 37 stents). Patients on average gained 38.7kg over 12.7yrs and minimum stented diameters increased from 3.4 to 11.3mm. Stented vessel gradient and RV/SBP remain low over this timeframe.
Conclusion: Stents can effectively relieve PA stenosis in infants and small children. Furthermore, serial stent expan- sion and additional stenting to accommodate somatic growth can be performed safely and effectively to maintain good hemodynamic and anatomic results from infancy to late adolescence and adulthood.
177. CATHETER STENT IMPLANTATION IN CLOSE PROXIMITY TO THE ORIFICES OF PULMONARY VEIN IN FONTAN PATIENT
Kenji Baba, Maiko Kondo, Yoshihiko Kurita, Takahiro Eitoku, Yuuki Imai, Yosuke Fukushima, Yusuke Shigemitsu, Kenta Hirai, Shin-ichi Ohtsuki
Okayama University Hospital, Department of Pediatric Cardiology, Okayama, Japan
Background: Pulmonary vein stenosis in Fontan patients is still a quite challenging disease. We present a patient with Fontan physiology who underwent catheter stent implan- tation in close proximity to the orifices of pulmonary veins.
Case: A five-years-old boy with hypoplastic left heart syn- drome underwent staged palliation for Fontan physiology. He underwent Norwood-Sano procedure on 7 days after birth, bidirectional Glenn at age of 5 months, surgical left pulmonary vein stenosis release at age of 8 months, and Fontan operation and re-operation for left pulmonary vein stenosis at age of 3 years and 9 months. As acute heart fail- ure occurred due to spontaneous fenestration closure on day 12 after Fontan operation, stent implantation (Express LD 7x17mm) for fenestration was performed. After fenes- tration stent deployment, his systemic oxygen saturation decreased to 60% despite receiving a FiO2 of 1.0 and nitric oxide, so the fenestration size adjustment using stent-in- stent and a detachable coil was required. The technique of fenestration size adjustment was that Express SD 5x19mm was deployed inside the previous Express LD 7x17mm and detachable coil (IMWCE-6.5 PDA3) was positioned as an anchor between Express SD 5x19mm stent and Express LD 7x17mm stent. After the fenestration size adjustment,
his systemic oxygen saturation increased to 78% receiving FiO2 0.5. Fourteen months later after Fontan operation, he suffered from left lower lobe pneumonia which was resistant to antibiotics therapy. After balloon angioplasty for left lower and upper pulmonary vein were performed, he recovered from pneumonia. One month later after balloon angioplasty for pulmonary vein stenosis, cathe- ter stent implantation for left lower pulmonary vein was planned. The orifice of left lower pulmonary vein was very close to that of the left upper pulmonary vein. After the left upper pulmonary vein flow was checked by transe- sophageal echocardiography under balloon inflation at left lower pulmonary vein, an Express SD, 6mm diameter and 18mm length stent was deployed at left lower pulmo- nary vein using 6French guiding catheter. After the stent deployment, the pressure gradient between left lower pul- monary vein and single atrium disappeared from 3 mmHg and the pressure gradient between left upper pulmonary vein and single atrium remained 2 mmHg without change. Ten months later after stent implantation for left lower pulmonary vein, the pressure gradient between left upper pulmonary vein and single atrium increased to 6 mmHg. An Express LD, 8mm diameter and 17mm length stent was deployed at left upper pulmonary vein using 6 French long sheath during balloon inflation at left lower pulmonary vein in order not to interfere the previous stent. After the procedure, the pressure gradient between left upper pul- monary vein and single atrium dropped to 2mmHg.
178. BIOABSORBABLE EVEROLIMUS-ELUTING STENT EXPERIENCE IN NEWBORNS AND INFANTS WITH CON- GENITAL HEART DISEASE – CLINICAL APPLICATION AND PHARMACOKINETICS
Kyong-Jin Lee, Atsuko Kato, Lee Benson, Winnie Seto, Rajiv Chaturvedi
Hospital for Sick Children, Toronto, Canada
Background: There remains a role for small diameter stents in the management of blood vessels associated with congenital heart disease. Shortcomings of current stents have been the limited future expansion capabilities and in-stent stenosis.
The ABSORB stent (Abbott Vascular, Santa Clara, CA) is a bioabsorbable (PDLLA) everolimus-eluting coronary stent which disappears over 2 years with potential to restore the regular functions of the blood vessel wall. Furthermore, even prior to complete disappearance, these stents may be amenable to circumferential unzipping and earlier intervention.
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205