Page 139 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
The idea of reporting the case is to show how the RV in cases of pulmonary atresia can be very stiff and non-com- pliant especially after suddenly decompressing it. The sud- den drop of pressure can force the RV to pass into standstill phase with the tricuspid valve leaflets in its closed systolic position. Given time the RV can gradually recover but will never be totally normal.
This is the first case in the literature to document this amaz- ing phenomenon.
183. VALVE SPARING STENTING OF THE RIGHT VENTRICULAR OUTFLOW TRACT IN FALLOTS: IS IT WORTH THE EFFORT?
Rizwan Rehman1, Chetan Mehta2, Vinay Bhole2, Milind Chaudhari2, Rami Dhillon2, John Stickley2, Oliver Stumper2 1Birmingham Womens and Children's Hospital, Birmingham, United Kingdom. 2Birmingham Womens and Childrens Hospital, Birmingham, United Kingdom
Introduction: Stenting of the right ventricular outflow tract (RVOT) is a safe and effective technique in the ini- tial palliation of selected patients with Fallot type lesions. Stenting of the RVOT increases pulsatile forward flow of systemic venous blood to the pulmonary arteries. This results in a greater rise in systemic oxygen saturations and promotes better pulmonary arterial growth compared to BT Shunt palliation.
Objective: We hypothesized that infants and neonates with a valve sparing RVOT stenting would alter surgical strategy and outcomes. Conceptually, not crossing the PV should have many advantages: potential for the pulmo- nary valve to grow, avoidance of free regurgitation and likelihood of later repair without trans-annular patch. Our objectives were to look for any true benefits of valve spar- ing RVOT stenting as per our hypothesis.
Methods: Retrospective, non-randomized, single centre review of patients with Tetralogy of Fallot and its variants, who underwent RVOT stenting followed by complete repair between 2010-2018. Pulmonary valve growth was assessed by serial echocardiography. We collected all data including surgical techniques.
Results: 64 patients were studied. Stents were placed crossing the valve in 29 patients (45%) and sparing the valve in 35 patients (54%). The median weight at the time of stent implantation in the valve sparing group was 3.76 kg with the smallest patient being 1.72 kg. There was a sig- nificant growth of the PV annulus (z score - 4.02 at the time of stent and - 2.95 at pre-surgical assessment in the valve
sparing group).[p < 0.01 ; two tailed t-test]. There were 2 procedure related deaths, 1 in each group.
Valve preserving Fallot repair was achieved in 4 cases (11%) of cases after valve sparing stent. There was no difference in the rate of trans-annular repair between the 2 groups. There was a lower need for conduit repair in the valve spar- ing stent group. (26 % vs 41%) [p < 0.03]
Conclusions: Initial palliation of Fallot with stenting the RVOT compares favourably to other forms of surgical pal- liation to augment pulmonary blood flow. Stenting the RVOT in Fallot lesions without crossing the pulmonary valve promotes growth of the PV annulus and thereby has potential for facilitating valve sparing corrective sur- gery at a later stage. This approach should be favoured in cases with hypoplastic pulmonary arteries, anomalous cor- onary arteries or those with associated cardiac lesions or syndromes.
184. ATRIAL SEPTAL STENTING- OUTCOMES FORM A SINGLE CENTRE.
Chetan Mehta1, Vinay Bhole2, Milind Chaudhari3, Rami Dhillon1, Oliver Stumper1
1Birmingham Womens and Childrens Hospital, Birmingham, United Kingdom. 2Birmingham Womens and Children's Hospital, Birmingham, United Kingdom. 3Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
Background: Atrial septal stenting provides a reliable access to Left Atrium for repeated pulmonary venous inter- ventions. An unrestricted atrial communication is essential in maintaining adequate physiology in palliation of uni- ventricular hearts.
Aim: To review our experience of Atrial Septal stenting and its outcomes.
Methods: Retrospective review of case records of all chil- dren, who had Atrial Septal stunting procedure.
Results: Over a period from 2008 to 2018, we found 22 patients who had an attempt at Atrial Septal stent- ing. Percutaneous Atrial Septal stenting was attempted in 20 patients and 2 had Hybrid intervention for Hypoplastic Left Heart syndrome (HLHS) with intact atrial septum. There were 3 patients with biventricular circulation and rest were single ventricular circulation with details in Table below.
Hijazi, Z
22nd Annual PICS/AICS Meeting