Page 17 - Journal of Structural Heart Disease Volume 5, Issue 4

79
Meeting Abstracts
and their z-scores were calculated before the procedure. Furthermore; area of left and right ventricle at end of dias- tole (LVa, RVa); left atrial end diastolic diameter (LADD), right atrial end diastolic diameter (RADD), area of left and right atria (LAa, RAa) were recorded. All echocardiographic measurements were repeated 1st and 6th months after the procedure.
Results: Twenty symptomatic patients with hemody- namically significant VSD were included in the study. Thirteen of these 20 patients were girls, patients aged between 2-171 months (median: 27months). Twenty- six patients (16 females, 10 male) were included as con- trol group. Age of the control group was between 3-187 months (median: 46 months). Echocardiographic evalu- ation before the procedure were shown in Table 1. LVTEI (median=0,42 vs. 0,40 p=0,031), RVTEI (median=0,39 vs. 0,36 p>0,05) VCI-EI (median:17,65 vs. 14,34 p>0,05) were found significantly high in the patient group. Types of VSD in the patient group were 12 perimembranous, 8 muscular type. Pulmonary hypertension was detected in 14 patients in the catheter lab. There was no statistically significance in echocardiographic values of pulmonary hypertensive patients when compared to the ones without pulmonary hypertension. In the 1st month control after percutaneous VSD closure LVTEI, TAPSE and MAPSE z-scores, also LVDD/ RVDD ratio significantly decreased (Table 2). LVTEI, RVTEI, TAPSE MAPSE z-scores were decreased linearly in the 6th month control.
Conclusion: Volume overload caused by VSD; had an inap- propriate negative effects on left ventricle function at first but also on right ventricle by time. Percutaneous VSD clo- sure is one of the safe and effective treatment model. In this study it was shown that percutaneous VSD closure had a positive effect on echocardiographic dynamics of the children
11. LONG SEGMENT COARCTATION WITH LARGE PDA AND SEVERE PHT IN A 16 KG: PLANNING AND APPROACH TO HYBRID STENTING
Supratim Sen1, Sneha Jain1, Priya Pradhan1, Dipesh Trivedi1, Bharat Dalvi1,2
1NH SRCC Children's Hospital, Mumbai, India. 2Glenmark Cardiac Centre, Mumbai, India
History and Physical: A 7 1⁄2 year old girl presented with breathlessness on exertion. Her weight was 16.2 kg. BP was 112/67 mm Hg in the upper limb and 94/63 mm Hg in the lower limb. On auscultation, she had a loud P2, ejection systolic murmur and early diastolic murmur. There was no
mid-diastolic murmur. She had undergone a balloon aor- tic valvotomy for severe aortic stenosis 6 years ago.
Imaging: Echocardiogram revealed bicuspid aortic valve, moderate aortic regurgitation (AR), large PDA, moderate long-segment coarctation with severe pulmonary hyper- tension (PHT). AR and right femoral artery thrombosis were sequelae of balloon aortic valvotomy in infancy. The anatomywasdelineatedoncineangiographyandCTangi- ography. Diagnostic cardiac catheterisation demonstrated significant coarctation and confirmed PHT reversibility after balloon occlusion of PDA and IV Sildenafil.
Indication for Intervention: Stenting is the preferred treat- ment for aortic coarctation in adolescents and adults. In younger children with coarctation, stents which can be post-dilated to adult size gradually are a good alternative to surgery. As our patient had significant coarctation and a large PDA causing severe pulmonary hypertension, a cov- ered stent would optimally address both the coarctation and PDA.
Intervention: The large calibre arterial access required was of concern. Hence, a hybrid intervention was planned. The surgeon exposed the common iliac artery by cutdown, allowing direct introduction of the 12F Cook Check-Flo sheath. A 16 mm X 3.9 cm Numed covered mounted CP stent was implanted over a BiB balloon with rapid RV pac- ing under angiographic guidance. Post-stent aortogram showed endoleak and filling of the PDA around the distal stent. Hence post-dilatation of the stent was done using a 18mm x 4 cm Andra balloon to splay the distal end to com- pletely occlude the PDA.Post-procedure, there was good flow across the stent with no residual PDA and no pressure gradient. On follow-up, pulmonary arterial pressures were normal.
Learning Points of the Procedure: Aortic coarctation with large PDA with severe PHT is a difficult combination where PHT reversibility needs to be confirmed followed by a well-planned treatment strategy. A covered stent in this setting is viable and effective. The limiting factor in young patients is the large calibre femoral artery sheath required, especially with covered stents.
Our hybrid approach allows safe arterial vascular access in smaller patients, enabling coarctation stenting for a younger subset of patients. In our case, meticulous plan- ning and teamwork ensured procedural success.
12. IMPROVING LUNG PATHOLOGY BY TACKLING SHUNT LESIONS: MODERATE PM VSD CLOSURE IN
Hijazi, Z
22nd Annual PICS/AICS Meeting