Page 20 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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Patient is an eleven year-old female, asymptomatic. Known heart murmur from birth, initially diagnosed as VSD. In the last year there was an increase in heart murmur intensity, pediatrician solicited an AngioCT that showed a large RCA fistula draining into RV cavity. Percutaneous treatment was indicated. Two strategies were programmed. Closure using a vascular plug or embolization with microcoils. Angiography showed a tortuous proximal right coronary fistula draining into RV, without significant stenosis, so the strategy with microcoils was aborted. Qp/Qs was 1,7/1,0. Approach was made with arterial and venous access with 6F sheaths. Catheterization of the fistula was achieved with JR 3.5 guiding catheter. A 0,014” x 300 cm floppy wire was used to cross the fistula and was positioned in the pulmo- nary trunk. Through the venous side, another JR 3.5 GC was positioned in pulmonary trunk and the floppy wire was snared and so the AV rail was made.
Then the venous guiding catheter was exchanged to a Cook® Flexor® Raabe® 6F sheath and through the 0,014” wire we sought to position it in the proximal part of the fistula, just next to a mild stenosis. The proximal diameter of the vessel was 7.2 mm and 3.8mm in the stenotic area. We chose an Amplatzer® Vascular Plug 2 of 8 mm and posi- tioned it through the venous 6F sheath, keeping the 0,014” wire in place, to improve support and to keep the AV rail in place in case the plug would not keep its position in the desired location.
After contrast injection through the arterial side to ensure the correct location of the plug, we removed the 0,014” very carefully and released the plug unscrewing the deliv- ery cable. Control injection showed a very stable plug posi- tion and a mild residual shunt. We kept the patient with aspirin, and she was discharged 48 hours after the proce- dure. An echocardiogram was performed pre-discharge and did not showed residual shunts. There was not any ischemic events, as the normal right coronary artery was irrigated through collaterals from the LAD.
Conclusion: closure of coronary fistula is feasible and easy to perform with vascular plugs, because they are flexible and emboligenic. New flexible sheaths are very safe and can cross tortuosities easily, making these procedures fast and predictable.
16. SEVERE CONDUIT CALCIFICATION PREVENTING PERCUTANEOUS PULMONARY VALVE IMPLANTATION SECONDARY TO CORONARY ARTERY COMPRESSION Elyssa Cohen1, Dennis VanLoozen 2,1, Zahid Amin2
1Medical College of Georgia at Augusta University, Augusta, USA. 2Division of Pediatric Cardiology, Children's Hospital of Georgia, Augusta, USA
Coronary artery compression is a serious complication that can occur in patients who are candidates for percutaneous pulmonary valve implantation (PPVI). Coronary artery com- pression most commonly occurs in PPVI patients whose coronary arteries are in close proximity to the conduit or in PPVI patients who have an anomalous course of their coronary arteries. Aortography and selective coronary angiography is performed in all cases to rule out potential compression of the coronary arteries before PPVI. The risk of coronary compression in cases of severe conduit calcifi- cation needs increased awareness, and our case is unique in that it emphasizes the potential for late coronary artery compression by peri-conduit calcification before PPVI. We describe a patient status post right ventricle – pulmonary artery (RV-PA) conduit placement with normal origin and course of the coronary arteries in whom a PPVI procedure was aborted due to severe peri-conduit calcification dis- placement during full balloon inflation. The mobility of the peri-conduit calcification enabled the calcification to impinge the left main coronary artery with angiography evidence of blunted blood flow, despite adequate dis- tance of the conduit from the coronary arteries. The goal of PPVI is to implant a valve of the maximum, and safest, diameter to ensure a maximum relief in RV to PA gradient. However, in this case, overextension of the initially placed conduit presented a risk of coronary artery compression. We emphasize that in order to evaluate for the potentially catastrophic complication of peri-conduit calcification mobility causing delayed coronary artery compression, it is critical to dilate the conduit to the diameter of the pro- posed valve diameter via balloon angioplasty with simul- taneous coronary angiography in order to assess coronary blood flow. It is essential for physicians to consider the amount of conduit calcification as a potential cause of delayed coronary artery compression and for clinicians to recognize the importance of evaluating the mobility of the calcification upon balloon angioplasty, in order to avoid the potential detrimental complications associated with coronary artery compression.
17. UTILIZATION OF MULTIFUNCTION OCCLUDER (MFO) FOR SUBARTERIAL VENTRICULAR SEPTAL DEFECT (VSD) : A SINGLE CENTRE CASE SERIES Anudya Kartika1,2, Mahrus Rahman2, Teddy Ontoseno2, Alit Utamayasa2
1Airlangga University, Surabaya, Indonesia. 2Soetomo General Hospital, Surabaya, Indonesia
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205