Page 21 - Journal of Structural Heart Disease Volume 5, Issue 4

83
Meeting Abstracts
Ventricular septal defects (VSD) remain the most common congenital heart defect at birth. Transcatheter closure has become the preferred strategy for isolated symptomatic defects, but it was formerly contraindicated to perform for this subtype of VSD. We hereby report percutaneously implanted MFO for 4 patients, aged 2 to 8 years at our cen- ter, without any device migration/embolization, shock, stroke, major morbidity, or mortality noted. The location of the subarterial VSD, with its close proximity to the aortic valve, often accounts for the possible subsequent devel- opment or even worsening of aortic regurgitation with this defect. Left-to-right shunting of blood through the defect is believed to pull aortic valve tissue progressively. Therefore surgical VSD closure has been the treatment of choice. The clinical judgement, approach, sizing, and care- ful implantation are important technical aspects to achieve feasible and successful procedures.
18. PRE-STAGE 2 VENTRICULAR END-DIASTOLIC PRESSURE IS ASSOCIATED WITH POOR OUTCOMES AFTER THE FONTAN OPERATION
Matthew Schwartz1,2, Aravinth Karunanandaa2, William Anderson3, J. Rene Herlong1,2, Joseph Paolillo1,4, Gonzalo Wallis1,2, Paul Kirshbom1,2, Thomas Maxey1,2
1Sanger Heart and Vascular Institute, Charlotte, USA. 2Levine Children's Hospital, Charlotte, USA. 3Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, USA. 4Levine Children's Hospital, Charlotte, United States Minor Outlying Islands
Introduction: Systemic ventricular end-diastolic pressure (SVEDP) is an important physiologic variable in patients with single ventricle congenital heart disease. Predictors of an elevated SVEDP prior to the Stage 2 operation have been incompletely identified.
Methods: All patients with single ventricle congenital heart disease who underwent the Stage 2 operation at our center between 1/07 and 3/17 were retrospectively identified. All had undergone pre-Stage 2 catheterization and relevant patient variables were extracted. For patients who had undergone Fontan operation at the time of this study, relevant post-Fontan patient variables were also extracted. Statistical analysis was performed to identify patient variables that were associated with pre-Stage 2 SVEDP and to identify the association between pre-Stage 2 SVEDP and outcomes after the Fontan operation.
Results: 100 patients were included with a mean weight of 6.4 kg ± 2.4 at the pre-Stage 2 catheterization. 71 (71%) patients had a systemic right ventricle (RV) and 55 (55%) had undergone a Norwood operation. At the pre-Stage 2
catheterization, the mean SVEDP was 8.7 mmHg ± 2.4. The mean SVEDP was higher amongst those with systemic RV compared to left ventricle (9.1 mmHg ± 2.1 vs. 7.7 ± 2.7 mmHg, p< 0.01). On univariate analysis, pre-Stage 2 SVEDP was positively associated with the presence of a systemic RV (p<0.01), history of recoarctation (p=0.03), history of Norwood operation (p=0.04), and ventricular systolic pres- sure (p<0.01).On multivariate analysis, SVEDP was positively associated with the presence of a systemic RV (p<0.01) and ventricular systolic pressure (p<0.01). Amongst those who had undergone Fontan operation at the time of study (n=49), the pre-Stage 2 SVEDP was associated with a com- posite post-Fontan outcome of death, transplantation, or listed for transplantation (p=0.02) and with the presence of heart failure symptoms (p=0.04) at a mean age of 5.2 yrs ± 1.3 at last follow-up. Of those with a pre-Stage 2 SVEDP < 9 mmHg who eventually underwent Fontan operation, none met the composite post-Fontan outcome of death, transplantation, or listed for transplant (negative predic- tive value of 100%, CI 87-100%).
Conclusions: In a cohort of patients with single ventricle heart disease undergoing Stage 2 operation, pre-Stage 2 SVEDP was higher in those with systemic RV compared to LV and was predictive of death or need for transplantation after Fontan operation. The volume-loaded, pre-Stage 2 state likely exposes diastolic dysfunction that may have important prognostic value.
19. DO WE FULLY UNDERSTAND AORTOPULMONARY COLLATERALS? A PICS INTERVENTIONALIST SURVEY Bassel Mohammad Nijres1, E. Oliver Aregullin1,2, Yasser Al- Khatib1,2, Bennett Samuel1, Joseph Vettukattil1,2
1Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, USA. 2Michigan State University College of Human Medicine, Grand Rapids, USA
Background: Aortopulmonary collaterals (APCs) fre- quently develop in patients with single ventricle physiol- ogy. The triggers for APC development and hemodynamic impact are not clearly understood. Consensus guidelines for timing and type of intervention are also lacking.
Study Design: A survey was emailed to the PICS mailing list between February and March 2019 to appreciate APC management.
Results: The responses of the 142 interventionalists are summarized in Table 1.
Hijazi, Z
22nd Annual PICS/AICS Meeting