Page 25 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
transcatheter assessment and valve deployment. We describe a rare complication and its management.
Case Description: A 9-year-old male with history of pul- monary atresia with ventricular septal defect (VSD) had VSD patch closure and right ventricular outflow tract reconstruction with transannular patch at 1-week of life. At 15-month of age, he underwent left pulmonary artery (LPA) stent placement. At 3 years of age, he required sur- gical pulmonary valve replacement using a 23mm Trifecta valve, partial removal of the LPA stent and patch aug- mentation of the LPA. Recent cardiac magnetic resonance revealed severely dilated right ventricle (RV) with moder- ately depressed RV systolic function (indexed RV end dia- stolic volume of 202 mL/m2). He was taken to the cardiac catheterization laboratory for possible transcatheter pul- monary valve replacement and balloon angioplasty of the LPA stent.
Intervention: Access was obtained via right femoral vein and artery. The distal LPA was accessed using an end-hole catheter and a 0.035” Lunderquist wire. Balloon angioplasty of the LPA stent was performed using a 12mm x 40mm Powerflex balloon. Following coronary compression test using a Z-MED II 22x4mm balloon, a 22mm Melody valve was prepped and loaded on the Ensemble system in the usual fashion, tracked over the Lunderquist wire and posi- tioned in the LPA. Due to difficulty in advancing the deliv- ery system, the valve was partially unsheathed to advance it. With this maneuver, the Melody valve was positioned inside the Trifecta valve, but the balloon slipped back with only the proximal half of the Melody valve still loaded on the BIB balloon. Moreover, part of the distal Melody valve stent strut was flared out presumably by being pushed against the “carrot”. The Melody valve was then completely unsheathed and the proximal end was deployed inside the Trifecta valve by inflating the inner and the outer balloons, giving the valve a conical configuration. While keeping the Lunderquist wire in place, the Ensemble system was care- fully exchanged for a 12x40mm Powerflex balloon across the Melody valve. This balloon was inflated to a maxi- mum pressure of 6 ATM resulting in partial expansion of the distal segment of the Melody valve. Subsequently, the Powerflex balloon was exchanged for a 22x40mm Atlas Gold balloon and inflated to 10 ATM pressure. Following complete inflation, the Melody valve was fully expanded. Angiographic assessment showed optimal valve position with good function and no paravalvular leak.
Conclusion: The presence of a branch pulmonary artery stent may hinder the smooth advancement of the Melody valve Ensemble system. Unsheathing the valve prior to
positioning in the intended position may carry the risk of dislodging it off the balloon; although challenging, the valve can still be deployed in a good position with the aid of several balloon combinations.
23. SAFETY AND FEASIBILITY OF DAY CASE PFO CLOSURE. COMPARISON BETWEEN OCCLUTECH AND AMPLATZER DEVICES USING TRANSTHOCACIC ECHOGRAPHY AND FLUOROSCOPIC GUIDANCE. François Godart, Jean Benoit Baudelet, Ali Houeijeh, Olivia Domanski, Anne Sophie Polge
Institut Coeur Poumon, Lille, France
The purpose of this work is to report one-year experience in day case transcatheter PFO closure using Figulla Flex II and PFO Amplatzer devices. A comparison study is also performed between 2 occluders.
From January to December 2018, 102 patients suffer- ing from a stroke underwent transcatheter PFO closure as day-case. Devices employed included: FigullaR Flex II (Occlutech, n=66), PFO AmplatzerTM (AGA, Saint Jude medi- cal) (n=36). Procedure was performed under local anesthe- sia with fluoroscopic and transthoracic echocardiographic (TTE) guidance. Implantation succeeded in all. The compli- cations included transient ST deviation in 10 patients due to air embolism with no permanent damage. In 2 cases, hospital discharge was delayed: one because femoral fis- tula requiring compression (day 5) and the other because of pericardial effusion requiring no drainage (day 2). At the one-month control, 5 patients complained of chest tight- ness, 8 reported palpitations, 5 had AF. Eighty-five patients had no shunt on contrast TTE, 16 had a persistent shunt, and 1 was lost on follow-up. At the 6-month control, 7 of these 16 patients had no residual shunt. In the compar- ative study, patients were older in-group Amplatzer but had a similar weight. No significant difference could be observed between the 2 groups concerning time of fluo- roscopy, dose of radiation, ST deviation, and persistence of shunt at one month (p = NS). No recurrence of stroke was noticed during follow-up (127±98 days).
To conclude, day-case procedure for percutaneous PFO occlusion is safe and effective. This approach is not more risky for the patients in terms of embolization. No signifi- cant difference could be observed between the Occlutech and Amplatzer PFO devices achieving both similar good results.
24. FUNCTIONAL TRICUSPID REGURGITATION AFTER
TRANSCATHETER DEFECT IN ADULTS
CLOSURE OF ATRIAL SEPTAL
Hijazi, Z
22nd Annual PICS/AICS Meeting