Page 26 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
88
Yvonne Bach 1,2, Lusine Abrahamyan 3,4, Jennifer Day 5, Eric Horlick6,7
1University Health Network, Toronto, Canada. 2University of Toronto , Toronto, Canada. 3University Health Network , Toronto
, Canada. 4University of Toronto, Toronto, Canada. 5University Health Network, Toronto , Canada. 6University Health Network , Toronto, Canada. 7University of Toronto , Toronto , Canada
Background: There remains a large proportion of patients who continue to have moderate to severe tricuspid regur- gitation (TR) after transcatheter atrial septal defect (ASD) closure. The baseline predictors and long-term outcomes of persistent TR are not well defined.
Objectives: This study aims to determine the clinical sig- nificance of functional TR in ASD patients and identify the baseline predictors of persistent TR after ASD closure to help define non-existent adult congenital heart disease guidelines.
Methods: 1509 patients who underwent transcatheter ASD closure from 1997-2016 were reviewed. Clinical and echocardiographic data were retrieved from electronic medical records at the University Health Network, Toronto. Primary (cardiovascular-related death and hospitalization due to heart failure) and secondary (stroke, new-onset atrial fibrillation, ASD re-intervention, and tricuspid valve surgery) long-term outcomes are currently being collected from Ontario health registries.
Results: A total of 804 patients met the inclusion criteria and had pre- and post-closure data. At baseline, 629 (78%) patients had mild/no TR and 175 (22%) patients had mod- erate to severe TR. 66 patients of the latter group (38%) did not have a reduction in TR grade at a median follow-up of four months, and were categorized as having persistent TR. Age ≥65 years (OR = 4.95, 95% CI 2.26-11.1) and right ven- tricular systolic pressure (RVSP) ≥45 mmHg (OR = 3.46, 95% CI 1.55-7.97) were independent predictors of persistent moderate to severe TR. Event-free survival and long-term analyses stratified by pre-procedural grade and post-pro- cedural grade will be available by the conference date.
Conclusions: In this single-centre study, isolated ASD clo- sure was insufficient in alleviating TR grade to at least mild in 38% of patients with pre-closure moderate to severe TR. If event-free survival is shown to be worse in patients with persistent TR, perhaps offering early device closure or surgical ASD closure and concomitant tricuspid valve annuloplasty/replacement may be of benefit to high-risk patients (i.e., patients older than 65 years old with a RVSP greater than 45 mmHg).
25. DILATATION WITH LARGE BALLOONS OF A MELODY VALVE IN MITRAL POSITION IN A 14KG CHILD WITH TRANS-APICAL ACCESS.
Marinos Kantzis, Suhair Shebani, Sanfui Yong, Saeed Imran EMCHC Glenfield Hospital , Leicester, United Kingdom
Background: The use of the stented bovine jugular vein graft (MelodyTM valve) in the mitral position in children is an off-label treatment option for valve replacement. It is useful as not only it can be implanted in very small annuli but also it may limit pannus formation. Additionally only antiplatelet treatment is sufficient postoperatively, com- pared to anticoagulation for mechanical valves.
Case Report: We describe a case of MelodyTM valve implan- tation in the mitral position in a three year old girl with Shone’s complex who underwent two unsuccessful mitral valve repairs followed by two mechanical valve replace- ments. Both mechanical valves prosthesis were 19 mm Saint Jude®, placed supra-annular. Within 3 months of each valve placement she presented with signs of valve obstruc- tion. Removal of both mechanical valves revealed pannus formation and secondary thrombus formation, which was impinging the valve mechanism with restricted leaflet motion.
It was felt that further mechanical valve replacement would lead to the same problem. An 18 mm MelodyTM valve was implanted surgically as per the technique described by the Boston Group (Shortening and trimming of the valve, creating a wide V shape opening to the outflow). The MelodyTM valve was then directly balloon expanded up to 18 mm. The heart resumed activity in complete heart block needing pacing. Later a permanent pacemaker was implanted. The immediate post-operative Echo showed valve length 23 mm with circumferential inner diameter 16mm. The mean estimated inflow gradient through the MelodyTM valve was 4 mmHg with no regurgitation or leak. The peak velocity in the left ventricle outflow tract was 1.6 m/sec. During the follow up two paravalvular leaks were documented. Five months after implantation of the valve the child presented with symptoms and signs of right heart failure Echocardiography showed severe leak around the valve and catheter documented pulmonary artery hyper- tension and elevated left atrial pressure. Due to the small size of the patient and the need for large balloons to dilate the valve, a hybrid approach with trans-apical access was felt to be the best option for balloon dilatation. Valve was gradually dilated up to 24mm with low pressure balloons and paravalvular leak was totally eliminated. Right heart failure signs were reversed, and the patient was discharged after a week in good condition.
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205