Page 27 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
Conclusion: In selected patients MelodyTM valve should be considered as a treatment option for mitral valve dis- ease in children especially where all other techniques have failed. This technique as described by the Boston Group can be safely performed. Re-adjustment of the valve size to the size of the mitral annulus is mandatory especially when paravalvular leaks are present and transapical access can be helpful to accommodate large balloons for the valve dil- atation. This use of the MelodyTM valve, is however off-label without long-term follow-up data, and so close follow-up of the patient is needed.
26. BALLOON ANGIOPLASTY OF BIDIRECTIONAL GLENN ANASTOMOSIS.
Amr Matoq1, Wolfgang Radtke2
1Alfred I. DuPont Hospital for children , Wilmington, USA. 2Alfred I. DuPont Hospital for Children, Wilmington, USA
Background: The second stage of single ventricle palli- ation consists of superior cavo-pulmonary anastomosis (SCPA). Two ways to achieve that is Bidirectional Glenn (BDG), or Hemi-Fontan (HF). Stenosis of SCPA can lead to impaired pulmonary blood flow and subsequently hypox- emia. It would also favor right to left shunt via azygous vein if it was not routinely ligated during the SCPA surgery. Balloon dilation of SCPA has been rarely reported among other transcatheter interventions in single ventricle staged palliation. The efficacy and clinical outcomes of this proce- dure has not been previously reported.
Objective: We aim to assess the safety, efficacy and clinical outcomes of transcatheter balloon dilation of SCPA.
Methods: Retrospective chart review of patients with 2nd stage single ventricle palliation surgery who under- went cardiac catheterization and angioplasty of SCPA (Hemi-Fontan (HF) and/or Bidirectional Glenn (BDG)). We reviewed the following 1) patient’s demographics, 2) car- diac diagnosis, 3) SCPA surgical details and post-operative course, 4) Cath hemodynamics, procedural technique, and angiography of each cardiac catheterization, and 4) Follow up cardiac catheterization following SPCA angioplasty.
Results: Between 2008 and 2017, Only 7 patient had sig- nificant narrowing of SCPA, and underwent balloon angio- plasty. All SCPA stenosis that required balloon angioplasty were BDG. Age at BDG surgery was 3.5 – 11 months, and weight was 5.5 – 8.4 kg. Indications for cardiac catheter- izations included persistent pleural effusion, hypoxemia, echocardiographic evidence of BDG stenosis or routine pre-Fontan cardiac catheterization. Stenotic BDG was left sided in 4 and right sided in 3 patients. BDG angioplasty
was done at 6 weeks to 23 months from BDG surgery with patient weight ranging between 7.7 and 13.7 kg. Procedure was successful in all cases with increase in the stenotic diameter from mean of 2.9mm (range; 1.2mm -4.7mm) to mean 4.9mm (range; 2.6mm -7.8mm). All cases had at least 1 follow up cardiac catheterization. Only one case of recurrent stenosis requiring re-angioplasty at 2.3 month follow up with no further recurrence. Sustained results were noted in all other cases up to 29 months of follow up cardiac catheterization. There were increase in average Qp:Qs from 0.5 to 0.6 (before Fontan completion). No adverse events encountered with the angioplasty.
Conclusion: Balloon angioplasty of BDG stenosis is feasi- ble and provide sustained results with rare recurrence of stenosis. Such procedure improves pulmonary blood flow, and help minimizing run off via azygos/hemi-azygos vein and/or veno-venous collaterals.
27. ATHEROSCLEROSIS
Purusharth Kumar Sharma, Ruhs, Jaipur, India
Object: Atherosclerosis is a disease state of heart which act as the base of other disease of heart . so my research work is to dissolve this plaque more effi- ciently with less side effect and more effectively .
Method: This plaque is majorly formed by cholesterol (LDL) so to dissolve this first we need to decrease the for- mation this LDL so there is composition of chemical which lead to decrease or stop the formation of LDL in liver after the mevolanate formation as we all know mevalonate is important for us. All receptor will accept this composi- tion first it decrease the formation of vldl and then it start removing the plaque which is already present in the artery wall . It can be given to a patient also who are at the border of having atherosclerosis. also given to a patient who are having sedentary life style.
Observation: The plaque is dissolved with very less side effect like urine colour will change into yellow if given then prescribed dose constipation can occur. Dizziness may occur if dose interval is not maintain.
Cannot given to a patient suffering from asthma and liver cirrhosis
Result: If given in prescribed amount then it will reduce plaque as it is a good lipid lowering agent as it is better than beta blocker and calcium channel blocker and increase synthesis of HDL .
Hijazi, Z
22nd Annual PICS/AICS Meeting