Page 32 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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exertional dyspnea. She was not considered a candidate for surgical PVR due to multiple comorbidities including oxygen dependent obstructive lung disease, pulmonary hypertension, and chronic kidney disease. Her RVOT was too dilated for TPVR and she was referred for hybrid TPVR as described above. A 30mm PTS-X sizing balloon follow- ing PA banding revealed a waist measuring 25mmx24mm, and a 29mm SAPIEN S3 valve was implanted with no regur- gitation or stenosis by TEE following implant. She was extu- bated in the OR and discharged home on POD 5 without any complications or adverse events.
Conclusion: Hybrid TPVR with a SAPIEN S3 valve can be performed safely without pre-stenting following PA band- ing through a left anterior mini-intercostal incision, and can be considered as an alternative to surgical PVR in high risk patients.
32. FIRST CLINICAL IMPLANTATION OF MED-ZENITH PT-VALVETM IN RIGHT VENTRICULAR OUTFLOW TRACT.
Shu Chen, Xiaoke Shang, Changdong Zhang, Nianguo Dong
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
Background: Transcatheter pulmonary valve replacement (TPVR) is a new, less invasive alternative to surgical valve replacement. We report four successful implantations, first in man, using Med-Zenith PT Valve for patients with severe PR in native right ventricular out flow tract(RVOT).
Method: Patients with native RVOT and severe residual PR were selected on a case-by-case basis according to the ana- tomical features of the patient and design of the valve. Patient demographics and pre-procedural, intra-proce- dural, and follow-up data were reviewed.
Result: Four patients(all males) with severe PR (grade 4+) were enrolled in this study with mean age of 31.50±4.43 years. All patients had previous surgery for tetralogy of Fallot (TOF). 3 patients were symptomatic with New York Heart Association(NYHA) heart function III and the other one was NYHA II at baseline. The distal and proxi- mal landing zone in these four patients was 35.5/33.4mm, 23.6/33.4mm,28.3/33.5mm and 29.4/20.6mm, 4 devic- es(44mm/36mm/36mm/32mm) were used for these patients respectively. Successful valve implantation was achieved in all four patients. No device malposition, cor- onary obstruction, reduced flow to the PA branches, or paravalvular leak were noted during the procedures. Mean pulmonary artery diastolic pressure increased from 4.3±1.7mmHg to 13.5±3.1mm Hg (P<0.05). In one month’s
follow-up, Magnetic Resonance Imaging (MRI) revealed positive RV remodeling with RVEDV volume decreased from 160.8±8.5ml to 88.0±3.2ml after intervention (P<0.05) and the mean RVOT pressure gradient was 6.8± 1.3mmHg.
Conclusion: This first in man study demonstrates the ini- tial safety and feasibility of the Med-Zenith PT Valve in the treatment of severe PR.
33. LARGER DEVICES IN SMALL CHILDREN - IS THERE ANY ADVANTAGE? EXPERIENCE IN DEVICE CLOSURE OF ASD IN LESS THAN 2 YEARS OF AGE Kalyanasundaram Muthusamy
GKNM Hospital, Coimbatore, India
Herein we report successful device closure of large atrial septal defect (ASD) in 115 children with less than 2 years of age over the period of 9 years. The study population age ranged from 8 months to 24 months and the weight ranges from 5.7 to 13.7 kg. Symptomatic children with dilated right heart were taken as criteria for the device clo- sure. The device sizes used in our study group were from 10 mm to 24 mm. We had high rate of successful deploy- ment (98%). All patients who underwent successful device closure tolerated the procedure well without any major complications
Introduction: Device closure of ASD in younger children with larger defects is a challenging one in view of requir- ing larger sized sheaths and devices and thin pliable rims compare to older children. The size of the defect in young children less than 3 mm, 3 to 8 mm and more than 8 mm are categorized as small, moderate and large sized defects respectively. In our study group we included symptomatic younger children of less than 2 years of age and the ASD size of more than 8 mm for device closure. There were 41 chil- dren under 1 year of age. Largest size of 22 mm ASD device was deployed in 1 year old child with weight of 8.6 kg.
Result: Out of 118 younger children taken for the device closure of ASD, 4 children did not undergo the procedure due to failure to position the device. 115 patients had suc- cessful device closure
Discussion: We noticed some of the younger children with larger ASDs with adequate rims suitable for device initially progressed to much larger in size than initial size and also rims became inadequate for device closure during the follow up period. Hence we decided to take up younger children with larger ASDs for the device closure. Our ini- tial concern was the haemodynamic instability and vas- cular complications. But all of our patients tolerated the
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205