Page 33 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
procedure well and there were no complications. All the children were followed over the period of 4 years and beyond that if any complication noticed by the parents or family physician.
Conclusion: Device closure of larger ASDs in younger chil- dren are feasible, safe and can avoid surgery in the later stage since some of the larger ASDs became unsuitable for the device closure during follow up period.
34. ENDOVASCULAR TREATMENT OF HYPOPLASTIC GOTHIC AORTIC ARCH IN COMBINATION WITH CONGENITAL ABSENCE OF THE LEFT COMMON CAROTID ARTERY
Manolis Pursanov, Mikhail Abramyan, Yurii Shamrin, Aleksei Bedin, Davronbek Pardaev, Ekaterina Kabanova, Elena Petryaykina
Morozov Children's City Clinical Hospital, Russian Federation, Moscow, Russian Federation
Background: A rare clinical case of endovascular treatment of a hypoplastic Gothic aortic arch (AA) with congenital absence of the left common carotid artery (CCA) in com- bination with ventricular septal defect (VSD) is presented. At the age of 1 year and 1.5 months, transcatheter VSD clo- sure was done using a 8mm Amplatzer Perimembranous Ventricular septal occluder along with balloon dilatation of the AA and the aortic isthmus (AI).
Methods: Retrograde catheterization of the aorta through the left femoral artery with installation of a 9Fr introducer sheath. Through the right internal jugular vein a 5Fr intro- ducer sheath was introduced and an intracardiac elec- trode placed in the right ventricle for pacing. An exchange length, Amplatz super stiff guidewire (Boston Scientific- City, State) was placed in the aortic root. Over this guide- wire 9Fr Mullins sheath (Cook) was advanced to the AA. Then, a Z-med balloon dilatation catheter (NuMED, Inc., Hopkinton, NY) 12x40 mm and was advanced and placed at the aortic hypoplasia zone. Under right ventricular pac- ing at 200 beats/minute, balloon dilatation was performed in order to determine the localization of its “waist” and to predict stent deployment. At a pressure of 7 atm. the “waist” in the inflated balloon disappeared, and its walls were firmly attached to the walls of the aorta. Subsequently AA stenting was performed. A 36 mm long stent “Intrastent LD Mega” (Bard, city, State) was manually mounted on the same balloon catheter Z-med (12x40 mm). Then, the entire assembly (balloon with the stent mounted on it) was advanced to the area of stenosis. The correct stent posi- tion in the AA obstruction area was monitored by contrast injection via side port of the sheath. When the proper stent
position was confirmed, the balloon was manually inflated during rapid right ventricular pacing at 200 beats/min- ute. At a pressure of 10 atm. complete deployment of the stent was achieved with normalization of the AA geome- try. Repeat aortogram showed good result, the stent was fully opened in the AA, with no signs of complications (ves- sel wall injury). Repeat pressure gradient revealed pres- ence of only 6 mmHg across the area.
Results: The postoperative period was uneventful. A day after the surgery, the arterial pulse in the lower extremi- ties was distinct, the difference in systolic blood pres- sure between the right hand and leg did not exceed 10 mmHg. Doppler ultrasound after stenting showed resto- ration of normal blood flow in the abdominal aorta, the SPG across the stent was of 20 mmHg.
Conclusion: We present the first case of successful staged endovascular treatment of complex congenital heart dis- ease – AA anomaly in combination with the absence of the left CCA and VSD. In a number of complex AA anomalies, such as the Gothic arch, stenting is still possible.
35. THE POSTTRAUMATIC DEBAKEY TYPE III AORTIC DISSECTION WITH THE ANEURYSM ISTHMUS DEVEL- OPMENT: THE FIRST CASE OF SUCCESSFUL ENDO- VASCULAR TREATMENT USING THE STENT GRAFT IN TEENAGER.
Manolis Pursanov1, Mikhail Abramyan1,2, Narek Zakaryan3, Aleksei Bedin1, Yurii Shamrin1, Davron Pardaev1, Ekaterina Kabanova1, Sofya Purkina1, Elena Petryaykina1
1State Budgetary Healthcare Institution of Moscow "Morozov Children's City Clinical Hospital of Health Department of Moscow", Moscow, Russian Federation. 2Peoples Friendship University of Russia, Moscow, Russian Federation. 3Volynskaya Clinical Hospital, Moscow, Russian Federation
Background: to present the immediate results of a rare clinical case of successful endovascular treatment of acute post-traumatic aortic dissection type III according to DeBakey with development of false aneurysm in the aortic isthmus using Valiant stent graft (Medtronic) in the 15-year-old teenager.
The girl of 15 years old was knocked down by a car. Primary care was provided in the regional children's hospital where the child was taken in serious condition due to multiple fractures and injuries of internal organs and the brain. In a CT scan, the rupture of the thoracic aorta was suspected. The patient was transferred to our clinics on the 10th day after the accident. In repeated CT, pathological dilation of
Hijazi, Z
22nd Annual PICS/AICS Meeting