Page 34 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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the aortic isthmus with signs of fenestration and aneurysm formation is visualized in the aortic isthmus area.
Methods: The puncture of the right radial artery (Introducer 5F) and an open section of the left common femoral artery were performed. When aortography revealed aneurysm of the thoracic aorta located at the left subclavian artery out- let level with extension to the descending part of the tho- racic aorta. The Captivia delivery system of 22F in diameter was introduced through the femoral artery. The position- ing and opening of the Valiant stent graft 22x152 mm was performed with its subsequent dilatation by a Reliant latex balloon. In control aortography, the stent-graft is com- pletely adjacent to the aortic walls, there is no endoleak.
Results: The postoperative period was unremarkable. In echocardiography, the gradient on the aortic isthmus was 13 mmHg. The pulsation on the lower extremity arteries is distinct. Before discharge, a control CT scan was per- formed: the aneurysm is not detected; there are no signs of dissection. The left subclavian artery is passable however there is a narrowing of its entrance. Extravasal location of contrast was not found.
Conclusion: The rare clinical case about repair of post- traumatic aortic dissection type III with aneurysm devel- opment as a result of the road traffic accident using the Valiant stent graft is presented. This is the first case of such surgery performed in the 15 years old teenager.
36. COMPARISON OF ECHOCARDIOGRAPHIC AND ANGIOGRAPHIC MEASUREMENTS USED FOR GUIDING OCCLUSION OF THE DUCTUS ARTERIOSUS: FOCUS ON PRETERM INFANTS
Brian Boe1, Evan Zahn2, Darren Berman1, Aimee Armstrong1, Corey Stiver1, Ruchira Garg2
1Nationwide Children's Hospital, Columbus, USA. 2Cedars Sinai Medical Center, Los Angeles, USA
Background: Percutaneous occlusion of the patent duc- tus arteriosus (PDA) has historically been performed using angiographic measurements (aortography) as the pri- mary source for procedural guidance. With the advent of PDA closure in preterm infants and desire to avoid arterial access, there has been an increased reliance on transtho- racic echocardiographic (TTE) assessment of PDA in terms of patient selection and procedural guidance. TTE mea- surements of PDA have not been validated in this setting, i.e. directly compared to angiography.
Methods: The Amplatzer PiccoloTM Occluder clinical study provided for echocardiographic and angiographic
guidance during PDA closure allowing for direct compar- ison between the imaging modalities. Clinically relevant PDA measurements included ductal length, minimum diameter, and maximum diameter. All enrolled patients who had both an intra-procedural TTE and angiogram were included in this analysis. Patients were separated into cohorts based upon factors such as admission to the neo- natal intensive care unit (NICU). PDA measurements were compared between imaging modalities using paired t-test and Bland-Altman analysis for the entire patient popula- tion, and for individual cohorts.
Results: The study population consisted of 170 patients, divided into NICU cohort (n=117) and non-NICU cohort (n=53). At the time of PDA closure the NICU cohort had a median (range) age and weight of 5.6 weeks (1.3 - 25.6) and 1.4 kg (0.7 - 5.5), respectively. The non-NICU cohort had a median age and weight of 50.1 weeks (2.1 - 942.1) and 9.1 kg (2.3 - 68.5), respectively. In the NICU cohort, there was good agreement between echocardiographic and angio- graphic measurements of PDA minimal diameter (mean difference = -0.08 mm, p=0.09). There was less agreement between the two modalities for maximum diameter (mean difference = -0.50 mm, p<0.0001) and length (mean differ- ence = -1.36 mm, p<0.0001). This led to a 2.9% difference in the minimum PDA diameter measurements by TTE and angiography, while the mean TTE ductal length was 12.5% shorter compared to the angiographic measurement. In the non-NICU cohort, there was good agreement between the two modalities for measurements of PDA minimal diameter (mean difference = 0.12 mm, p=0.09) and length (mean difference = -0.78 mm, p=0.06), however, there was less agreement between the two modalities for the maxi- mum diameter (mean difference = -0.88, p=0.002).
Conclusions: On average, TTE measurements of PDA are similar to angiographic measurements but there are some important differences which may be clinically rele- vant. Notably, in NICU patients, there is good agreement for minimal PDA diameter. However, there is less agree- ment between the two modalities for ductal length. This may be increasingly important as percutaneous closure becomes more common place in preterm infants as it per- tains to both patient selection and procedural guidance. Understanding the relationship between these measure- ments will be useful in the planning and execution of per- cutaneous PDA occlusion, particularly in preterm infants.
37. EFFECT OF INTERVENTIONIST’S EXPERIENCE AND VARIATION OF PRACTICE ON LEVEL OF RADIATION EXPOSUREDURINGTRANSCATHETERATRIALSEPTAL DEFECT CLOSURE.
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205