Page 37 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
with Lifetech (Heart R/CeraTM) ASD occluder in a large cohort of patients including children and adults.
Methods: This was a retrospective review of patients who underwent ASD closure using Lifetech CeraTM/Heart R sep- tal occluder between 2007 to March 2019 from a northern Indian cardiac referral center. There were total 302 patients of which 109 (36%) were males and 193 (64%) were females. The median age was 24 years (range 1 - 74 years). Success rate was 100%. The mean device to defect ratio was 1.2 (range 1 to 1.4). There were 18 patients with 2 atrial septal defects and 1 patient with 3 atrial septal defect, of which 10 patients had closure using single device and 8 patients required implantation of 2 separate devices. One patient had 3 defects and complete closure was achieved using 2 device. Immediate closure was obtained in all patients. There were 2 patient with incidence of advanced heart block, one with preexisting bigeminy and other with long Qtc syndrome and after device placement underwent Permanent pacemaker insertion (DDDD), 1 patient had device embolization in immediate post procedure period at day 1 of procedure. 1 patient had anaphylactic reaction at day 2, had ARDS and had to be ventilated for 13days. 1 patient had additional procedure of Balloon pulmonary valvotomy and 10 patients needed elective/post proce- dure DC cardioversion. Five patients were managed medi- cally for Atrial flutter.
Results: Follow-up data is available for 276 patients (91.3%). Follow up period is from 03 months to 120 months (median 56 months). On follow up, device was in position in all patients, 02 had residual shunt, one additional tiny defect that persisted after 1 year of follow up and other closed off after 3 months of follow up and no evidence of thrombosis. Interventricular septal motion normalized on day of procedure in 79% patients, in 16% over 3 months while flat septal motion persisted in 5% (n=14, all in age group > 35 years) of cases. Symptom-free survival was 92% (254/276) in patients who came for follow up. 5 of 10 patients were in atrial fibrillation (AF) before the procedure and remained in AF on follow up.
Conclusions: Our study showed that percutaneous clo- sure of fossa ovalis ASD with Lifetech (Heart R/CeraTM) ASD occluder is a safe and effective procedure on intermediate and long-term follow up in both the children as well as adults. Technical factors during the procedure and proper follow up are important. Our single center intermediate and long term experience in a large number of patients support the use of device closure as an alternative to surgery
41. TRANSCATHETER RETRIEVAL OF THE AMPLATZER VASCULAR PLUG II USED FOR CLOSING PATENT DUC- TUS ARTERIOSUS: WHAT IS THE TURNING POINT TO DECIDE THE RETRIEVAL OF THE DEVICE
Naomi Nakagawa, Masahiro Kamada, Yukiko Ishiguchi, Yuji Moritoh, Kengo Okamoto, Noriko Kawata, Tomoya Tsuchihashi
Hiroshima City Hospital, Hiroshima, Japan
Introduction: Use of Amplatzer vascular plug II (AVPII) is feasible for closing certain types of patent ductus arterio- sus (PDA). Although flexibility and low profile on account of a thin wire and lack of polyester fabric are benefits of AVPII, it is associated with a higher possibility of instability and migration than Amplatzer duct occluder I (ADOI).
Case 1: A 7-day-old boy weighing 2.6 kg with critical pul- monary stenosis was transferred after an unsuccessful per- cutaneous transcatheter pulmonary valvuloplasty (PTPV). Systemic circulation had collapsed due to excessive pul- monary flow from a huge PDA. We performed PTPV, PDA closure was also attempted at the same time with an 8-mm, 10-mm, and 12-mm AVPII, respectively. The 12-mm of AVPII caused left pulmonary artery (PA) obstruction, and the 10- mm AVPII caused right PA obstruction; how- ever, a repeated angiography revealed that the PDA size was reduced owing to several attempts to close it and the 8-mm AVPII was successfully deployed without obstruct- ing the right or left PA. A wiggle verified its stability and it was then detached. Although his blood pressure and sys- temic circulation had stabilized following the PDA closure, his blood pressure suddenly dropped after ten 10 minutes. Fluoroscopy confirmed the dislocation of AVPII into the left PA with the screw located distally. A Berman balloon catheter was used to reverse the direction of the device and the screw was captured by with a 10-mm Goose Neck snare after multiple attempts, and withdrawn into a 5-Fr long sheath.
Case 2: A 12-month-old boy weighing 9.7 kg with tubular PDA (6.6 mm of minimal diameter) was referred. The reten- tion disk of a 10-mm ADOI was too large for his descend- ing aorta. A 12-mm AVPII was deployed because a 10-mm AVPII slipped into the aorta. Although a wiggle verified its stability, the position and the shape of the body changed gradually after detachment. It appeared to be “squeezed out of the PDA.” We decided to retrieve the 12-mm AVPII. The screw was immediately captured with a 10-mm Goose Neck snare through the original 5-Fr sheath to prevent embolization. Another Goose Neck snare was inserted through the 8-Fr long sheath into the contralateral femo- ral artery. The AVPII was released and recaptured through
Hijazi, Z
22nd Annual PICS/AICS Meeting