Page 38 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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the 8- Fr sheath. As the screw was hooked at the tip of the sheath, the tip of the sheath was beveled to facilitate screw. The AVPII was retrieved into the sheath at last.
Discussion: As reported, obtaining a better position of the screw using other catheters or wires, switching to the larger sheath, and beveling the tip of the sheath are important tips for retrieval of the device. Moreover, a care- ful observation of the position and form of the AVPII is essential even after its successful deployment, especially in infants because their PDAs have large extensibility and can expand easily. Its retrieval before the embolization is recommended even if the sign of the deformity and/or dis- placement is not evident.
42. STENT IMPLANTATION FOR AORTIC COARTATION IN CHILDREN LESS THAN 6 YEARS OF AGE: INITIAL AND 10 YEARS RESULTS
Basil (Vasileios) Thanopoulos1, George Tsaousis2, Andreas Giannopoulos3, Petros Dardas1, Vlasis Ninios1
1Agios Loukas Clinic, Thessaloniki, Greece. 2Agia Sophia Childrens Hospital, Athens, Greece. 3AHEPA University Hospital, Thessaloniki, Greece
Background: Although stenting has been used as a treat- ment option for CoA at increasingly younger ages, there is limited information on the long-term follow-up of stent implantation for native CoA in small pediatric patients. This study reports initial and 10-years results following stent implantation for coarctation of the aorta (CoA) in children less than 6-years of age.
Methods: Sixty-three patients with native CoA (NaCoA) (median age 3 years, range 1–5.5 years) underwent stent implantation (SI) using PG2910B and ev3 stents. Bench testing of the stents was performed to determine the smallest sheath diameter that is required for their use. Patients with hypoplasia of the proximal aortic isthmus or transverse aortic arch were excluded from the study.
Results: The PG2910B (51-81%) stents were crimped on a 6-8 mm balloon (PTA, Bard, USA) and implanted through a 6 sheath. The stents were further dilated to a larger diame- ter using 10-12 mm balloons that were introduced through a 7 sheath. The ev3 stents (12-6.3%) (patients ≥ 5 years of age) were crimped on a 10-12 mm balloon and introduced through a 8 sheath. Immediately after stenting the peak systolic pressure gradient fell from 68±16 mmHg to 8±5 mmHg (p<0.05), while CoA diameter increased from 5±3 mm to 16.±3 mm (p<0.05). 21 (31%) patients with an arm/ leg pressure gradient ≥ 20 mm Hg underwent successful stent re-dilation 4 to 8 years after the initial procedure for
a relative to growth stenosis. After re-dilation peak systolic pressure gradient was reduced from 30 ± 5 mm Hg (25 to 38 mm Hg) to 5 ± 3 mmHg (range 0 to 8 mmHg). There were no major procedural complications. Late aneurysm forma- tion and stent fracture that required a new stent implanta- tion were observed in 2 and 3 patients, respectively. At the end of follow-up no cases of coarctation were identified on angiography, or MSCT. Fifty – eight (92%) of the patients were normotensive at the end of follow – up period.
Conclusions: Stent implantation is an effective and safe alternative to conventional surgical management for the treatment of selected pediatric patients with CoA.
43. FEASIBILITY OF THREE-DIMENSIONAL ROTATIONAL ANGIOGRAPHY IN INFANTS AND CHILDREN LESS THAN 10KG
Marisha McClean, Konstantin Averin, Yashu Coe, Cameron Seaman
University of Alberta, Edmonton, Canada
Background: Cardiac catheterization is an important tool in the management of congenital heart disease (CHD) with angiography being essential for diagnosing and treating cardiovascular lesions. Fixed plane 2-dimensional conventional angiography (CA) has traditionally been the main modality of image acquisition. CA has limita- tions when applied to complex 3-dimensional structures. 3-Dimensional Rotational Angiography (3DRA) can more accurately define cardiac anatomy through multiplanar reformatting and help determine optimal angles for sub- sequent CA. Rapid ventricular pacing during acquisition allows for reduced contrast volume and improves image quality but for right heart imaging 3DRA has traditionally required a second venous sheath for placement of a pacing catheter. Due to the known risk of vascular injury in small children we modified our approach to require the use of only 1 venous sheath. The aim of this study was to review and describe our institutional experience with 3DRA in infants and children less than 10kg.
Methods: Retrospective review of pediatric patients less than 10 kg who underwent 3DRA at our institution between 2016 - 2018. In cases where right heart 3DRA was performed, a single 5 or 6 Fr venous long sheath was advanced to the right ventricle (RV), through which a 4 Fr pacing catheter was positioned in the RV apex. 3DRA was performed with a 5 second injection of contrast via the sheath into the RV and simultaneous RV pacing.
Results: Fifty-one patients underwent successful 3DRA. There were 21 males (41%), mean age 8.9 ± 6.5 months and
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205