Page 41 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
48. PERCUTANEOS TRANSCATHETER CLOSURE OF A MASSIVE PULMONARY ARTERIOVENOUS FISTULA IN A NEWBORN.
Alberto Zarate, Iñaki Navarrro, Ramon Minguet, Jorge Robles Issste, Mexico, Mexico
Pulmonary arteriovenous fistulas (PAVFs) is a rare cause of cyanosis in the newborn. Only 17 cases of newborn pul- monary arteriovenous fistula have been reported. The etiology of this disorder is unknown Typical signs at pre- sentation include cyanosis, murmur, and congestive heart failure. Large PAVFs produce symptoms and predispose to serious complications and hence require early treat- ment. Imaging plays a very major role in the pre-opera- tive diagnosis of these conditions, included chest x-ray in which are common findings: cardiomegaly, oligemia, and focal pulmonary density. Surgical resection was the only treatment available till the introduction of interventional procedures. Since then, transcatheter embolotherapy with coils and vascular plugs have become the treatment of choice in most of the centers
The patient was a 38-week product of a pregnancy com- plicated by intrauterine growth retardation. He was deliv- ered by emergency Cesarean section for fetal distress. Was admitted to the NICU because of antenatal diagnosis of a pulmonary arteriovenous fistula. After 24 hrs the patient revealed profound desaturation, 75% and respiratory dis- tress, phase II ventilation mode was needed. Deep cyano- sis and a harsh grade 6/6
Initial chest x ray showed mild vascular oligemia. An opac- ity in the left upper lobe. The initial echocardiographic examination confirm a large pulmonary arteriovenous fistula near the descending aorta. CT revealed an aneu- rysmal fistula emerging from the left pulmonary artery. Cardiac catheterisation was performed, Cardiac catheter- ization showed normal pressures except for a low diastolic pressure in the pulmonary artery. Selective pulmonary angiograms confirmed the diagnosis, showing a direct communication
from the left pulmonary artery to the left atrium, an the aneurysmal pouch size was 2 x 1.9cm. Through 4 Fr cath- eter we delivered an Amplatzer PDA II-AS 3-4 to occlude the fistula. An angiogram subsequent to release of the occluder revealed the complete closure of the fistula, with disappearance of the aneurysmal pouch. The newborn was discharged home four days after the procedure. Six months after the procedure, he is in perfect condition, with normal echocardiographic findings
49. STENT IMPLANTATION FOR TREATMENT OF BRANCH PULMONARY ARTERY AND ANASTOMO- SIS STENOSIS IN CHILDREN WITH UNIVENTRICULAR HEARTS
Lei Yang, Ying Guo , Tingliang Liu, Wei Gao, Meirong Huang,
Yibei Wu , Xinyi Xu, Xu Zhang
Department of Cardiology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
0bjective: Patients with single-ventricle physiology pose a wide variety of therapeutic challenges. Pulmonary artery or anastomosis stenosis in single-ventricle physiology will have only subtle hemodynamic derangements due to the lack of the pumping chamber to force blood across the ste- nosis. This study aimed to evaluate the feasibility and use- fulness of the stent implantation for treatment of branch pulmonary artery and anastomosis stenosis in children with univentricular hearts.
Methods: Retrospective analysis of 8 implanted stents between March 2014 and January 2015 in Shanghai Children’s Medical Center. Transthoracic echocardiography, chest roentgenography and electrocardiography were car- ried out as follow-up studies at the second day after opera- tion and 1, 3, 6, 12 months after the procedure.
Results: In all of eight patients (6 males and 2 females), 5 cases were post-Glenn operation and 3 cases were post-Fontan operation. The median age was 6.6 years (range 4.0-8.5 years).The median weight was 19.5 kg (range 13.8-25.6 kg). 9 stents were implanted successfully in all patient, 6 in left pulmonary arteries, 2 in fight pulmonary arteries and 1 in anastomosis. All stents were placed in the target lesion without any complication. The diameter of the narrowed segment improved from (3.63±2.06) mm to (7.89±1.62) mm (P<0.01). During follow-up, no other complication occurred except thrombus in one patient because of discontinuation anticoagulation.
Conclusion: Branch pulmonary arterial stenosis in sin- gle-ventricle patients may often be underestimated due to the low pressure venous system and/or the development of venovenous collaterals bypassing and decompressing the pulmonary circuit. In these patients, even mild stenosis should be treated aggressively, especially in the presence of pleural effusions, pericardial effusions, protein-losing enteropathy and low-output states. Stent implantation is an effective method of treating branch pulmonary artery stenosis.
Hijazi, Z
22nd Annual PICS/AICS Meeting