Page 42 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
104
50. THREE CASES OF SUCCESSFUL TRANSCATHE- TER REHABILITATION TO PULMONARY ARTERIES IN MAJOR AORTOPULMONARY COLLATERAL ARTERIES WITH DIMINUTIVE PULMONARY ANTEGRADE FLOW Mizuhiko Ishigaki, Sung-Hae Kim, Keisuke Sato, Jun Yoshimoto, Norie Mistushita, Masaki Nii, Yasuhiko Tanaka Shizuoka Children’s Hospital, Shizuoka, Japan
Background: Major aortopulmonary collateral artery (MAPCA) with diminutive pulmonary artery (PA) is a com- plex and rare form of congenital heart disease. The most important consideration in this disease is how to facilitate pulmonary arterial growth. Generally, a surgical strategy involving unifocalization of the MAPCAs or rehabilitation of the native PA by systemic-pulmonary artery shunt is used. We report three rare cases of complete transcatheter rehabilitation of the native PA without surgery in patients with MAPCAs and diminutive pulmonary antegrade flow, using balloon valvuoplasty (BVP) for pulmonary valve or right ventricular outflow tract (RVOT) stenting and embo- lization of MAPCAs.
Case Series
Case 1: The patient was a three-month-old boy weighing 5.1kg diagnosed with double outlet right ventricle, subar- terial (doubly-committed) ventricular septal defect, pul- monary valve stenosis involving a diminutive tethered pulmonary valve (diameter: 3.7 mm, z score: -6.4), right aortic arch, and 5 MAPCAs.
Case 2: The patient was an one-month-old boy weighing 3.0kg diagnosed with tetralogy of Fallot, subarterial ven- tricular septal defect, pulmonary valve stenosis involving a diminutive tethered pulmonary valve (diameter: 3.7 mm, z score: -5.5), and 4 MAPCAs.
Case 3: The patient was a two-month-old girl weigh- ing 3.9kg diagnosed with double outlet right ventricle, perimembranous ventricular septal defect, pulmonary valve and subpulmonary stenosis involving a diminutive tethered pulmonary valve (diameter: 3.5 mm, z score: -7.4), right aortic arch, and 4 MAPCAs.
All patients required intervention for severe cyanosis in early infancy. To increase pulmonary blood flow, we selected BVP in former 2 cases of subarterial ventricu- lar septal defect and RVOT stenting in latter 1 case of perimembranous ventricular septal defect. A series of interventions with BVP or RVOT stenting and emboliza- tion of MAPCAs were performed to promote native PA
growth and maintain SaO2 without any complications. After growth from a diminutive PA to an appropriately sized PA (Nakata index; Case1:49"137, Case2:49"229, Case3:154"352mm2/m2), all patients received complete repair without any surgical PA rehabilitation strategies. The postoperative courses were uneventful, and echocardiog- raphy indicated acceptable right ventricular pressure.
Conclusion: This strategy can be a useful option as a bridge to definitive repair for this particular patient group, and therefore palliative surgery in early infancy, which is associated with a relatively high mortality, can be avoided. The important factor in this strategy is a sufficient dual sup- ply from the native PA and the MAPCAs.
51. PATENT DUCTUS ARTERIOSUS CLOSURE USING OCCLUTECH DUCT OCCLUDER ;SOHAG UNIVERSITY HOSPITAL EXPERIENCE, EGYPT
Safaa Ahmed1, Amal EL Sisi2
1Sohag University Hospital, Sohag, Egypt. 2Cairo-university, Cairo, Egypt
Aim: To evaluate our experience in percutaneous tran- catheter closure of patent ductus arteriosus (PDA) with the Occlutech duct occluder (ODO) .
Methods: It was a prospective study to evaluate effi- cacy and safety of the Occlutech duct occluder as a new device in our hospital for trancatheter closure of PDA in 43 patients. All consecutive patients receiving an Occlutech® PDA occluder for closure of PDA from May 2017 to April 2019 were included in the study. Occluders were implanted using a conventional technique. Residual shunting, adverse events and mid-term outcomes were assessed and reported.
Results: All patients (43) underwent to successful ODO implantation. The median patient age was 2 years (range, 5months-25 years). The patient weight was 10 Kg (range,6- 65Kg) . PDAs were of type A (n = 37), type E (n = 8) . The median narrowest PDA diameter was 3.4mm (1.9-8mm). Median procedure time was 65 min (range, 47–110 min). Median fluoroscopy time was 6.9 min (range, 4.5-16 min). The device diameter (pulmonary end) was 7mm (range,6- 15mm). The standard shank length was used in 36 cases, and the long shank was used in 7 cases. Median follow-up period was 18 months. All devices were successfully implanted. Total occlusion was achieved the following day in 40 /43 (93%), but three patients (7%), in whom it was confirmed one week later on echocardiography . No major adverse events occurred. Mild Aortic disc bulging occurred in one patient without hemodynamic consequences.
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205