Page 47 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
Our case highlights a few significant issues which are lia- ble to be missed at times and can lead to catastrophic consequences. The first and foremost would be to keep a watch on the procedure time, check ACT and infuse hep- arin accordingly. As we saw, closure of a PDA may rarely manifest as a latent coronary fistula and hence meticulous follow up is required at least for a few months after device closure of a PDA. The above case also opens up the discus- sion on performing CT angiograms for every case of coro- nary artery fistula in resource limited countries.
59. PERVENTRICULAR DEVICE CLOSURE OF LARGE MUSCULAR VSDS; SINGLE CENTRE EXPERIENCE
Ahmet Celebi, Emine Hekim Yilmaz, Ilker Kemal Yucel, Husnu
Firat Altin, Numan Ali Aydemir
Dr Siyami Ersek Hospital for Cardiology and Cardiovascular Surgery , Istanbul, Turkey
Introduction: Surgical repair of VSDs ensures direct visual access but for muscular ventricular septal defects (mVSDs) exposure may be limited due to coarse trabeculations of right ventricle(RV) and postoperative residual shunt con- tinues to be of concern. Left ventriculotomy may provide better exposure but not preferred in small infants due to potential long term complications. Palliative pulmonary artery banding (PAB) is associated with RV hypertrophy and myocardial remodeling and necessitate reinterven- tions in long term. Percutaneous closure of mVSD avoids sternotomy and CPB and has been an alternative tech- nique in selected patients but its application is limited in small infants <8kg. Perventricular device closure (PVDC) of mVSDs is a hybrid procedure involving a limited ster- notomy and direct RV puncture to introduce a sheath to deploy the device.We herein describe our single center experience on the feasibility and outcome of PDVC of iso- lated large mVSD.
Patients and Method: Between 2008-2019, 25 infants who had either single or multiple large mVSDs with evi- dence of nonrestrictive left to right shuntson transtho- racic echocardiography (TTE) examinations, and who were symptomatic with failure to thrive due to congestive heart failure (CHF) and had significant pulmonary hypertension (PH) underwent PVDC procedure. All interventions per- formed in operating theatre under general anesthesia with the guidance of continuous transesophageal echocardi- ography (TEE). Sixteen (64%) were female, 9 (36%) were male in genderwith a mean age of 4,1 ±1,3 months (1 - 6 months) and a mean body weight of 4,22±0,75 kg (3.5 - 5.3 kg). Fifteen (60 %) children had single mVSD while ten (40 %) children had multiple mVSD which was large and required additional device usage in two case. According
to anatomic type of defect eighteen patient had mid mus- cular, three patient had apical muscular, two patient had muscular inlet, two patient had large multiple defects. Five patients had previous preoperative procedures.
Results: Mean diameter of defects measured on TTE was 8.06±1.5 mm (5–11 mm) while measurements on TEE was 8.88±1.46 mm ( 5.8-12 mm).In all cases muscular VSD occluders used in sizes ranging from 8 to 16 mm, result- ing in a device to defect ratio of 1.29±0.11 (1.1-1.5). Twenty five successful device deployment procedures performed in 23 patients, as double device used in two cases. Among three procedures which was deemed as unsuccessful, two underwent PAB and one expired. Thirteen case had resid- ual shunts but it was significant only in 1. During mean 58,71±38,62 (0,25-120,median 63) month follow up with- out need for any other intervention, without any ventricu- lar dysfunction and rhythm problem, nineteen patients are attending to outpatient clinic visits regularly.
Conclusion: Low body weight remains a strong predic- tor of higher mortality and morbidity for surgical correc- tion and percutaneous route may be complicated in small infants. For early correction of large interventricular shunts PVDC may be a safe and effective option either substitut- ing or complementing the conventional surgical closure. Although combines the advantages and reduces the inva- siveness of cardiac surgery and transcatheter interven- tions, it is not free from complications entirely.
60. OUTCOMES AFTER TRANSCATHETER REINTERVENTION FOR DYSFUNCTION OF A PREVIOUSLY IMPLANTED TRANSCATHETER PULMONARY VALVE
Shabana Shahanavaz1, Felix Berger2, Thomas Jones3, Jacqueline Kreutzer4, Julie Vincent5, Andreas Eicken6, Lisa Bergersen7, Jonathan Rome8, Evan Zahn9, Lars Sondergaard10, John Cheatham11, David Balzer1, Doff McElhinney12
1Washington University SOM, St. Louis, MO, USA. 2German Heart Institute Berlin, Berlin, Germany. 3Seattle Children's Hospital, Seattle, WA, USA. 4Children's Hospital of Pittsburgh UPMC, Pittsburgh, PA, USA. 5Children's Hospital of NY, New York, NY, USA. 6German Heart Center Munich, Munich, Germany. 7Boston Children's Hospital, Boston, MA, USA. 8Children's Hospital of Philadelphia, Philadelphia, PA, USA. 9Cedars-Sinai Heart Institute, Los Angeles, CA, USA. 10The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 11Nationwide Children's Hospital, Columbus, OH, USA. 12Lucile Packard Children's Hospital Stanford, , Palo Alto, CA, USA
Background: Transcatheter pulmonary valve replacement (TPVR) with the Melody valve has demonstrated sustained
Hijazi, Z
22nd Annual PICS/AICS Meeting