Page 54 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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changes in CRI, which suggests that the immediate ben- efits of TcPVR may be impacted by the contemporaneous state of ventricular remodeling. It also suggests that acute improvements in hemodynamic efficiency may be more tangible in patients with outflow stenosis rather than regurgitation-mediated dilation. CRI should be further studied in patients undergoing either surgical or tran- scatheter pulmonary valve replacement to quantify rapidly evolving changes in circulatory volume and compensatory reserve that are evident during the immediate post-proce- dural phase.
68. TRANSCATHETER PULMONARY VALVE REPLACE- MENT: THE AUSTRALIAN AND NEW ZEALAND PERSPECTIVE
Claire Lawley1,2, David Tanous3, Benjamin Anderson4,5, Stephen Shipton6, William Wilson7, David Celermajer8,9, Clare O'Donnell10, Philip Roberts1
1The Heart Centre for Children, The Children’s Hospital at Westmead, Sydney Children’s Hospital Network, Westmead,
New South Wales, Australia. 2Discipline of Child & Adolescent Health, The Children’s Hospital at Westmead Clinical School, Sydney Medical School, Westmead, New South Wales, Australia. 3Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia. 4Queensland Paediatric Cardiac Service, Children’s Health Queensland, South Brisbane, Queensland, Australia. 5The University of Queensland, St Lucia, Queensland, Australia. 6Children's Cardiac Centre, Perth Children's Hospital, Nedland, Western Australia, Australia. 7Department of Cardiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia. 8Department of Cardiology, The Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. 9Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia. 10Paediatric and Congenital Cardiology Service, Starship Children's Health, Auckland, New Zealand
Background: The Australian and New Zealand (ANZ) population undergoing transcatheter pulmonary valve replacement (TPV),with either a Medtronic MelodyTM valve or Edwards SAPIEN valve, has not been fully character- ised. This region faces particular geographic challenges and presents an opportunity to explore outcomes of TPV outside of the historically reported European and North American centres. In particular, there have been specific concerns raised about the rate of infective endocarditis in this cohort.
Methods: A multi-site retrospective cohort study across seven centres in ANZ was undertaken. TPV cases were identified through institutional databases. Relevant details including baseline demographics, procedural details and outcomes were collected. Key outcomes evaluated at fol- low-up included mortality, morbidity (repeat procedure,
infective endocarditis, device explantation) and echocar- diographic data. Ethics approval was obtained.
Results: From June 2009-March 2018, 136 individuals (female = 63, 46%) underwent TPV utilising 124 Medtronic MelodyTM valves and 12 Edwards SAPIEN valves (median age 18 years, range 9-60 years; median weight 58kg, range 24-137kg). The most common underlying diagnoses were tetralogy of Fallot (n=45, 33.1%) and pulmonary atresia +/- ventricular septal defect (n=28, 20%). The main sites for implantation were a homograft in 89 (65%) cases and a bio- prosthesis in 39 (28.6%) cases. Five valves were implanted into the native right ventricular outflow tract. The indica- tions for TPV were conduit/right ventricular outflow tract stenosis (n=75, 55%), regurgitation (n=12, 9%) or mixed disease (n=49, 36%). Immediate haemodynamic outcome was good; in the stenosis subgroup the mean peak conduit gradient prior to procedure was 40.6mmHg (std. dev. 15.8) and post procedure 11.4mmHg (std dev 7.1), p < 0.001. The mean peak RV-to-systemic pressure prior to TPV was 70.9% std. dev. 18.2), and post procedure 39.3% (std. dev. 9.36), p < 0.001. Major procedural complications were very rare. There was one early post procedural death, due to device embolisation within the right ventricular outflow tract. In follow-up (median 21 months, range 0-98 months) there were two further deaths unrelated to TPV. Thirteen indi- viduals developed infective endocarditis (annualised inci- dence rate 4.6% per patient-year), 9 of these individuals required surgical valve explantation and replacement. Two further valves required explantation and replacement in individuals without infective endocarditis.
Conclusions: TPV as performed in selected ANZ centres provides a relatively safe and feasible method of rehabil- itating the RVOT. A further three sites are expected to be included – encompassing all TPV across the region. An intention to treat analysis is planned.
69. TRANSCATHETER CLOSURE OF RIGHT PULMO- NARY ARTERY TO LEFT ATRIUM FISTULA UNDER TRANSESOPHAGEAL ECHOCARDIOGRAPHY GUID- ANCE (A CASE REPORT)
Yasmin Ali, Heba Nossir, Amira Nour, Mahmoud Baraka, Maiy El sayed
Ain Shams university, Cairo, Egypt
We present a case of a 12-year-old student who com- plained of exertional dyspnea and easy fatigability over the past few months. His mother reported mild cyanosis since birth which increased with exertion. On examination, he had central cyanosis with grade II clubbing in both fin- gers and toes, silent precordium with no audible murmur
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205