Page 55 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
over his back). ECG showed normal sinus rhythm with no abnormality. CXR showed an abnormal shadow related to right cardiac border with prominent pulmonary artery and otherwise normal pulmonary vasculature. His com- plete blood count showed erythrocytosis with hemoglo- bin concentration of 16.4 gm/dl and hematocrit value of 69.2%. Transthoracic echocardiography showed dilated left atrium with dilated right pulmonary artery. Patient was diagnosed to have a right pulmonary AV malformation. Invasive cardiac catheterization was done to identify size and number of this pulmonary AV malformation. Right pul- monary angiography showed a right pulmonary artery to left atrium fistula (type I) measuring 11 mm in its narrowest diameter with free shunting of blood. TEE guidance inside our cath. Lab. Showed normal pulmonary venous drainage into left atrium, dilated right pulmonary artery opening into left atrium through an opening 10 mm with systolic flow across of low gradient (15mmHg). A balloon was advanced across the fistula for sizing. Stretched diameter of fistula measured 13mm. An Amplatzer ventricular septal occluder 14 was successfully positioned across the fistula. Right pulmonary angiography assured patent right lower pulmonary artery. TEE assured normal pulmonary veins flow into left atrium. Patient saturation rose from 75% to 95%.
70. TRANSCATHETER ASD CLOSURE IN A PATIENT
WITH DEXTROVERSION (A CASE REPORT)
Yasmin Ali1, Alaa Roshdy1, Khaled Shams2, Noha Gamal3
1Ain Shams university, Cairo, Egypt. 2Helwan university, Cairo, Egypt. 3Assuit university, Assuit, Egypt
Cardiac dextroversion is location of the heart in the right chest with the left ventricle remaining in the normal posi- tion to the left but lying anterior to the right ventricle. We present a case of secundum atrial septal defect (ASD) in a patient with dextroversion, situs solitus, AV concordance and VA concordance. Patient was referred for transcath- eter closure of ASD. Her transthoracic echocardiography showed a 7mm secundum ASD, Upper normal RV size, small restrictive VSD 2mm and a dilated main pulmo- nary artery. Transesophageal echocardiography showed an 11mm defect with abnormal orientation of inter atrial septum due to cardiac dextroversion. Usual technique for positioning of ASD Amplatzer device (ASO 11) failed with prolapsing of the device into right atrium. Failed right upper pulmonary vein technique. With successful posi- tioning of the device across the interatrial septum using left upper pulmonary vein technique.
71. A NOVEL THREE DIMENSIONAL ECHOCARDIO- GRAPHIC TECHNIQUE FOR DEVICE SIZE SELECTION
IN PATIENTS UNDERGOING ASD TRANS-CATHETER CLOSURE
Yasmin Ali, Alaa Roshdy, Aya EL sayegh, Hebattallah Attia, Azza EL fiky, Maiy Elsayed
Ain Shams university, Cardiology Departement, Cairo, Egypt
Objective: To establish a simple and accurate method for device size selection using three-dimensional echocardio- graphic interrogation of the ASD.
Background: Proper device size selection is a crucial step for successful ASD device closure. The current gold standard for device size selection is balloon sizing. Balloon sizing can be tedious, time consuming and increase fluoroscopy and procedure times as well as risk of complications.
Methods: This is a prospective observational study con- ducted over a period of 12 months. All patients underwent 2D TTE, three dimensional echocardiographic assess- ment of the IAS and transoesophogeal echocardiogram. Comparison between echocardiographic variables was done using independent sample t test. Linear correlation was established between three dimensional echocardio- graphic variables and respective variables of device size and 2D TTE and TEE measurements.
Results: The study included 50 patients who underwent successful ASD device closure. There was no significant difference between 3D ASD maximum diameter and all diameters measured by TTE and TEE. There was a strong positive correlation between device size used for closure and both 3D measured ASD area (r = 0.907, P<0.0001) and 3D measured ASD circumference (r = 0.917, P<0.0001). Two regression equations were generated to determine proper device size where Device size = 10.8 + [3.95 x 3D ASD area] and Device size = [3.85 x 3D ASD circumference] -1.02
Conclusion: Three-dimensional echocardiogram can pro- vide a simple and accurate method for device size selection in patients undergoing ASD device closure using either 3D derived ASD area or ASD circumference
72. TRANSRADIAL ACCESS IN THE CONGENITAL
CARDIAC CATHETERIZATION LABORATORY
Arash Salavitabar1, Darren Berman1, Andrew Harrison1,
Randi Pfeffer1, Shasha Bai2, Aimee Armstrong1, Brian Boe1
1Nationwide Children's Hospital, Columbus, USA. 2The Ohio State University Wexner Medical Center, Columbus, USA
Background: Transradial access (TRA) is the standard approach for coronary catheterization in adults, with improved outcomes and higher patient satisfaction
Hijazi, Z
22nd Annual PICS/AICS Meeting