Page 57 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
1Augusta University, Augusta, USA. 2Medical College of Georgia, Augusta, USA
Background: Hybrid procedures are now widely accepted techniques to repair complex cardiac defects. We describe a series of 9 cases that were performed at our institution for varied cardiac pathology.
Case Series: Two patients with large omphaloceles and respiratory failure had large secundum ASDs with inter- rupted IVC. Internal jugular venous access was not feasi- ble. Both patients had significant comorbidities. Both cases were closed via mini-sternotomy and ‘per-atrial’ approach, under TEE guidance with an Amplatzer Septal Occluder, with no complications.
Two patients under 10 Kg had recurrent coarctation of aorta. One patient had single ventricle physiology sta- tus post Glenn anastomosis and also had LPA stenosis. A 4F sheath was placed in the right femoral artery and a Glidewire was advanced to the right common carotid artery (RCCA). A surgical cutdown was performed and the wire was externalized. A sheath was placed over the wire into the RCCA. A stiff wire was advanced from the RCCA across the area of coarctation and an adult sized stent was placed. In the patient with LPA stenosis, the right internal jugular vein was accessed and used for LPA stenting. Both patients had their RCCA repaired.
A four month old patient with multiple VSDs, including a large muscular VSD below the moderator band, under- went hybrid repair. A sheath was placed into the RV and across the VSD. Under TEE guidance, an Amplatzer VSD Occluder was deployed without any complication and the remaining VSDs were closed surgically.
In two patients, perventricular approach was used to place Edwards and Melody pulmonary valves. A sub-xiphoid incision was performed, a sheath was placed in the RV and an extra stiff wire was advanced to the distal LPA. A 22F Cook Feloxr sheath was advanced over the wire, and a 20 mm Melody valve was placed. The 2nd patient had a 23mm Edwards XT valve implanted in a native RVOT s/p transan- nular patch repair, followed by hybrid branch pulmonary artery stenting.
Conclusion: Varied hybrid approaches can be applied suc- cessfully to address an array of complicated cases with suc- cessful outcomes.
74. USE OF INTRACARDIAC ECHOCARDIOGRAM TO DIFFERENTIATE POST-TAVR VALVE INSUFFICIENCY MASQUERADING AS PARAVALVULAR LEAK
Michael Bykhovsky1, Kimberly Atianzar2, Shvetank Agarwal2, Pushpa Shivaram1, Zahid Amin1
1Children's Hospital of Georgia, Augusta, USA. 2Augusta University, Augusta, USA
Introduction: Transcatheter aortic valve replacement (TAVR) has rapidly become a widespread treatment for severe aortic stenosis in adults. A common complication associated with this procedure is paravalvular leak (PVL) which is associated with increased mortality. Multimodal imaging techniques may be employed to accurately char- acterize post-TAVR aortic regurgitation.
Case Presentation: The patient was a 71-year-old man who underwent TAVR by transfemoral approach for severe symptomatic non-rheumatic aortic valve stenosis which was complicated by post-deployment aortic regurgita- tion. After post-implantation balloon dilation, the imme- diate post-TAVR transesophageal echocardiogram (TEE) as well as follow-up transthoracic echocardiograms (TTEs) demonstrated what appeared to be a significant paravalvu- lar leak involving the non-coronary cusp. Since the patient remained symptomatic on medical management, he was set up for PVL closure. During subsequent catheterization, imaging modalities including TEE, en face angiography, and intracardiac echocardiography (ICE) were utilized to assess the aortic insufficiency with successful diagnosis of a frozen intra-TAVR cusp with central regurgitation by ICE.
Discussion: Current guidelines recommend quantitative and qualitative assessment of PVL using various imaging techniques including TTE, TEE, and fluoroscopic angi- ography. Imaging interrogation limitations of eccentric regurgitant jets post-TAVR can result in the misdiagno- sis of intravalvular regurgitation for paravalvular leaks. Supplemental imaging with ICE has been shown to be effective in distinguishing TAVR characteristics while improving spatial resolution and providing immediate results.
75. PRINTING
AND AIRWAY ANATOMIC 3D MODELS FROM 3D ROTATIONAL ANGIOGRAPHY.
Jenny E. Zablah1, Alex Haak2, Nicholas Jacobson3, Michael DiMaria1, Gareth Morgan1
1University of Colorado, Aurora, USA. 2Philips Healthcare, Andover, USA. 3Inworks/University of Colorado, Aurora, USA
AND VALIDATING
VASCULAR
Hijazi, Z
22nd Annual PICS/AICS Meeting