Page 63 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
Objective: To report a series of cases with favorable out- come where was necessary a off-label use of materials or unusual vascular accesses.
Cases: The procedures were performed in a premature baby, 980 grams with severe coarctation of aorta, where a istmoplasty was performed with coronary stent by axillary artery puncture; in a boy, 12 kg, left isomerism, dextrocar- dia, absence of right SVC where a atrial septal defect was closed by the left internal jugular vein; in a neonate, 2,8 kg, to performer a pulmonary vein stenting to treat a severe stenosis after a surgery to correction of total anomalous pulmonary venous return by hybrid procedure; in a girl for multiples pulmonary arteriovenous fistulas occlusion with coils and glue; in a patient to treat a pseudoaneurysm in a branch of the right hepatic vein with coils; in a patient with large atrial septal defect occlusion by trans hepatic punc- ture and in a patient for closing a anomalous artery from descendent aorta to lungs using PLUGs.
Results: All patients were treated successfully. All patients but one did not need any further intervention. The patient that had a stent implanted in pulmonary vein in a hybrid procedure was discharged and was being followed for the possibility of further dilation of the stent. No deaths or major complication occurred in this series.
Discussion and Conclusion: Although we do not have specific materials for the treatment of all congenital heart diseases that can be treated percutaneously and we can not always use the usual accesses for procedures, the use of alternative pathways must be considered. The off-label use of available materials, increasing experience among inter- ventionist and the possibility to work with experts from different areas has been made possible the percutaneous treatment of rare and unusual congenital heart diseases.
83. SURGICAL PLACEMENT OF ADJUSTABLE PDA BAND FACILITATES DUCTAL STENTING IN STAGE 1 HYBRID PALLIATION PROCEDURE
Sharib Gaffar1,2,3, Joanne Starr1, Richard Gates1, Michael Recto1
1CHOC Children's Hospital of Orange County, Orange, USA. 2University of California Irvine, Irvine, USA. 3Miller Children’s and Women’s Hospital Long Beach, Long Beach, USA
Background: The hybrid stage I procedure is an accepted alternative for high-risk patients with hypoplastic left heart syndrome (HLHS) facing increased mortality following the Norwood operation. The procedure involves bilateral pul- monary artery banding, atrial septostomy, and stenting of the patent ductus arteriosus (PDA). Prostaglandin infusion
(PGE) is required to maintain ductal patency, and most interventionalists discontinue PGE prior to the procedure to modulate PDA caliber. Although effective in maintain- ing ductal patency, dose adjustment of PGE cannot accu- rately predict ductal diameter, which is crucial in selection of appropriate stent size. The patients in this case series were maintained on PGE until just prior to placement of the adjustable PDA band. The adjustable PDA band was placed after bilateral pulmonary artery banding and prior to PDA stenting. When required, the PDA band was adjusted to desired diameter following angiographic review prior to PDA stent implantation.
Methods: Six patients (4 males, 2 female), 5 with HLHS and 1 with left ventricular hypoplasia, mean age 8 days (range 3-16), mean weight 2.72kg (range 2-3.2) underwent hybrid stage 1 palliation due to anatomic or weight con- cerns regarding viability of the Norwood procedure. In 5 cases, banding of the pulmonary arteries and stenting of the PDA were completed as a single procedure; in 1 case, a patient had bilateral pulmonary artery bands completed initially, followed by PDA stenting 11 days later. Umbilical tape was initially wrapped around a 6mm Hagar and cut to size. It was then encircled around the PDA and secured with two hemoclips. Following PDA banding, a 7F sheath (Cook) was positioned in the main pulmonary artery (MPA) above the pulmonary sinuses of Valsalva. An angiogram was then performed through the sheath and the PDA with ductal band was measured. The band was positioned in the midportion of the PDA with mild constriction. Based on the angiographic appearance, the band was loosened (removal of 1 clip) or tightened (addition of 1 clip). A fol- low-up angiogram was then performed. Once ideal ductal diameter was obtained, either a Cordis Genesis (Cardinal Health) premounted balloon-expandable stent, or EV3 Everflex (Medtronic) self-expandable stent was utilized for ductal stenting, with the hemoclips anchoring the PDA band in place used as a landmark. Angiography post-PDA- stenting confirmed proper stent placement. The sheath and wire were then removed, and MPA puncture site repaired. All 6 patients underwent successful PDA stent- ing without complication, and postoperative courses were uneventful.
Results: All patients had large PDAs echocardiographi- cally, with average diameter 7.35mm (range 6.3-8.7). Post- banding average diameter angiographically was 4.9mm (range 4.2-5.8). Post-stenting average diameter angio- graphically was 6.2mm (range 5-7.4).
Conclusion: Adjustable PDA banding with umbilical tape in the stage 1 hybrid procedure for HLHS allows for PGE
Hijazi, Z
22nd Annual PICS/AICS Meeting