Page 65 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
1Department of Paediatric Cardiology, Queen Mary Hospital, Hong Kong, Hong Kong. 2Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong. 3Department of Medicine, Hong Kong, Hong Kong
The atrial flow regulator (AFR) is currently under compas- sionate use for right ventricular failure due to pulmonary hypertension (PHT) or heart failure with left atrial (LA) hypertension. We report the challenge in implanting the AFR for LA decompression in a patient with palliated con- genital heart disease with LA hypertension despite an existing atrial stent. The patient presented at 16 years old with worsening exercise tolerance. Diagnosis was atrioven- tricular discordance, double outlet systemic right ventricle, subpulmonary ventricular septal defect, severe tricuspid regurgitation and stenosis with PHT. Patient was palliated with mechanical tricuspid valve (TV) replacement and pul- monary artery (PA) banding. Physiological “total” repair was deemed impossible during intra-operative assessment. Despite initial improvement, the patient developed pro- gressive LA hypertension secondary to a relatively small mechanical TV with recurrent symptomatic atrial tachycar- dia (AT) and was in NYHA class II. Catheterization at age of 18 showed pulmonary arterial wedge pressure (PAWP) of 15mmHg with mean PA pressure of 35mmHg hence atrial septostomy and stenting with 6x18mm Genesis stent was performed. However, recurrence of LA hypertension was evident subsequently, with LA dilatation, AT and worsen- ing of symptoms. Catheterization at 22 years old showed LA pressure of 22mmHg and pulmonary hypertension despite a patent atrial stent. Further aggressive dilata- tion of the stent was deemed risky since the stent was located at the anterio-inferior septum which was in close proximity to the mechanical TV. The heart team decision was to workup for a second transcatheter atrial commu- nication creation. The AFR appear to be an ideal device to create such reliable and sizable atrial communication, yet the challenge was the positioning of the AFR in the pres- ence of a pre-existing atrial stent. Detailed pre-procedural echocardiogram, CT and 3D model suggested that there would be adequate landing zone for the largest AFR. The procedure was then performed under general anaesthesia when patient was 23 years old. Trans-septal puncture using RF-trans-septal needle (C0 curve, Baylis) and SL1 sheath was performed with trans-esophageal echocardiogram (TEE) guidance to ensure a posterior-superior location, tar- get site being as far away as possible from the pre-exist- ing atrial stent, to minimize the risk of device interaction, yet ensuring enough space for full deployment of the AFR. After successful trans-septal puncture, progressive balloon dilatation was performed using balloons up to 14x20mm. AFR (10mm fenestration/5mm height) was implanted via
a 14F Occlutech delivery sheath. TEE showed satisfactory device position and no interaction with the pre-exist- ing atrial stent. The PAWP and mean PA pressure reduced from 27mmHg to 16mmHg and 42mmHg to 33mmHg respectively. Intriguingly the Qp/Qs decreased from 4.88 to 3.25 while cardiac index increased slightly. The device was released after confirmation of a favourable haemody- namics. Follow-up echocardiography 1 month post-pro- cedure showed patent stent and AFR with stable position. The TV mean gradient reduced from 18mmHg to 7mmHg indicative of a significant LA decompression. This is the first reported case of AFR implantation in close proxim- ity with another atrial decompressive device. The report highlighted the importance of pre-procedural planning and precision in trans-septal puncture in achieving good results.
86. PDA CLOSURE WITH A MFO
Jesús Damsky Barbosa1, Liliana Ferrin2, Victorio Lucini1, Adelia Marques Vitorino1, José Alonso3, Marcelo Rivarola4, Julio Biancolini1, Fernanda Biancolini1, Judith Ackerman1, Ines Martinez1, Ana María Susana de Dios5
1Pedro de Elizalde, Hospital, Buenos Aires, Argentina. 2Instituto del Corazón, Corrientes, Argentina. 3“High complexity “JUAN DOMINGO PERON” Hospital, Formosa, Argentina. 4University Austral Hospital, Pilar, Argentina. 5Mitre Institution, Buenos Aires, Argentina
Goal: Demonstrate the new Multifunctional Occluder (MFO)in the closure of the PDA
Materials and Method: Since 2018, the MFO is used in Argentina.9 procedures were performed: 8patients (p) pediatrics and 1p adult (p=9) with Median age: 3.75 yo and Median weight: 11.2 kg (See table 1)
2 p below 10kg. 2 p were treated with the new protocol (Eco guided without arterial approach)
Prosthesis description: Nitinol mesh with 2 equal diame- ter discs joined by a truncated cone shaped waist. The base of the cone is attached to the left disc or high pressure and the truncated vertex is attached to an arm that joins the right disc or low pressure. Both discs have a double sided screw for retrograde or antegrade approach. The denomi- nation of the prosthesis is given by the 2 diameters of the waist (base and truncated vertex).
Statistical Analysis: The T-test method was used to com- pare the right and left diameters of the PDA with the right and left diameters of the prosthesis where p < 0.05.
Hijazi, Z
22nd Annual PICS/AICS Meeting