Page 66 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
128
Results: 9 p with complete occlusion during the immedi- ate period (see table 2).
The follow-up mean time was: 9 m (1 to 13 m).
Pulmonary pressures: systolic mean: 26 mmHg (21 to 44 mmHg) and the diastolic mean: 24mmhg (7 to 25 mmHg).
The average QP / QS: 2.28 / 1 (1.8 to 3). Diameters:
Entry: X: 3.67 (5 to 10 mm)
Right side: X: 3.90 (3 to 8 mm)
Left diameter of the waist: 6.06 mm (5 to 10 mm) Right diameter of the waist: 3.90 mm (3 to 8 mm)
When the left and right PDA diameters are linked to the prosthesis diameters, the left diameter has a NON signifi- cant difference of 2.39 mm (p:0213) to the left prosthesis diameter and the difference of the right diameter of the prosthesis to the right diameter of the PDA was NON sig- nificant either (p:0.399).
Follow-up: there were no complications.
Discussion: The bibliography suggests using devices 2 to 4 mm greater than the right diameter.
If the waist diameter is strictly taken into account, there is a risk that the discs can generate some type of obstruction in the left pulmonary artery or descending aorta. Therefore when using a waist of the same diameter of the PDA, the risk of embolization or residual permeability are prevented by the presence of the 2 discs.
In the 2p of lower weight, a smaller waist diameter than the corresponding one was used. Nevertheless the goal was fulfilled by the 2 discs that worked closely in the occlusion.
Conclusions:
1. MFO allows the endovascular treatment, observing complete occlusion in the immediate period.
2. As the discs collaborate in the occlusion of the PDA, there is no need to overdistention of the PDA for final occlusion.
3. During the follow up, no residual gradients were ob- served in descending aorta and LPA.
4. No displacements or deformities of the prosthesis
Journal of Structural Heart Disease, August 2019
were observed either.
5. A greater number of cases are needed to establish
meaningful Conclusions.
87. USE OF REAL-TIME THREE-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN CLOSURE OF MULTI-FENESTRATED ATRIAL SEPTAL DEFECTS
James Kuo, Lisa Roten, Steve Muyskens
Cook Children's Medical Center, Fort Worth, USA
The use of real-time three-dimensional (3D) transesopha- geal echocardiography (TEE) has emerged as an important imaging modality to assist with interventional catheter- izations. We describe two cases where 3D TEE delineated anatomy integral to guiding transcatheter device occlu- sion of multi-fenestrated atrial septal defects (ASDs) not identified by two-dimensional (2D) TEE.
Patient 1 was a 16 year old with large secundum ASD and moderately dilated right ventricle on transthoracic echo- cardiogram (TTE). 2D TEE demonstrated a large defect measuring 22x20 mm with short 2 mm posterior rim, and a separate anterior defect measuring 5 mm. However, 3D TEE demonstrated a thin band of septal tissue running through the middle of the larger defect, effectively separating it into two defects, one anterior measuring 8x8 mm and the other posterior measuring 10x12. It was felt that this band of tissue was very thin and would be significantly displaced or torn with a sizing balloon. The smaller inferior, anterior defect was crossed under 3D TEE guidance. Inflating the sizing balloon resulted in a significant waist measuring 11.5x11.4 mm without any disruption in the band of tissue. The superior, posterior defect was crossed and the sizing balloon had a waist measuring 16x17.6 mm. Because there was no apparent disruption of the thin band of tissue, it was felt that the tissue would safely support device place- ment. Initially, a 30 mm Cardioform Septal Occluder was placed in this larger posterior defect, but it did not cover the smallest separate most anterior defect and there was a significant amount of residual shunting posteriorly. A 35 mm Amplatzer Cribriform device was then placed in this defect. The device occluded the most anterior defect and it only left a tiny 2mm residual shunt posteriorly. This device was released. Transthoracic echocardiogram at 4 month follow-up showed no evidence of residual shunting.
Patient 2 was a 19 year old with multi-fenestrated ASD with an inferior defect, separate patent foramen ovale (PFO), and right atrial enlargement seen on TTE. By 2D TEE, the inferior defect measuring 5x11 mm and PFO were confirmed. The
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