Page 72 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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due to elevated risk of pulmonary hypertension with sys- temic desaturation, low output syndrome, cardio-respira- tory compromise and right heart failure.
[1] Robert Schueler, C. O. (2015). Persistence of Iatrogenic Atrial Septal Defect After Interventional Mitral Valve Repair with the Mitraclip System. JACC: Cardiovascular Interventions Vol. 8 No. 3, March 2015: 450-9.
96. FONTAN PATHWAY AND FONTAN FENESTRATION TEST OCCLUSION EVALUATION IN THE ICMR SUITE
Yousef Arar1, Tarique Hussain 1, Vasu Gooty1, Riad Abou Zahr2, Joshua Greer1, Jennifer Hernandez1, Gerald Greil1, Prathyusha Mahasamudram3, Surendranath R. Veeram Reddy1
1UT Southwestern Medical Center, Dallas, USA. 2King Faisal Specialist Hospital, Riyadh, Saudi Arabia. 3University of Texas, Dallas, Dallas, USA
Introduction: Fontan pathway and Fontan fenestration test occlusion (FFTO) evaluation is traditionally performed in the cardiac catheterization laboratory. Transcatheter clo- sure of Fontan fenestration has been shown to be safe and effective in raising arterial oxygen saturations. However, the optimal timing and indications for such closure remain a matter of debate. In addition, there are concerns regard- ing the validity of the data (cardiac flows/output) obtained during traditional FFTO evaluation in the cath lab.
In this study, we explore the feasibility and safety of per- forming radiation-free interventional cardiac magnetic resonance (iCMR) catheterization in the Fontan popula- tion. We also describe our initial experience with FFTO evaluation in the iCMR suite, which allows for simultane- ous measurement of catheter-based hemodynamics and CMR-derived flows to more accurately quantify pulmonary (Qp) and systemic (Qs) blood flow. FFTO evaluation in the iCMR suite also allows for quantification of the Fontan fen- estration flow and thereby its contribution to the overall cardiac output which in turn aids in making critical deci- sions regarding candidacy for Fontan fenestration device closure (FFDC).
Methods: Fontan patients underwent iCMR RHC and LHC procedure using dilute gadolinium-filled balloon-tip cath- eter in combination with the MRI compatible EmeryGlide guidewire (Nano4Imaging,Aachen,Germany) for Fontan pathway/RHC, LHC, and FFTO under real-time MRI visual- ization. A recently developed partial saturation (pSAT) pas- sive catheter tracking technique was used for simultaneous visualization of the gadolinium-filled balloon, EmerygGlide guidewire, and cardiac structures.
Once baseline hemodynamics and cardiac flows were measured, the Fontan fenestration is crossed using the 0.035” EmeryGlide guidewire under MR guidance. The
96. Figure 1. Successful Fontan Fenestration Test Occlusion (FFTO) followed by successful Fontan Fenestration Device Closure in the Cath Lab. Red Arrow - Gadolinium-filled balloon; Green Arrow - MRWire.
Journal of Structural Heart Disease, August 2019 Volume 5, Issue 4:75-205