Page 76 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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Methods: Patients with SV CHD underwent real-time interventional CMR (iCMR) at 1.5 T. The MRWire (angled- tip Emeryglide MRWire, Nano4Imaging, Aachen, Germany) was used to aid completion of RHC and LHC. A dilute gad- olinium-filled balloon-tip catheter was used for RHC and LHC/aortic pull back under real-time MRI visualization. A recently developed passive catheter tracking technique with a real-time single-shot balanced steady-state free precession (bSSFP), partial saturation (pSAT) pulse of 40° with flip angle of 35-45° was used to visualize the gadolin- ium-filled balloon, MRWire and cardiac structures simulta- neously. A series of 4 conditions were performed to evaluate for test-retest reliability. The first and second conditions were catheterization and CMR data obtained at baseline and the third and fourth conditions were retest catheter and CMR data respectively. Pearson correlation coefficients (PCC) was used to measure test-retest reliability.
Results: A total of 18 SV CHD (14 Male) patients partici- pated in the iCMR reproducibility study at our institution. Median age and weight were 8.6 years and 27.3 kg (range: 3-33 years and 14.7-80.7 kgs). SV patient were split evenly with 9 referred for pre-Fontan evaluation, and 9 post-Fon- tan patients for PLE/cyanosis evaluation. Real-time MRI- guided RHC (18/18 patients, 100%), retrograde and prograde LHC/aortic pull back (18/18 patients, 100%) were successfully performed when the MRWire was utilized. No catheter related complications were encountered. Time taken for first pass RHC and LHC/aortic pull back was 5.2, and 2.7, respectively. Patients were transferred to the fluo- roscopy lab if further intervention was required including Fontan fenestration device closure, balloon angioplasty of pulmonary arteries, CoA stenting, and/or coiling of aor- topulmonary (AP) collaterals.
The PCC for Cath derived Qp (0.71) and Qs (0.6) was signifi- cantly lower than MRI derived Qp (0.91) and Qs (0.92).
Conclusion: Feasibility for diagnostic RHC and LHC iCMR procedures in SV patients with CHD is demonstrated. MRWire was used to successfully complete detailed RHC and LHC iCMR procedures in complex CHD. A novel real- time pSAT sequence with optimized FA-pSAT angle has facilitated simultaneous visualization of the catheter bal- loon tip, MRWire, and cardiac/vessel
MRI-derived flows have higher test-retest reliability than the catheterization-derived Fick method. This is most evi- dent when comparing the cardiac output between each modality. With more accurate iCMR Qp assessment, our PVR measurements will become more reliable to appro- priately triage SV patients for their next stage of palliation,
Fontan fenestration device closure etc. In addition, using the iCMR technique, we can more reliability obtain infor- mation about important cardiac output states.
99. BUILDING OPERATOR DEPTH FOR A SUSTAINABLE PEDIATRIC CARDIAC CATHETERIZATION PROGRAM: UGANDA HEART INSTITUTE’S EXPERIENCE
Twalib Aliku1, Kanishka Ratnayaka2, Sanjay Daluvoy3, Krishna Kumar4, Shakeel Qureshi5, Sulaiman Lubega1 1Uganda Heart Institute, Kampala, Uganda. 2Rady Children's Hospital / UCSD, San Diego, USA. 3World Children's Initiative, Palo Alto, USA. 4Amrita, Kochi, India. 5Evelina Children's Hospital, London, United Kingdom
Background: The Uganda Heart Institute (UHI) cardiac catheterization program was started in February 2012. The first primary operator (SL) was trained with a combination of the following: visiting team clinical service and training trips, out-of-country training fellowships, and weekly tele- medicine case discussion/mentorship. With one operator (SL), UHI achieved its aim of developing independent oper- ation after five years (2012-2016) of international mentor- ship, performing over 100 independent cases per year in 2017 and 2018, and is on track to perform 140 cases in 2019.
Methods: With an eye toward a sustainable practice, a prospective plan to build depth was instituted focused on in-country training of a second primary operator. In year two of operation (2013), dedicated in-country training of a junior attending pediatric cardiology physician was ini- tiated. The goal was, in successive years, progression from tertiary to secondary to primary operator performing in-country UHI pediatric cardiac catheterization cases.
Results: Since 2012, UHI has performed 561 congenital heart disease catheterization procedures. 392 (70%) are independent UHI procedures (no international provider presence). Procedures are patent ductus arteriosus (PDA) device closure (278), diagnostic catheterization (164), bal- loon pulmonary valvuloplasty (69), and other (50)].
Of the 561 UHI cases, the new operator (TA) has partic- ipated in 454 (81%). TA performed as tertiary operator in 56 (86% of those were in years 2013-2014), as secondary operator in 310 (96% of those were in 2015-2018), and as primary operator in 61 (98% of those were in 2018-2019). TA has been the primary operator in (50), 94% of all cases done so far this year (2019).
Cases performed by TA as primary operator include PDA device closure (38), diagnostic catheterization (13), balloon
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205