Page 77 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
pulmonary valvuloplasty (8), balloon atrial septostomy (1), and pericardiocentesis (1).
Conclusion: Through in-country training, Uganda Heart Institute is building operator depth toward a sustainable pediatric cardiac catheterization program.
100. PULMONARY VEIN ATRESIA: TRANS-CATHETER INTERVENTIONS AND LONG TERM OUTCOMES
Varun Aggarwal, Gary E Stapleton, Henri Justino
Texas Children's Hospital and Baylor College of Medicine, Houston, USA
Background: Outcomes for congenital or acquired pulmo- nary vein atresia (PVA) have historically been poor, often leading to progressive pulmonary hypertension, cardiac failure and death. Furthermore, transcatheter or surgical treatment options had been limited by high failure rates. We describe our single center outcomes of transcatheter management of PVA.
Methods: Retrospective chart review of all patients (pts) who were diagnosed with PVA and underwent cardiac catheterization (cath) from 1995 to 2019 at a single tertiary center.
Results: 50 pts with 83 atretic veins underwent cath from April 1995 to May 2019 for evaluation/management of PVA. The median (IQR) age at cath was 1.6 (0.7, 6.45) years. Most common diagnosis was PVA associated with complex congenital heart disease (n=22 pts), followed by isolated congenital PVA (11), total or partial anomalous pulmonary venous return post-surgical repair (8), and prematurity (6). One pt each had fibrosing mediastinitis, Adams Oliver syndrome, and PVA following atrial fibrilla- tion ablation. 37 pts had biventricular circulation and 13 patients had undergone single ventricle palliation. 25 pts (50%) did not undergo any intervention, the other 25 pts received transcatheter interventions on 41 atretic veins. Only 4 pts underwent recanalization attempts prior to 2015; 21/25 pts received attempted interventions after January 2015. 16/25 (64%) pts had successful PV recanal- izations. All recanalization attempts were performed from the left atrium to the atretic PV except in 2 pts (one with unsuccessful attempted recanalization via the collateral vessel from the other ipsilateral PV and one with trans- thoracic PV access and successful recanalization). 21/25 attempted recanalizations were performed using 0.014” chronic total occlusion (CTO) wires [most commonly used wires include Victory wire (Boston Scientific), Pilot wire (Abbott Vascular)]. Radiofrequency (RF) perforation with a Nykanen 0.024” RF Wire (Baylis Medical) or by electrifying
a 0.014” guidewire was used in 4 pts. The atretic length of the recanalized vein in the successful cases varied from 4-22mm. 3/16 pts underwent balloon angioplasty alone and 13/16 (81.3%) pts had drug eluting stents (DES) placed. 12/13 pts received 4mm diameter DES (Promus Premier, Boston Scientific), and one received a 5mm DES (Resolute Onyx, Medtronic). 3 pts had complications during the reca- nalization procedure (1 pulmonary hemorrhage, 1 peri- cardial effusion and 1 with intimal injury of recanalized vein). 10/16 pts had subsequent reinterventions at last fol- low up. The median time from PVA recanalization to last angiographic evaluation among the 10 pts was 0.6 (0.25, 1.6) years. One patient had recurrent atresia of a stented PV which was successfully recanalized, while the recanalized PVs in other 9 pts (90%) remained patent but needed fur- ther angioplasty for either in-stent restenosis or to account for pulmonary vein growth.
Conclusions: We describe the largest cohort of PVA under- going transcatheter interventions, the majority of which were performed after 2015. Success of recanalization has remarkably improved over the years with the use of CTO wires and RF. We describe the first transthoracic PV reca- nalization in one pt. The long-term outcomes for this chal- lenging lesion are encouraging but continued surveillance and frequent reinterventions are needed in these pts.
101. PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE AND ITS IMPLICATION IN THE DEVELOPMENT OF NEW-ONSET ATRIAL FIBRILLATION
Laura Oliva1, Claudia Frankfurter1, Madeleine Barker1, Lusine Abrahamyan1,2, Eric Horlick3,1
1University of Toronto, Toronto, Canada. 2Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Canada. 3Peter Munk Cardiac Centre, Toronto, Canada
Objectives: This systematic review and meta-analysis syn- thesized evidence on the effect of transcatheter patent foramen ovale (PFO) closure on the risk and predictors of atrial fibrillation (AF) development.
Background: Affecting approximately 20% adults, PFO increases the risk of cardiovascular complications such as cryptogenic stroke. The transcatheter closure of PFO is the current standard of care but has recently been implicated in post-closure, new-onset atrial fibrillation (AF).
Methods: Randomized controlled trials, cohort, and case/ control studies were retrieved from electronic databases and selected according to the inclusion criteria of adults with PFO (> age 18) without a history of AF that underwent a transcatheter closure surgery. Baseline characteristics
Hijazi, Z
22nd Annual PICS/AICS Meeting