Page 79 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
against the walls of the vessels in the lungs manifesting as a condition known as pulmonary hypertension (PH).
If left untreated, PH in patients with ASD can be associated with poor prognosis including: atrial arrhythmias, heart fail- ure, heart functional limitations, and other increased mor- bidity and mortality. The role of ASD closure and its effects on PH are unclear. While closure of significant sized ASDs should result in a lowering of mPAP, there is a subset of patients in which ASD closure increases mPAP. Information regarding the relationship between ASDs and PH and the mechanisms by which they operate is limited. Research is needed on the reduction or development of PH post ASD closure, changes in mPAP, and important clinical features in patients undergoing ASD closure to address this gap.
Objective: The purpose of this review is to report the prev- alence of PH, report changes in mean pulmonary pressure, and report clinical outcomes in patients undergoing tran- scatheter ASD closure. In addition, this study aims to report key patient characteristics and the identify PH cut offs used in the literature.
Methods: EMBASE and MEDLINE were searched for peer reviewed literature until February 2019. All studies includ- ing PH prevalence and outcomes before and after closure in an adult population were included. Papers were assessed and data was summarized.
Results: Prevalence of PAH ranged from 5% to 27% follow- ing ASD closure. The pooled mean pulmonary artery pres- sures (mPAP) were 51.88 mmHg before closure and 36.63 mmHg after closure. Prevalence of PH and mPAP decreased before and after ASD closure in all studies.
Conclusions:This review has found a reported prevalence of PH among patients that have undergone ASD closure to be between 5% and 27%. Because of this substantial pro- portion of patients that still have PH following closure, long term follow-up is necessitated. All studies included in this review reported declines in mean pulmonary arterial pres- sure following transcatheter closure in their study popula- tions. The observed reduction in mPAP, was correlated with pre-closure mPAP levels. Patients with higher mPAP before ASD closure, experienced a greater decline post closure in comparison with those with lower initial mPAP.
104. COMPARISON OF FUSION IMAGING AND TWO- DIMENSIONAL ANGIOGRAPHY FOR GUIDANCE OF PERCUTANEOUS PULMONARY VEIN INTERVENTIONS
Sebastian Goreczny1,2, Jenny Zablah2, Gareth Morgan2,3, Daniel McLennan4, Rizwan Rehman5, Michal Schafer2, Michael Ross2
1Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland. 2Children's Hospital Colorado, Aurora, Colorado,
USA. 3University of Colorado Hospital, Aurora, Colorado, USA. 4University of Iowa, Stead Family Children's Hospital, Iowa City, Iowa, USA. 5Birmingham Children's Hospital, Birmingham, United Kingdom
Background: Congenital and acquired pulmonary vein (PV) stenoses comprise a group of complex conditions often requiring numerous interventions in early childhood. Balloon dilation has demonstrated limited long-term effi- cacy, whereas stent implantation requires repeat dilations to match somatic growth or in-stent restenosis. Modern angiographic imaging platforms allow three-dimensional (3D) guidance with fusion of pre-operative computed tomography (CT) or magnetic resonance imaging (MRI) datasets promising reductions in contrast and radiation dose, fluoroscopy and study time.
Objectives: We report our initial experience with fusion imaging (FI) for guidance of percutaneous PV interven- tions and compare this with patients undergoing PV inter- vention using traditional 2D angiography.
Methods: A retrospective review of our institutional data- base was performed to identify all patients who underwent percutaneous PV interventions. Patients demographics, pre-procedural cross-sectional imaging and catheteriza- tion data were collected. Patients who underwent fusion of pre-catheter scans (VesselNavigator, Philips Healthcare; available for the last 9 months of the studied period) for procedural guidance were matched (1:1) to those with standard 2D angiography. The following parameters were used for matching: body surface area, type of intervention (balloon dilation ± stent implantation), number of treated veins. Statistical analysis was performed using Wilcoxon- matched pairs signed rank test.
Results: Between 12/2017 and 5/2019, 24 patients with PV stenosis underwent 64 catheterizations: 8 diagnostic and 56 interventional. Fusion imaging was utilized during 7 interventional catheterizations. One case of radiofre- quency PV perforation with FI was excluded from further analysis due to lack of a matching example in the 2D group. There were no significant differences between those with 2D guidance (n=6) and FI (n=6) in terms of body surface area (median 0.38 vs. 0.4 m2, p=.812), weight (7.5 vs. 7.8 kg, p=0.999) and age (13.5 vs. 19 months, p=.625). Similarly, there were no differences in CRISP score (11 vs. 10 points,
Hijazi, Z
22nd Annual PICS/AICS Meeting