Page 83 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
109. PERICARDIAC MASS CAUSING RIGHT VENTRIC- ULAR OUTFLOW TRACT OBSTRUCTION FOLLOWING BALLOON DILATION OF A RIGHT VENTRICLE TO PUL- MONARY ARTERY HOMOGRAFT.
Shanique Sterling1, Rachel Manalo1, Robert Toussant1, Satinder Sandhu2
1Jackson Memorial Hospital, Miami, USA. 2University of Miami, Miami, USA
Contained and uncontained disruption of the homograft has been described in patients undergoing transcatheter dilatation or stent placement in a stenotic or regurgitant right ventricle (RV) to pulmonary artery (PA) homograft. Disruption of the homograft can be asymptomatic or can cause hemodynamic compromise during the procedure or within hours. We describe the presentation of hemody- namically significant right ventricular outflow tract (RVOT) obstruction by external compression more than 11 months after the procedure.
A 26 year old male with Type II truncus arteriosus previ- ously underwent ventricular septal defect closure and multiple right ventricle to pulmonary artery conduit revi- sions. At 15 years of age a 24 mm RV to PA aortic homo- graft was placed and a bovine pericardial patch was used to extend the homograft. In addition a gortex pericardial membrane (Gore, Flagstaff, Az) was placed to cover the homograft. At 26 years of age he presented with a heav- ily calcified, stenotic and regurgitant homograft. He underwent balloon dilation with a high pressure balloon followed by prestenting of the homograft with a Palmaz XL 3110 (Cordis, Milpitas, Ca) into which a 22 mm Melody valve (Medtronic Inc, Minneapolis, MN) was placed on a 20 mm Ensemble. There was a decrease in the right ventric- ular pressure from 65% systemic to 38% of systemic. At 1 year follow up post procedure an increasing gradient was noted across the RVOT below the melody valve from external compression. An MRI done revealed a pericardiac lesion compressing the RV free wall and the RVOT. There was no communication noted between the RVOT and the compressing lesion. A CXR done showed no narrowing or fracture of the melody valve. A cardiac catheterization was done 17 months post Melody valve placement and on balloon dilation of the RVOT there was no residual waist. A covered CP stent was placed across the valve and the RVOT and a 22mm Melody valve was placed within it. There was restenosis noted at the 1 month follow up. He underwent surgery and on removal of the gortex pericardium it was noted that there was a large amount of old clot that had accumulated under the gortex membrane which was com- pressing the RVOT. The second stent and melody valve were removed. The original melody valve was functional
and was left in place and a new pericardial patch was placed to extend the homograft.
Conclusion: Disruption of RV to PA homograft is an estab- lished yet relatively infrequent complication with most cases presenting in the periprocedure period. In this patient the gortex membrane placed to cover the homo- graft became a pocket in which the bleeding from the pro- cedure resulted in clot formation that remained contained over an extended period of time eventually resulting in compression of the RVOT.
110. COIL EMBOLIZATION OF MAJOR AORTOPULMONARY COLLATERALS IN A CRITICALLY ILL INFANT WITH SCIMITAR SYNDROME
Raymond Morales1, Aya El Jerbi2, Joshua Murphy1
1Rush University Medical Center, Chicago, USA. 2Southern Illinois University, Springfield, USA
Scimitar syndrome is a rare congenital heart anomaly, con- sisting of abnormal partial anomalous pulmonary venous drainage to the inferior vena cava and right lung hypopla- sia in association with dextroposition of the heart. Patients may have variable presentation ranging from a lack of symptoms to florid congestive heart failure. We report on a rare case of a 2 month old infant with Scimitar syndrome who developed acute cardiopulmonary compromise sec- ondary to a viral infection that only improved after coil occlusion of two aortopulmonary collaterals. This report provides further evidence that early identification and per- cutaneous treatment of these collaterals may have signifi- cant clinical benefit prior to any surgical intervention.
111. NOVEL ULTRASOUND GUIDED INTRAOPERATIVE NEEDLE BIOPSY OF INTRACARDIAC TUMOR
Subhrajit Lahiri, Henri Justino, Jeffrey Heinle, Jeffrey Kim, Santiago Valdes, Jose Hernandez, Christina Miyake Texas Children's Hospital, Houston, USA
Background: This is a case report of a patient with intra- cardiac teratoma and ventricular tachycardia. In this case report we describe the use of a novel hybrid approach to histopathologic diagnosis of a ventricular septal teratoma using ultrasound guided intraoperative biopsy without need for cardiopulmonary bypass.
Case Report: Patient was born with a prenatal diagnosis of a intracardiac tumor in the interventricular septum which was confirmed post-fatally. An open surgical biopsy of the mass was considered after birth but was deferred because the mass was deemed unresectable due to the size and location of the tumor occupying the entire interventricular
Hijazi, Z
22nd Annual PICS/AICS Meeting