Page 88 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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months (range 79 days to 5.5 years); average weight was 8.4kg (range 4.3kg-12.6kg). Eight stents (32%) developed a spontaneous circumferential fracture without hemody- namic or clinical implications. Three stents (12%) were frac- tured intentionally with re-stenting within the fractured stent. The Cook Formula stents (n = 15) were expanded on average to 169% of their original diameter (OD), 151% of the (manufacturer recommended) nominal expansion diameter (NED), and 82% of the experimentally reported maximal expansion diameter (MED). Genesis stents (n = 6) were expanded on average to 145% of their OD, 145% NED, and 82% MED. VisiPro stents (n = 4) were expanded on average to 170% OD, 151% NED, and 106% MED. There were no major adverse events (stent embolization, ves- sel disruption with hemorrhage, stent thrombosis) in the cohort.
Discussion: Small, low-profile stents have a capacity for safe expansion far beyond what is recommended by the manufacturer. Dilation to or beyond the reported maximal expansion diameter and even fracture of the stent with re-stenting did not result in significant adverse events in this cohort. This data suggests that use of small stents with serial dilations over the course of months and years is a safe and effective strategy. Additionally, the technique of expanding small stents to or near the point of fracture, then deploying a larger stent within the smaller stent while intentionally fracturing the original small stent, which was utilized in a few cases, shows promise and will be the focus of further study in this cohort as patient growth continues.
Conclusion: Serial balloon dilation of small stents beyond the manufacturer recommended expansion diameter to or near the true maximal expansion diameter appears safe in this cohort of children. Intentional stent fracture with re-stenting also appears safe, although the number of patients is small. Further study is needed to confirm these initial observations.
118. USE OF DEFLECTABLE SHEATHS TO GUIDE COMPLEX CONGENITAL HEART INTERVENTIONS
Khalid Al-Alawi, Li Yen Ng, Paul Oslizlock, Kevin Walsh, Damien Kenny
Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
Introduction: As the complexity of transcatheter interven- tions have increased, so has the requirement for adjuncts to assist in catheter support and precise catheter position- ing. Deflectable sheaths have been used in electrophysi- ology studies for many years to optimize precise catheter placement and are becoming more commonplace partic- ularly in complex anatomy to assist with stent and device
placement. We present our single centre experience using deflectable sheaths in pediatric patients undergoing com- plex interventions.
Methods: We conducted a retrospective review of all pedi- atrics patients who required a deflectable steerable sheath during cardiac catheterization in our center. Medical records were reviewed to obtain clinical, demographic and outcome data.
Results: Deflectable sheaths were used in 15 patients. The median IQR age was 8 years (2yr 11 months – 13 yrs) with median IQR weight 18.7kg (14.9– 47). Six patients under- went pulmonary artery bifurcation stenting, four requiring Y stent technique. Three patients underwent successful closure of either complex membranous (n=2), or suprac- ristal (n=1) VSD’s. Two patients underwent Fontan fenes- tration interventions. One child underwent ovalisation of a LPA stent and another had occlusion of a complex collat- eral with two previous unsuccessful attempts using a fixed curve sheath. One teenager with severe idiopathic pulmo- nary hypertension underwent a reverse Potts shunt. One further child underwent distal RPA stenting with balloon- ing into a side branch assisted by a defelectabel sheath. All procedures were successful with no complications related to the use of the deflectable sheaths.
Conclusion: Deflectable sheaths assist in optimizing access to complex congenital heart lesions and provide support for device and stent delivery. In particular pulmo- nary artery bifurcation stenting and hybrid subxiphoid VSD closure in smaller children may benefit from this approach.
119. ANOMALOUS ORIGIN OF LEFT CORONARY ARTERY FROM RIGHT PULMONARY ARTERY IN ASSOCIATION WITH SCIMITAR SYNDROME
Safwat Aly1,2, Ramiro Lizano Santamaria1, Shi-Joon Yoo1,2
1The Hospital For Sick Children , Toronto, Canada. 2University of Toronto , Toronto, Canada
Clinical Presentation: A full-term neonate was referred to our institution because of respiratory distress requiring respiratory support. Chest x-ray was significant for right lung hypoplasia and mild cardiomegaly. Electrocardiogram showed normal sinus rhythm, right atrial enlargement, and right ventricular hypertrophy with no signs of isch- emia. Genetic testing revealed FRAS1 gene mutation.
Imaging Findings: The initial echocardiogram demon- strated a partial anomalous pulmonary venous drainage with the right upper pulmonary vein draining into infe- rior vena cava /right atrium (IVC/RA) junction with flow
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205