Page 94 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
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median radiation dose of 20 DAP/kg [11, 43] while among the remaining centers (n=3) median radiation dose was 79 DAP/kg [47, 149]. The lower exposure group had a shorter median procedure time (66 min [48, 94] versus 87 min [67, 123]) and median fluoroscopy time (13 min [9, 18] versus 23 min [16, 41]). Percentage of cases with a fellow present did not differ between groups, 83% and 84%. Median ASD size was similar, 11 [8, 16] and 11 [9, 15]. High severity AE (level 3, 4 or 5) were recorded in 5.2% (n=22) of cases, with no mortality and a higher rate of AE among the higher-ra- diation group (9% versus 3%).
Conclusions: Differences in median radiation dose by cen- ter exist and are associated with differences in procedure and fluoroscopy time between lower- and higher-radiation centers, suggesting potential to modify practices during transcatheter ASD closure to decrease patient radiation exposure.
124. OVER-EXPANSION OF RIGHT VENTRICLE
no different between groups (19.7 over-dilation vs. 20.2 mm control, P=0.2). Procedural complications were more frequent in the over-dilation (18%) compared to the con- trol (7%) groups (nearly all were able to be successfully addressed during the procedure). Only one patient from each group required urgent surgical intervention. There was no mortality in either group.
Conclusions: Over-expansion of RV-PA conduits during TPVR can be safely and effectively performed. Procedural complications are more frequent with RV-PA conduit over-dilation, but there was no difference in the rate of life-threatening complications. The long term outcomes of TPVR with conduit over-expansion requires further study.
125. ENDOVASCULAR TREATMENT OF COMPLEX AORTIC ANEURYSM – PRE-PROCEDURAL USE OF 3D PRINTED MODEL
Rachel Taylor, Thomas Forbes, Daisuke Kobayashi
Children's Hospital of Michigan, Detroit, USA
Introduction: Pre-procedural planning is crucial for complex transcatheter intervention. Three-dimensional printed model is an emerging modality for congenital and structural heart disease. We report a pediatric case of native complex aortic aneurysm. Pre-procedural planning and case simulation was performed using the life-sized 3D printed model. Transcatheter covered stent placement was successfully performed.
Case: A 17-year old girl was found to have aortic aneu- rysm on echocardiography from a heart murmur evalua- tion. Chest computed tomography with contrast showed a large complex aneurysm of the proximal descending aorta (Figure 1A). This complex lesion appeared to take a very tortuous course with stenosis component. The larg- est diameter of aneurysm measured 33 x 37 mm. The fea- sibility of transcatheter therapeutic option was discussed but deemed challenging due to its complex anatomy. The life-sized 3D Printed Model (Figure 1B) was used to help understanding of the anatomy. Furthermore, the model was used for procedural case simulation (Figure 1C). After these exercise, she was taken to the catheterization lab- oratory and underwent endovascular treatment of this complex aortic lesion. There was 20 mmHg of systolic pressure gradient across the aortic lesion, consistent with coarctation component. Angiography showed a very large and tortuous complex aortic aneurysm (Figure 1D). Using a 14-Fr Flexor sheath, two covered stents (45 mm NuMed Covered CP stents) were delivered serially by 18 and 20 mm x 5 cm BIB balloon catheters during right ventricular pacing. Further stent dilation was performed by 22 mm
TO PULMONARY ARTERY
TRANSCATHETER PULMONARY VALVE PLACEMENT Dana Boucek1, Athar Qureshi2, Varun Aggarwal2, Michelle Riley1, Joyce Johnson3, Robert Gray1, Mary Hunt Martin1
1University of Utah/Primary Children's Hospital, Salt Lake City, USA. 2Texas Children's Hospital, Houston, USA. 3Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
Objectives: To determine the safety and feasibility of over-expansion of right ventricle to pulmonary artery con- duits (RV-PA) during transcatheter pulmonary valve place- ment (TPVR).
Background: TPVR has become an accepted alternative to surgical pulmonary valve replacement. Traditionally, it was thought to be unsafe to expand a conduit to >110% of its original size.
Methods: This is a retrospective cohort study from two centers of patients with RV-PA conduits who underwent attempted TPVR using the Medtronic Melody Valve from 2010-1017. Demographic data, procedural success, and complications were compared between control and over-dilation (expanded to >110% original conduit size) groups.
Results: A total of 172 patients (51 over-dilation and 121 control) had attempted TPVR with a success rate of 98% in both groups. The over-dilation group was younger (11.2 vs 16.7 years, p=<0.001) and smaller (32.8 vs. 57.8 kg, p=<0.001) with smaller original conduit diameters (15 vs. 22 mm, P=<0.001), however, the final valve size was
CONDUITS DURING
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205