Page 97 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
evaluated by increase in Qp/Qs or decrease in RV/LV ratio with the addition of supplemental oxygen and/or inhaled nitric oxide (iNO). Only 4 (36%) of the patients showed significant reactivity of PH with either 100% FiO2 oxygen or iNO. In five of the eleven cases (45%), the severity of PH precluded further cardiac intervention and repair of cardiac defects. Three of these patients were placed on Bosentan and Sildenafil, one was on Sildenafil then tran- sitioned to Tadafil, but all ultimately died. The six patients with significant reactivity were able to undergo complete repair pulmonary vasodilators post operatively. Of these six patients who were able to undergo complete repair four are currently alive with a median length of survival of 3.9 years old.
Conclusion: The degree of PH is important in determining the management of patients with Trisomy 18 and CHD. A subgroup of these patients appear to have more severe PH at an earlier age than children without Trisomy 18 with comparable congenital heart defects. The severity of the PH and absence of reactivity may limit the ability to offer cardiac intervention in some patients and may contrib- ute to mortality. In the most severe patients of our small series, pulmonary vasodilators did not seem to improve survival. Given the complex decision-making for cardiac intervention in this population of patients, preoperative cardiac catheterization may need to be considered for risk stratification prior to intervention.
128. INITIAL LATINAMERICAN EXPERIENCE WITH THW NEW KONAR-MF OCCLUDER INCONGENITAL HEART DISEASE
Liliana Ferrin1,2, Jesus Damsky Barboza3, Marcelo Rivarola4, Victorio Luccini5, Teresa Escudero1, Fernanda Biancolini3 1instituto De Cardiologia De Corrientes, Corrientes, Argentina. 2colegio Argentino De Cardioangiologos Intervencionista, Buenos Aires, Argentina. 3hospital De Ninos "Pedro De Elizalde", Buenos Aires, Argentina. 4hospital Universitario Austral, Buenos Aires, Argentina. 5hospital De Ninos Pedro De Elizalde, Buenos Aires, Argentina
Background: Device closure is now an accepted modal- ity of treatment for cardiac septal defects, patent ductus arteriosus and other non septal defects with well accepted indications. Devices used for these defects have usually not been specifically designed for use in them. The Konar MF occluder is a woven nitinol mesh self center device with two discs joined by an articulated arm which let that the device adapt to any anatomical defect. Our purpose is to assess the feasibility use of this device as well as the short and mid-term results in cardiac diseases and other cardiac
and vascular defects although it has not initially for use in such conditions
Methods: From October 2017, 40 patients from 1month to 37yr, were treated percutaneously with the MFO device for various conditions. All patients were > 2,5 kg and had clinical defect closure indication. The cardiac diseases were divided in 3 anatomical groups: Ventricular septal defects (VSD) n=27, patent ductus arteriosus (PDA) n=11, and Miscelaneous as OTRVF occlusion n=1, Blalock Taussig shunt n=1 and Total Cavo-pulmonary bypass fenestration n=1. Successful results graduated as none or minimal shunt immediately and 24 hours pos intervention, moderate or large shunt unsuccessful. Follow up at a week, 1 month, 3, 6 and 12 month. A t-test or student test has been used for statistical analysis
Results: Successful occlusion without shunt immediately or till 24 hours was achieved in all but one patient. VSD clo- sure has been performed in 26 of 27 patients. Three patients weighed less than 5 kg and had associated complex con- genital heart disease. VSD type were 17 perimembranous and 9 muscular, one of these infundibular subpulmonary VSD was closed by retrograde way. Gerbode type were 4 of them, 3 residual post surgical closure in Tetralogy of Fallot. The average of right waist was 5.07 mm(+-1,52), the left waist was 7.07mm(+-1,52). Procedures were successful in 26 of 27 pt with trivial or not residual shunt (97%). The failed procedure was in a large muscular VSD but transient AV Block was present.
The patent ductus arteriosus procedures were suc- cessful with complete closure immediately. Krischenko type A ductus in 6, type C in 3, D and E 1 pt each one. Anterogradely approach was used in 8 and retrogradely in 3. The OTRVF occlusion has been done in a Tricuspid Atresia with non functional Glenn anasthomosis because of antegrate pulmonary flow. A 14-12 mm MFO device was deployed through the Pulmonary Valve with normalized pulmonary pressures after occlusion. There were no com- plications related to device in any patient in short to mid term follow-up.
Conclusion: It is feasible in patients with cardiac septal and non septal defects, patent ductus arteriosus and other selected defects to treat successfully with the Konar-MF device occluder without significant complication. The low profile allows closure of large defects even in low weight patients. There will be necessary long term follow up to let us know more details
Hijazi, Z
22nd Annual PICS/AICS Meeting