Page 98 - Journal of Structural Heart Disease Volume 5, Issue 4

Meeting Abstracts
160
129. UTILIZATION OF 3D RECONSTRUCTION OF CT OVERLAID ON FLUOROSCOPY FOR AORTOPULMONARY COLLATERALS EMBOLIZATION IN COMPLEX ANATOMY
Rahul Singh1, Zhongyu Li2, Ponraj Chinnadurai3, Brian Karahalios1, Miguel Chavez1, Stephanie Fuentes1, John Breinholt4, C. Huie Lin2
1Houston Methodist Hospital, Houston, USA. 2Houston Methodist DeBakey Heart & Vascular, Houston, USA. 3Siemens Medical Solutions USA, Inc. , Hoffman Estates, USA. 4Memorial Hermann, Houston, USA
Introduction: Pre-procedure cardiac CT overlaid on live 2D fluoroscopy provides real-time guidance for complex cases such as aortopulmonary collateral embolization. 3D regions of interest generated on CT mark collateral takeoffs and nearby landmarks and optimal projection angle can be determined for maximum visualization of collaterals. We present two cases in which we used this tool for embo- lization of aortopulmonary collaterals.
Case 1: 34 yo F with PDA and Eisenmenger syndrome being treated medically for pulmonary hypertension pre- sented with recurrent hemoptysis. Previous CMR showed large (~1.0 cm) PDA with bi-directional shunting (Qp:Qs = 0.8). CTA showed aortopulmonary collaterals in the ante- rior and inferior right upper lung lobe with surrounding residual hemorrhage.
In the cath lab, we obtained images from RAO 61and LAO 30 to preform 2D/3D registration with the CTA, using the spine, a pigtail catheter in the aorta, a wire in the right atrium and the area of pulmonary hemorrhage as land- marks. This enhanced the efficient cannulation and suc- cessful embolization of RIMA, LIMA and bronchial artery collaterals.
Case 2: A 35 yo F with a h/o single chamber atrium, hetero- taxy (right atrial isomerism) with interrupted IVC and pul- monary hypertension on 5L home oxygen presented with SOB on minimal exertion. Angiography showed Qp:Qs=2.2 and aortopulmonary collaterals from the RIMA, medial sur- face of the descending thoracic aorta and arch vessels. We decided to embolize the collaterals to prevent peri opera- tive bleeding at the time of transplant.
We obtained images from RAO 1 and LAO 36 to preform 2D/3D registration. The spine, bronchial tree and a cathe- ter coming from the descending aorta to the innominate artery worked as landmarks in X-ray. We embolized the right pectoral, RIMA, LIMA and bronchial artery collaterals.
We obtained closure of the proximal left bronchial artery with a vascular plug.
Discussion: 3D reconstruction of CT overlaid on fluoros- copy is a powerful method to maneuver within complex anatomy and identify optimal fluoroscopic projection for cannulation and embolization of aortopulmonary collat- erals potentially reducing contrast and fluoroscopy time. Timely treatment of these collaterals is critical to prevent fatal hemoptysis and operative bleeding.
130. FIRST REPORTED CASE OF CLOSURE OF TYPE III INTRA HEPATIC PORTO-SYSTEMIC SHUNT WITH PORTAL ANEURYSM IN A NEONATE PRESENTED WITH SEVERE PULMONARY HYPERTENSION AND CARDIAC FAILURE
Sudeep Verma, Ananta Ram Gudipati, Gouthami V, Nanda Kishore V
Krishna Institute of Medical Sciences , HYDERABAD, India
INTRODUCTION: Congenital portosystemic shunt is a rare congenital abnormality. We are presenting here a case of persistent pulmonary hypertension (PPHN) and cardiac failure in a 8 days old neonate due to intrahepatic porto- systemic shunt with communication between Left hepatic vein and left portal vein through an aneurysm (Type III Park Portosystemic shunt). Successful closure of the shunt was done with multiple coils deployed into an aneu- rysm with improved clinical status.
CASE DETAILS: One day old male late preterm neonate (35 weeks) delivered by caesarean section referred to our neonatal ICU in view of respiratory distress soon after birth. In view of increasing oxygen requirement and chest radio- graph showing cardiomegaly with bilateral diffuse lung opacities, baby was intubated and surfactant was admin- istered. Echocardiography showed dilated right ventricle with moderate tricuspid regurgitation and severe pulmo- nary artery hypertension (PAH) for which baby was started on intravenous Sildenafil infusion. In view of persistent oxygen requirement and PAH with poor response to med- ical and ventilatory management radiology opinion was taken to rule out secondary causes of PAH beyond heart and lungs. Ultrasound abdomen showed a Park type 3 congenital intrahepatic portosystemic shunt through an aneurysm with mild ascites and diffuse subcutaneous oedema. Persistent severe Pulmonary hypertension was attributed to intrahepatic shunt, which is a known com- plication of the shunt and percutaneous shunt closure was planned in view of deteriorated clinical status. CECT abdomen was acquired prior to shunt closure which con- firmed a tubular vascular channel measuring 4.5 mm
Journal of Structural Heart Disease, August 2019
Volume 5, Issue 4:75-205