Page 102 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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Sapien 3 THV. Diagnoses included tetralogy of Fallot (n=3) or valvar pulmonary stenosis (n=3). All patients had severe pulmonary regurgitation (100%), and no or trivial stenosis. Median age was 30.5 years, median weight 69.5 kg, and median height 167 cm. Most patients were only mildly symptomatic with NYHA class I/II (5) symptoms. All six patients were successfully implanted with both the Alterra prestent and SAPIEN 3 THV during a single procedure. Primary and secondary endpoints will be available at the time of the presentation.
Conclusions: The Alterra Adaptive Prestent potentially expands the number of patients with dysfunctional RVOTs who are candidates for transcatheter pulmonary valve replacement.
167. NOVEL TECHNIQUE FOR CORRECTION OF SEVERE LEFT PULMONARY ARTERY STENOSIS USING A GORE® VIABAHN® VBX BALLOON EXPANDABLE ENDOPROSTHESIS
Bawa, D., Thakkar, A., Rojas, S.F., Karanja, E., Monteiro, G., Breinholt, J., MacGillivray, T., Lumsden, A.L., & Lin, C.H..
Background: Pulmonary artery stenosis not infrequently complicates congenital heart disease. Availability of cov- ered stents for high risk dilations has been limited in the US to the covered Cheatham Platinum stent. We describe the rst use of the GORE® VIABAHN® VBX balloon expandable covered stent in pulmonary arterial intervention in a 46F with severe left pulmonary artery (LPA) stenosis.
Case: A 46F with a history of childhood VSD s/p patch repair, RVOT stenosis s/p trans-annular patch and LPA stenosis s/p re-implantation of LPA at age 5 presented with heart failure. Transthoracic echocardiography (TTE) showed LVEF 25-29%, severe hypertensive RV with enlargement and severely depressed function, mod-severe pulmonic regurgitation. CTA revealed severe stenosis at LPA ostium. Catheterization demonstrated severe RV hypertension 93/19 mm Hg, RPA 88/17/40 mm Hg, distal LPA 18/12/15 mm Hg, LV 90/14 mm Hg, PVR 9 WU. Angiography demon- strated an atretic LPA ostium but a main vessel of 13mm diameter. Quantitative lung perfusion scan demonstrated 89% blood ow to right and 11% to left lung. Intervention on LPA stenosis to reduce RV pressure was planned, how- ever, given the chronic severe RV hypertension and concern for disrupting the atretic ostium of the LPA, we planned to use a covered stent. As such, we chose a 9 mm x 29 mm GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis (Flagsta , AZ) and deployed this at nominal through an 8Fr Cook Check ow Performer braided sheath at the lesion.
To optimize apposition, we then successfully post-dilated the stent using a 12 mmx40 mm Armada® balloon (Abbott Vascular). Post intervention hemodynamics demonstrated a reduction of RV pressure to half systemic and no resid- ual gradient to LPA. TTE 1 week after procedure showed improved RV size and function.
Conclusion: We report the rst use of the GORE® VIABAHN® VBX Balloon Expandable Endoprosthesis in pulmonary arterial intervention. The advantages of this device include the ability to deliver through an 8Fr system, ability to post-dilate up to 16mm, and balloon-expandable covered stent platform with excellent radial strength. These qual- ities may be ideal in pediatric and congenital heart inter- ventions. However, long term outcomes with the use of this device in congenital heart interventions will require study.
168. DIFFERENCES AMONG EASTERN AND WESTERN REGIONS IN THE PATTERNS OF INTERVENTIONS
IN PAEDIATRIC CARDIOLOGY-A REGIONAL COMPARISON
Amjad Mehmood, M.D. Professor of Paediatric Cardiology
Armed Forces Institute of Cardiology & National Institute of Heart Diseases Rawalpindi, Pakistan.
Objective: This study was aimed to analyse the factors responsible for the variations in the patterns of paediatric cardiac interventions in Eastern and western regions of the world.This type of study is not carried before.
Background: Paediatric cardiac interventions are done globally in various centers of the world .The variety of cases and hardware is enormous to treat these cases in cath lab.There are multiple factors responsible for the vari- ation in types of procedures and types of devices used .The major di erences are Economics,Population,Literacy Level,Number of paediatric cardiac centers,Social Taboos,Training programmes,Types of manufacturing equipment,Structured sophisticated schedules,Account- ability,Government priority for Paediatric cardiology,Al- location of budgets for Paediatric cardiac services,Public awareness.In this study all these factors are looked in to detail and short coming are highlighted with practical and feasible recommendations.
Methods: In this study Asian areas like Pakistan, India, China, Japan, Thailand, Vietnam are compared with European and American regions.Statistical data from all these regions are collected and analysed in detail. Major centers in all these countries are selected for comparison.
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206