Page 13 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
Objective: To analyze rst experience of balloon angio- plasty of CoA in newborns and infants.
Material: Enrolled 60 patients with CoA, of them: 41(68.3%) - underwent surgery; 19 (31.7%) - endovascular interven- tion. Males to female ratio = 2.74. Age of patients =1 to 360 days (98.9±10.8). In 34 (57.6%) patients diagnosis was done prenatal.
Patients underwent a routine exam including neurosonog- raphy. 9 (15%) patients underwent MDCT. In 22 (36.6%) patients, CoA combined with concomitant congenital heart diseases: VSD in 9 (40.9%) ASD -in 3(13.6%), bicus- pid aortic valve in 5 (22.7%), TGA in 3 (13.6%), complete endocardial cushion defect in 2 (1%). All 60 patients were in NYHA class IV. 41(68.3%) patients underwent surgery; 19(31.7%) - balloon angioplasty.
Results: Mean pressure gradient prior intervention com- prised 58±1.7mm Hg; mean LVEF - 51±12%. In surgical group mean pressure gradient comprised 57±16mm Hg; mean LVEF - 58±7%. In endovascular group mean pressure gradient prior angioplasty was 59±18 mm Hg; mean LVEF 41±9%.
After surgical treatment, mean pressure gradient decreased to 18±6 mm Hg; mean LVEF increased to 67±8%. After bal- loon dilatation mean pressure gradient decreased to 19±7 mm Hg; mean LVEF increased to 63±7%.
In-hospital complications of surgery presented in 4 (9.7%) patients: 2 patients, after repair of arched hypoplasia, faced with chylothorax; one patient - paresis of the left dome of diaphragm. Wound infection observed in one patient. Neurological complications were absent. Endovascular group made an uneventful recovery. 13 (68.4%) patients need surgery for re - CoA on 3 - 6 months after dilatation.
Conclusion: In critic newborns and infants with CoA bal- loon intervention should be preferred with good in-hos- pital results. However, endovascular angioplasty of CoA in newborns and infants with isolated CoA remains contro- versial through a high rate of re-coarctation and necessity for re - interventions.
3. EFFICACY AND SAFETY OF CATHETER CLOSURE OF ATRIAL SEPTAL DEFECTS USING THE AMPLATZER VERSUS THE COCOON SEPTAL OCCLUDER. A MULTICENTER RANDOMIZED STUDY
Basil (Vasileios) Thanopoulos1,2, Petros Dardas1, Vlassis Ninios1, George Giannakoulas3, Dan Deleanou4, Silvia Lancovici4
1 Agios Loukas Clinic, Thessaloniki, Greece
2 Iatrikon Medical Center, Athens, Greece
3 Ahepa University Hospital, Thessaloniki, Greece 4 Ares Cardiology Center, Bucharest, Romania
Introduction: Transcatheter closure of atrial septal defect (ASD) using the Amplatzer Septal occluder (ASO) has become the procedure of choice in most cardiac centers. However, despite its technical simplicity the procedure is still associated with complications which, although very rare, are potentially life-threatening. The Cocoon septal occluder (CSO) is an improved ASO with certain design features (Nanoplatinum coating, softness) that may poten- tially reduce the risk of device related erosions and nickel allergic reactions. We design a randomized controlled study to prospectively compare the e cacy and safety of these two devices
Methods: 718 patients (median age 14.5 years) from 4 major centers in Greece and Romania were randomly assigned in a 1:1 ratio to catheter ASD closure using the ASO (group 1) and CSO (group 2), respectively. The pro- cedure was guided by uoroscopy and 2D and 3D transe- sophageal echocardiography.
Results: Mean echocardiographic ASD diameter was 21±7mm (range 14-35 mm); 22 ± 6 mm (range 12-34 mm) in group 1 and group 2, respectively. Mean device diame- ter was 24±9 mm (range 17-40 mm) and 22 ± 8mm (range 14 – 38 mm in group 1 and group 2, respectively. The device was permanently implanted in 353 (98.3 %) and 352 (98%) patients of the group 1 and group 2, respectively. Follow-up (FU) ranged from 6- 48 months. Complete ASD occlusion at 1 month FU was 99%) in both groups of patients. One device erosion (surgical removal) and severe skin allergic reaction (AR) that required chronic treatment with cortisone were observed in one (0.3%) and 2 (0.6%) patients, respectively, of group 1. No device erosions or ARs were observed in group 2. Device embolization was observed in 2 (0.6 %) and 3 (0.85%) patients of group 1 and group 2, respectively. Thrombus formation on the device was observed in 1 patient in both groups.
Conclusions: The ASO is a safe and e ective in the great majority of cases. The CSO is a safe and e ective device that adds to our armamentarium for as much safer catheter ASD closure. Further studies with a larger patient popula- tion are needed to con rm our results.
Hijazi, Z
21st Annual PICS/AICS Meeting