Page 15 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
6. HYPOTENSION AFTER DEVICE CLOSURE OF ASD
Kalyanasundaram Muthusamy
GKNM Hospital, Coimbatore, India
4 years old male child with history of recurrent respira- tory tract infection and poor weight gain was evaluated and showed large ostium secundum atrial septal defect of 22 mm in size with adequate rims for the device clo- sure. Under general anesthesia 24 mm Amplatzer septal occluder was deployed under uroscopic and transesoph- ageal echocardiogram (TEE) guidance. Before releasing the device TEE showed device was well in position, no residual shunt, normal AV valve ows and both systemic and pul- monary venous blood ows were normal. Hemodymanics and electrocardiogram were normal. 10 minutes after the device was released and just before the femoral sheath was removed, ECG showed signi cant ST segment eleva- tion, tachycardia of 180 per minute and blood pressure dropped from 100 to 30 mm Hg. Recheck echocardiogram showed device was in position, no AV valve or aortic com- pression, normal systemic and pulmonary venous ows. Since we could not identify the cause of the haemody- namic instability and we decided to retrieve the device. While we were retrieving the device using 20 mm Goose neck snare and the device was partially retrieved, we noticed the ECG became sinus rhythm and blood pressure became normal. During the process of the retrieving the device the device got loosened o from the snare and it went back to normal position. But ECG again showed ele- vation of ST segment and blood pressure dropped to 30 mmHg. Meanwhile one of our collegue did coronary artery angiogram while device was still in situ. It showed abnor- mal origin of left coronary artery from right coronary and it was compressed by the device. Since we identi ed the cause of ECG changes and hypotension, we retrieved the device using snare with much di culties and it took about 45 minutes to retrieve the device. It was our luck on that day that we could retrieve the device in the cath lab itself otherwise child could not have survived since there was no time to shift the child to operation room for surgical retrieval.
7. ACUTE KIDNEY INJURY AFTER CORONARY ARTERY BYPASS GRAFTING IN PATIENTS RECEIVING PREOPERATIVE INTRA-AORTIC BALLOON PUMP Hussain Aboud, Olanrewaju Olaoye, Amir Kazory
University of Florida, Gainesville, USA
Introduction: Placement of preoperative prophylactic intra-aortic balloon pump (IABP) has been suggested to provide improved outcomes in high-risk patients
undergoing coronary artery bypass grafting (CABG). Postoperative acute kidney injury (AKI) is an established predictor of adverse outcomes in cardiac surgery. The aim of this study was to examine the impact of preoperative prophylactic IABP on the incidence of postoperative AKI in high-risk patients undergoing CABG.
Methods: Articles cited in PubMed database from Inception to February 2018 using keywords “intra-aortic balloon pump” and “coronary artery bypass grafting” were searched. Clinical trials evaluating pre-operative IABP in high-risk patients undergoing CABG were reviewed. Clinical trials that contained data on renal parameters were selected. Pertinent data including baseline renal function, de nition of AKI, and incidence of AKI were extracted and recorded.
Results: A total of 104 citations were reviewed and after exclusion of duplicate articles, 17 clinical studies (includ- ing 6 randomized controlled trials) with 4481 participants were included. The mean age was 64.7 years, and 74.7% were men. Between 2.6 and 23% of the study population were reported to have preoperative chronic kidney disease (mean 9.1% ± 6.3). Substantial variation existed across studies in the de nition of AKI and the time to primary endpoint assessment. The incidence of AKI was between 0 and 22% in the IABP group (median 4.1% ± 6.1) and between 0.5 and 20.4% (median 8.7% ± 8.9) in those who did not receive IABP.
Conclusion: We found that preoperative CKD and postop- erative AKI are common in high-risk patients undergoing CABG. Moreover, the incidence of AKI seems to be lower in those patients receiving prophylactic preoperative IABP likely due to hemodynamic stabilization by IABP. Future studies are needed to identify the population at risk for renal complications, and to explore management strat- egies aiming at preservation of renal function in these patients.
8. CATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS IN ADULT PATENTS USING AN OUTPATIENT PROTOCOL. A RANDOMIZED MULTICENTRE 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
Hijazi, Z
21st Annual PICS/AICS Meeting