Page 16 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
118
Introduction: Transcatheter closure is the treatment of choice for the majority of patients with a patent ductus arteriosus (PDA). However, the standard technique of this procedure uses an arterial access and requires immobili- zation of the patients for 24 hours and may be associated with arterial complications. The aim of this study was to report experience with catheter closure of PDA in 104 con- secutive adult patients with the Cocoon PDA occluder on outpatient basis using an exclusive venous approach.
Methods: The age of the patients ranged from 16-72 years (median 36 years. In group 2 the procedure was guided using hand injections of contrast media through the deliv- ery sheath and 2D and color Doppler echocardiography from suprasternal and parasternal long and short axis, respectively.
Results: Group 1: The PDA diameter range from 3 to 10 mm. The device diameter ranged from 4 to 12 mm. The PDA occluders were permanently implanted in all patients. Two and 4 patients had absent and reduced arterial pulses, respectively, that were restored with intravenous infusion of heparin and rtPA, were the main complications of the procedure. . The hospital stay of the patients ranged from 24-48 hours. Group 2. The mean PDA diameter ranged from 2 – 9 mm. The device diameter ranged from 4 – 10 mm. The PDA occluders were permanently implanted in all but 2 patients. There were no arterial complications. The hospital stay of the patients ranged from 6 -8 hours. There was a reduced cost that ranged from 300- 500 €. Complete echocardiographic closure of the ductus at 1-month fol- low-up was observed in all 102 patients (100%).
Conclusions: Exclusive transvenous PDA occlusion using combined angiographic and echocardiographic guidance is an e ective and safe method that prevents the arterial complications of the standard approach. In addition, in adult patients, this technique, may be used on outpatient basis resulting in early patient mobilization and reduce hospital cost.
9. AMPLATZER VASCULAR PLUG II (AVP II) IS AN ALTERNATE TO AMPLATZER DUCT OCCLUDER (ADO I OR ADO II) FOR UNSUITABLE PDA ANATOMY Kalyanasundaram Muthusamy
GKNM Hospital, Coimbatore, India
Every patent ductus arteriosus (PDA) has di erent mor- phological anatomy. There will be a problem in closing the PDA with ADO I or II device when it is large and long with no adequate ampulla, like Type C PDA (by Krichenko et al classi cation), especially in neonates. Similarly any type of
PDA with mild Coarctation of aorta where closure of PDA with ADO I or II might increase coarctation gradient. Such types of PDAs can be closed with AVP II. We had six cases of PDA in the last two months with anatomy not suitable for device closure with ADO I or II. Four children with ages between 2 to 4 months had large and long PDAs with no adequate ampulla (almost like Type C PDA). Two patients had moderate to large sized PDA with mild Coarctation (CoA gradient of 10 to 15 mmHg). All these patients under- went successful device closure of PDA with AVP II with no residual shunt on table. Post procedure angiogram showed no aortic encroachment or blocking of branch pulmonary arteries by the device. Patients who had coarctation of aorta showed reduction of gradient to 5 mmHg in one case and nil gradient in the other case. Device sizes used were from 6 mm to 12 mm. The size of the device selection was 1 1⁄2 to 2 times of the duct size on the pulmonary artery end. Two neonates had hemodynamic instability while delivery sheath was negotiated from right atrium to PDA. Sheaths used were Amplatzer delivery system, Cooks mullein sheath and Jugkins right guiding catheter. We conclude that device closure of PDA where anatomy is not suitable for device closure with ADO I or ADO II may be a candidate for AVP II device.
10. FEASIBILITY OF DEVICE CLOSURE OF SUB PULMONIC VENTRICULAR SEPTAL DEFECT (VSD)
Kalyanasundaram Muthusamy
GKNM Hospital, Coimbatore, India
There are enough literatures available to prove beyond doubt that device closure of muscular VSDs and peri- membranous VSDs are feasible with acceptable safety. But there are not much published datas available about device closure of sub pulmonic VSDs. The closure of sub pulmonic VSD is necessary even if it is small because they present frequently with complication of aortic regurgi- tation. Conventionally sub pulmonic VSDs are closed by surgery. But sub pulmonic VSD was not considered earlier for device closure because of its proximity to both semilu- nar valves and the fear of interference with their function including development of aortic regurgitation. We report 32 cases of sub pulmonic VSDs who underwent successful device closure. Out of 306 cases who underwent success- ful device closure of VSDs from 2008 to 2017, 32 were sub pulmonic VSDs. Rest of them were perimembranous (230), muscular (29) postsurgical residual VSDs (9) and post MI VSD (2). Demographic features of sub pulmonic VSD cases were age (1 year to 27 years), male (18 no), female (14 no) and weight (9 to 57 kg). The size of the VSD ranges from 3 mm to 12 mm and device sizes used were 4 mm to 14 mm.
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206