Page 18 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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on the LV side of the defect. But, this produced severe LV out ow ow obstruction. Then, we placed 2 lobes on the left atrial side. This not provided complete elimination of mitral regurgitation, a stable position and lack of LV out- ow tract gradient. Patient had a dramatic improvement and remains free from heart failure at 2 month follow up.
Discussion: We describe o label use of a vascular plug to seal o a large iatrogenic perforation of the anterior mitral lea et. We explored various devices to match the device to the defect and providing stability on a mobile lea et without obstructing LV out ow tract or impeding pros- thetic aortic valve function. To our knowledge, this is the rst report of a de nitive percutaneous closure of such a defect.
14. PERCUTANEOUS OCLUSION OF INTER ATRIAL SEPTAL DEFECTS IN SMALL INFANT WEIGHING UNDER 5 KG WITH IMPORTANT COMORBIDITIES. Fabio Bergman1, Luis A Christiani1,2, Alan E. da Silva1, Rafael F. Agostinho1, João C. Tress3
1 Babycor Pediatric and Fetal Cardiology, Rio de Janeiro, Brazil 2 UERJ, Rio de Janeiro, Brazil
3 Complexo Hospitalar de Niteroi, Rio de Janeiro, Brazil
Introduction: percutaneous oclusion of inter atrial septal defects in small infants are not esaily indicated. Funtionally major defects, with huge pulmonary ow, pulmonary desease or persistent ventilation, right ven- tricular enlargment and pure weight gain should be present and enforce the decision to treat. Safety and e cacy have been published, but are still an issue.
Case Report: 6 month age male, 4,9 kg, long term hos- pitaliation ( ICU ), repeated pulmonary infeccions and low weight gain. A 10 mm inter atrial septal defect and a very small inter ventricular septal defect asso- ciated. Right ventricule overload. The x ray show augmented cardiac index and pulmonary con- gestion. The procedure was performed under general anesthesia with transthoracic echocardiogram, right fem- oral vein was punctured, for the procedure, left femoral artery was also punctured. The patient was fully heparin- ized and prophilactic antibiotic therapy was performed. Regular study was performed, ballon assessment of the defect was avoided. A super sti guide wire, was posi- tioned in the left upper pulmonary vein, 6 french long sheath Amplatzer for PDA closure (AGA Medical, Golden Valley, MN) was used to deliver a 10 mm Amplatzer septal occluder (AGA Medical, Golden Valley, MN). Transthoracic echocardiography demonstrated the
device appropriately seated with atrial septal tissue cap- tured between the left and right atrial parts of the device, only then released. No hemodynamic changes, vascular injury or bleeding at the end of the procedure. A 15 min- utes compression of the puncture was enough to stop the bleeding. The patient was taken back to ICU. Despite the uneventful procedure, correct indication and execution and evident signs of immediate improvement, in short-term fol- low up, the patient presented a new episode of lung infec- tion, did not went well and died 4 weeks after the procedure.
Conclusion: We do not recommend the routine closure of an atrial septal defect before 3 years or 12 kg, but in certain small patients with lung desease and others comorbidities would bene t from closure of their defect.
15. USE OF INSTITUTIONAL CRITERIA FOR TRANSCATHETER DEVICE CLOSURE OF FONTAN FENESTRATION – MIDTERM OUTCOMES
Nikhil Thatte1, Vivian Dimas2, Alan Nugent2, Thomas Zellers2, Joseph Forbess3, Luis Zabala2, Surendranath Veeram Reddy2 1 Boston Children's Hospital, Boston, USA
2 UT Southwestern, Dallas, USA
3 Lurie Children's Hospital, Chicago, USA
Background: There are no established catheter based cri- teria to decide ideal candidacy for device closure of patent Fontan fenestration. Our institution broadly follows a set of catheter based parameters to decide a patient’s candi- dacy for Fontan fenestration device closure. The criteria are: an unobstructed Fontan pathway with no signi cant decompressing venous collaterals, baseline Fontan pres- sures ≤15 mm Hg, baseline cardiac index ≥ 2 L/min/m2, and a decrease in cardiac index not more than 20% from baseline with test occlusion of the Fontan fenestration. The objectives of this study were to review mid-term patient outcomes following device closure of Fontan fenestration using our institutional criteria.
Methods: A retrospective chart review of all patients who underwent a fenestrated Fontan procedure at our institu- tion between May 2005 and January 2015 was performed.
Results: Of the 203 patients who underwent fenestrated Fontan palliation during the study period, 51 patients were referred to the catheterization laboratory for fenestration closure. 42 of 51(82.4%) patients met the institutional cri- teria and underwent successful fenestration device closure (Group A). Fenestration closure was deferred (Group B) in the remaining 9 (17.6%) as they were deemed high risk. Demographics, clinical, and pre- and post- test occlusion
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206