Page 24 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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uoroscopic time and procedure time were 20.3(4.9 – 52.3) and 80.3(33.0 – 166.0) min., respectively.
Conclusions: VesselNavigator is a promising modality for CHD diagnosis and treatment. It is tremendously ben- e cial for some CHD interventional procedures. Using VesselNavigator as a 3D roadmap without additional 3D rotational angiography, we can reduce uoroscopic and procedural time, contrast amount and radiation exposure.
26. SUBACUTE BACTERIAL ENDOCARDITIS PRESENTING IN PATIENTS WITH PERCUTANEOUSLY IMPLANTED PULMONARY VALVE NOT DETECTED ON INITIAL TRANSESOPHAGEAL ECHOCARDIOGRAM Angela Li, Sawsan Awad
Rush University Medical Center, Chicago, USA
Introduction: Percutaneous pulmonary valve replace- ment (PPVR) within an existing bioprosthetic pulmonary valve (BPV) is an increasingly attractive surgical alternative for adult congenital heart disease patients with BPV fail- ure. Infectious endocarditis (IE) in this subset of patients may be subacute as described below.
Case Description:
Case #1: A 57 year old female with unknown congenital heart disease (recent percutaneous Melody valve replace- ment within old bioprosthetic valve) presented to cardiol- ogy clinic with one month of early satiety and progressive fatigue. EKG in clinic revealed new onset atrial brillation; TTE with increased right ventricular out ow tract (RVOT) gradient and evidence of acute on chronic right heart failure. Patient was admitted with plan for cardioversion, but developed fevers prior to intervention. Serial blood cultures obtained with growth of Strep milleri. Initial TEE did not reveal vegetations; however, repeat TEE was performed which con rmed vegetations. Patient received 2 weeks of IV antibiotics prior to surgical replacement of pulmonary valve and MAZE procedure.
Case #2: A 21 year old male with history of Tetralogy of Fallot (status post pulmonary homograft replacement with resultant pulmonic insu ciency, and subsequent percutaneous Melody valve replacement), presented to outside hospital with ve days of nausea, vomiting that progressed to fevers and myalgia. Initially treated for viral gastroenteritis, patient developed frank hematuria prompting additional workup. CBC with acute thrombo- cytopenia, serial blood cultures with growth of Methicillin resistant staph aureus. Outside hospital TEE showed no
obvious vegetation, noted severe stenosis of biopros- thetic pulmonic valve with increased RVOT gradient. Repeat TEE after transferring to our institution signi cant for large vegetation on pulmonic valve lea ets. Patient received 3 weeks of IV antibiotics prior to surgical replace- ment of pulmonary valve.
Discussion: Reports on IE in PPVR patients are limited; one prospective study of patients undergoing PPVR found that vegetations were not seen on TTE/TEE for all patients, but all had increase in RVOT gradient compared to prior echocardiogram, as was true in our patients. New increase in RVOT gradient may serve as a good indicator of IE in PPVR patients, when standard diagnosis with imaging has shown to be limited due to di cult cardiac anatomy.
27. HOW TO PENETRATE TOUGH AND SCLEROTIC LESIONS IN POSTOPERATIVE PATIENTS WITH COMPLEX CONGENITAL HEART DISEASE. NOVEL TECHNIQUE BY COMBINATION OF A STEERABLE SHEATH AND SHARPENED STIFF WIRE
Hisashi Sugiyama, Kouta Taniguchi, Hiroki Mori, Keiko Toyohara
Tokyo Women's Medical University, Tokyo, Japan
Background: Recently, the necessity for penetration of tough and sclerotic lesions increased in postoperative patients with complex congenital heart diseases (CHD). We developed a new technique, which combined a steerable sheath and sharpened sti wire, to penetrate tough and sclerotic lesions. E cacy and safety of the procedure was evaluated.
Subjects and Methods: A total of 4 lesions in 4 patients (2 male and 2 female, age ranging from 11 to 41 years old, 3 total cavo-pulmonary connections and one Mustard procedure) were applied for the procedure. Purpose was access for catheter ablation in 3 and recanalization of SVC syndrome in one. In all patients, penetration could not be achieved by the Brockenbrough procedure. Three of those were a synthetic conduit used for total cavo-pulmonary connection and one was an occlusion between the SVC and neo right atrium in the patient after Mustard opera- tion with transposition of the great arteries. Multi-planar reconstruction (MPR) imaging by cardiac CT was done for planning before all procedures. Under ICE and uoroscopy guidance, a steerable sheath (8 Fr) was perpendicularly adjusted to objects. The sharpened edge of 0.014 inch guide wire was pushed via the sheath. Adding continu- ous force could easily penetrate the tough lesions. Then micro catheter was advanced over the wire. Subsequently,
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206