Page 25 - Journal of Structural Heart Disease Volume 4, Issue 4

127
Meeting Abstracts
a balloon catheter was exchanged. Balloon dilatation was performed from a small balloon to a large one step by step.
Results: In all patients, penetration could be success- fully completed. Catheter ablation could be achieved in 3 patients and symptom of SVC syndrome disappeared in one patient. No complication was recorded.
Conclusion: This procedure could safely penetrate for even calci ed synthetic conduits or sclerotic lesions, which could not be penetrated by a Brochenbrough needle or radiofrequency wire. Steerable sheath could easily become peripendicular to the object for preventing from slippage and conveying e ective force. MPR imaging is an essential modality for planning the procedure.
28. AN UNUSUAL CASE OF TRANSTHORACIC ACCESS FROM THE RIGHT AXILLA
Saadeh Jureidini1, Robert Petersen1, Lisa Bade2, Charles Huddleston1
1Saint Louis University, St. Louis, USA. 2SSM Cardinal Glennon Children's Hospital, St. Louis, USA
Transthoracic access (TTA) in congenital heart disease (CHD) has been well described for the purpose of diag- nostic and transcatheter interventional procedures. TTA is used when other routes fail to allow access to target areas. Typically, TTA requires adherent heart to chestwall, as in post operative conditions, and is performed mostly from para sternal approach. We describe, herewith, the perfor- mance of TTA in an unconventional location, to achieve dif- cult interventions, that would have been otherwise not possible.
A 4 year old, 17 kg male with recently diagnosed left pul- monary veins stenosis presented for transcatheter ther- apy prior to completion of an extracardiac Fontan. He was born with a complex CHD including hypoplastic left heart, Scimitar syndrome and interruption of IVC to right azygous. His surgical procedures included Norwood with Sano, Kawashima operation and resection of the right lung due to severe hypoplasia of right pulmonary artery contributing to pulmonary hypertension. Two cardiac catheterizations, including transhepatic were performed somewhere else and were unsuccessful to enter the left pulmonary veins. At our center, a MRI and transthoracic echo from the right axilla con rmed that the right atrium is adherent to right axillary chest wall. In the cath lab, angiography in the left pulmonary artery, azygaus vein and right ventricle allowed spatial understanding of his anatomy. Transthoracic access was performed in mid right
axillary location to place a 7 French sheath and allowed successful access to the right and left atria, and left lower and upper pulmonary veins. Balloon angioplasty of the lower vein to 12mm and upper vein to 9mm resulted in resolution of angiographic discrete stenosis and drop in gradient from 6 to 3 mm Hg. Removal of sheath with man- ual pressure allowed hemostasis as con rmed by echo. He later underwent successful extracardiac Fontan with fen- estration. After a year of follow-up he continued with very good clinical and echocardiographic evaluations.
We conclude that TTA can be performed safely from unusual locations if proper imaging is done to understand the chest wall – atrial relationship.
29. ACUTE OUTCOME OF PULMONARY BALLOON VALVULOPLASTY FOR THE TREATMENT OF PULMONARY VALVE STENOSIS
Bianca Lavoile1, Siddharth Gupta2, Richard Ringel3, Allen Everett3, Ram Bishnoi4
1Geisinger Medical Center, Danville, USA. 2Rutgers New Jersey Medical School, Newark, USA. 3Division of Pediatric Cardiology Johns Hopkins, Baltimore, USA. 4Division of Pediatric Cardiology Geisinger Medical Center, Danville, USA
Title: Acute Outcome of Pulmonary Balloon Valvuloplasty for the Treatment of Pulmonary Valve Stenosis
Introduction: Balloon pulmonary valvuloplasty (BPV) is the primary treatment modality for congenital pulmo- nary stenosis. The Mid-Atlantic Group of Interventional Cardiology (MAGIC) registry, is a centralized database for submission, storage, and analysis of pediatric cardiac cath- eterization data.
Aim: To review data from the registry to assess technical aspects, safety, and e ectiveness of BPV.
Methods: All patients who underwent BPV from 11/2004– 3/2013, with data in the registry, were included. Data included: demographics, associated cardiac defects, uo- roscopy time, hemodynamics, assessments of pulmonary valve (PV), pulmonary annulus size, right ventricular pres- sure, Doppler gradient through the PV, balloon sizes, and procedurally related adverse events.
Results: Data from 349 patients was analyzed. Patient age ranged: 1 month to 57 years. Annulus size measured by echo ranged from 2–24mm (mean 9.08±3.96mm; median 8mm), versus angiography, 2.2 – 25mm (mean 9.89±4.2mm; median 8.65mm). Balloon to annulus ratio (BTA) was divided
Hijazi, Z
21st Annual PICS/AICS Meeting