Page 32 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
134
Aim of our study is to evaluate the feasibility and e cacy of ADO II in non ductal position
Material and Results: 102 cases of VSDs and one case each of aorto right ventricular, aorta right atrial tunnel, infantile hepatic endothelioma, aortopulmonary window, paraval- var leak, perforation of LV, common iliac artery aneurysms were closed by retrograde transcatheter method with ADO II, formed the material for this prospective study. Age: 45 days old neonate to 30 years (mean 9.4 years). 74 perimem- braneous VSDs, 14 muscular VSDs,13 Gerbode defects, one midmuscular VSD with dextrocardia, were closed with ADO II of various sizes. The shortest uoroscopic time was 4.2 min, mean was 8.4± 4.1min. In six cases there was initially a small residual shunt which had closed on three months follow up. Eleven cases developed transient com- plete heart block which resolved on medical management and only patient needed temporary pacing.
Discussion: ADO II has a very low pro le, and is easily track able as there is no polyester material in it and can be easily delivered through 4- 5F guiding catheter, needs very short uoroscopic time as artero-venous (AV) loop is not needed in this retrograde approach. Cost is 1/3 the cost of regular ventricular septal occluder. However, it is not useful in VSDs measuring more than 6 mm and in those with insu cient aortic rim. Trackability of ADO II is excellent in rare, tortu- ous tunnels.
Conclusion: ADO II is e cacious in non ductal position. Procedure time and the cost are signi cantly lesser than regular devices. The success rate is very high and compli- cation rate is very low.
40. TIMING OF THE EVALUATION OF THE BALLOON PULMONARY VALVULOPLASTY EFFECTS IN NOONAN SYNDROME.
Masahiro Kamada, Naomi Nakagawa, Yukiko Ishiguchi, Yuji Moritoh, Takayuki Suzuki, Kengo Okamoto
Dep. of Pediatric Cardiology, Hiroshima City Hp., Hiroshima, Japan
In most center, balloon pulmonary valvuloplasty (BPVP) is the rst choice for the treatment of pulmonary valvular ste- nosis (PVS). Balloons with a diameter approximately 1.25x times that of the pulmonary valve (PV) annulus are recom- mended. Although balloons 1.4-1.5x the PV diameter may be used to dilate dysplastic PVs, BPVP is often ine ective and surgical valvotomy is required.
Cases: We experienced 3 cases of Noonan syndrome with dysplastic PVs. In the rst 2 cases (cases 1, 2: 2.5-, 1.3-year old boys), BPVP was performed with a balloon 1.25 x the PV annulus. The results were unsatisfactory and propran- olol was started. However, the gradients decreased even after propranolol was stopped. The maximum gradient on echocardiography (Echo-G) decreased from 64 to 24 and 19mmHg at 2 and 5 years respectively in case 1, and from 39 to 24 and 18mmHg in 1 and 2 years respectively in case 2.
In case 3 (2-month old boy), the rst BPVP with a 1.2x the PV was not e ective. The maximum gradients on catheteriza- tion (Cath-G) decreased from 48 to 37mmHg and Echo-G decreased from 65 to 61 mmHg. Based on experiences, we awaited improvement. However, as the Echo-G increased to 80mmHg at 1 year, a second BPVP (1.26x the PV) was performed. The Cath-G increased from 47 to 56mmHg because of re ex subvalvular stenosis. After 6 months on propranolol, the Echo-G stabilized at 58mmHg. A third BPVP (1.39x the PV) improved Cath-G from 49 to 32 mmHg and Echo-G from 48 to 30mmHg at 1 year. (261)
PV thicknesses was measured on cine-angiography. The anterior/posterior lea ets (PV annulus) measured 1.7/2.0 (10) mm, 1.9/1.9 (10.4) mm and 1.3/1.5 (13.0) mm on the rst, second, and third cineangiograms respectively. The thicknesses/ annulus ratio of the 2 lea ets decreased from 0.37 to 0.22 over time and motion improved.
Conclusion) In PVS with dysplastic PV, thick and redun- dant valves generate resistance in a small PA and mask the e ects of BPVP. The true e ects of BPVP require a wait of the pulmonary artery growth at least ≥ 1 year prior to evaluation.
41. DOUBLE MELODY VALVE (VALVE-IN-VALVE) IMPLANTATION IN PULMONARY AND TRICUSPID VALVE POSITION. : A UNIQUE CASE
Ashish Garg, Satinder K. Sandhu
University of Miami/Jackson Memorial Hospital, Miami, USA
Case presentation: A 66 year old female with congenital pulmonary valve stenosis requiring pulmonary valvotomy at 12 years of age. Her clinical course was complicated with heart failure from severe pulmonary and tricuspid valve regurgitation. She underwent placement of a #25mm Bioprosthetic valve in the pulmonary (Pericardial pros- thesis) and tricuspid valve (St. Jude) position at 48 and 60 years of age. Six years after replacement of tricuspid valve she again developed exercise intolerance (NYHA Class
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206