Page 33 - Journal of Structural Heart Disease Volume 4, Issue 4

135
Meeting Abstracts
III) and pedal edema. An echocardiogram demonstrated moderate pulmonary valve stenosis (PISG 57 mmHg) and tricuspid stenosis (mean gradient 10 mmHg). At cardiac catheterization there was a 56 mmHg gradient across the pulmonary valve and a 12 mmHg gradient across the tri- cuspid valve with elevated right atrial (RA) pressure of 18 mmHg.
Procedure Description: A balloon was in ated across the pulmonary valve and coronary angiogram was done. Balloon sizing of the pulmonary valve and the tricuspid valve was performed. A 22 mm Melody Medtronic Valve® was mounted on a 22-mm proprietary delivery cathe- ter (Ensemble NU10, Medtronic), advanced through the femoral vein, positioned and implanted across the bio- prosthetic pulmonary valve (valve-in-valve). The residual systolic pressure gradient across the pulmonary valve was 7 mmHg. A lunderquest wire was positioned in the left pul- monary artery, a second 22 mm Melody Medtronic Valve® was placed on 22-mm delivery system. The delivery system was positioned across the bioprosthetic tricuspid valve and a Melody Medtronic Valve was implanted. The resid- ual gradient across the tricuspid valve was 4 mmHg and the RA pressure was 11 mm Hg. At 1 month follow-up, she had no edema, improved exercise tolerance (NYHA Class II) which improved to NYHA class I at 3 month follow up. Echocardiogram demonstrated no stenosis or gradient across the pulmonary valve and 6 mmHg gradient across the tricuspid valve.
Discussion: Bioprosthetic valves often require reinterven- tion due to degeneration. Surgical intervention has its associated morbidities. We present a successful and unique case of transcatheter implantation of double valve in valve in pulmonary and tricuspid valve position.
42. TRANSCATHETER DEVICE CLOSURE OF CARDIAC SHUNT LESIONS WHEN FEMORAL VEIN IS INACCESSIBLE
Rajasekaran Premsekar
Dr.Kamakshi Memorial Hospital, CHENNAI, India
Femoral venous access for transcatheter device closure is not feasible when the inferior vena caval interruption is either congenital with multiple small venous channels draining in to the azygous system or when it is acquired owing to thrombosis from previous interventions. The prev- alence of interruption in inferior vena cava (IVC) is reported at 0.2-3%. While IVC interruption with azygous continua- tion to superior vena cava provides a circuitous channel for cardiac catheterisation and intracardiac interventions,
rarely the caudal venous drainage occurs through multi- ple small venous channels which denies femoral venous access to the heart.
We report three cases where successful transcatheter device closure was performed in the setting of inaccessible femoral venous access to the heart. The rst was in a 4 years old female child with a large secundum atrial septal defect (ASD) and IVC interruption with multiple small, tortuous venous channels coursing cranially to the azygous vein. The defect was closed with a 20mm septal occluder (Lifetech Scienti c Co Ltd) from the jugular access. The second case was an one year old female child with a 8mm perimembra- nous Ventricular septal defect (VSD), whose IVC interrup- tion was diagnosed during the catheterisation procedure. The VSD was closed retrograde with a 10mm symmetrical perimembranous VSD occluder (Lifetech Scienti c Co Ltd) through a 7 French delivery sheath. The third case was in a 17 years old male patient who had undergone surgical patch closure of a large aortopulmonary window during infancy and presented with a small 4mm residual shunt and was detected to have bilateral thrombosed femoral veins during the procedure. The defect was closed with a 5mm Amplatzer duct occluder II (St Jude Medical) from the jugular access.
We conclude that judicious choice of occluder and route ensures successful transcatheter device closure in the absence of femoral venous access.
43. EVALUATION OF THE INFLUENCE OF SINGLE VENTRICLE MORPHOLOGY ON THE QUALIFICATION FOR FONTAN COMPLETION.
Jacek Kusa1,2, Pawel Czesniewicz2
1Medical University of Silesia, Katowice, Poland. 2Regional Specialist Hospital in Wroclaw, Research and Development Centre, Wroclaw, Poland
Objectives: The purpose of this paper is to report our experience in interventional treatment of patients before last stage of Fontan palliation and to focus on the in uence of single ventricle morphology on the need for percutane- ous interventions.
Background: The staged-Fontan operation is widely used to treat patients with a single functional ventricle. Cardiac catheterization remains a basic tool in the evaluation of haemodynamic data before last stage of Fontan palliation. A lot of percutaneous interventions can be successfully performed during this procedure. We hypothetize that the
Hijazi, Z
21st Annual PICS/AICS Meeting