Page 36 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
138
Hospital, Miami, USA. 10Mattel Childrens Hospital, Los Angeles, USA. 11Childrens Hospital of Michigan, Detroit, USA
In 2015, Children’s National Medical Center reported a 1.1% incidence of vocal cord paralysis (VCP) secondary to recurrent laryngeal nerve injury (RLNI) following congeni- tal heart surgery in 3036 patients and multifactorial in ori- gin due to its location during aortic arch, left pulmonary artery (LPA) and patent ductus arteriosus procedures (PDA). Recovery of VCP varies between 0-82%. The incidence of left RLNI and VCP following pediatric interventional cathe- terization procedures has been reported as isolated cases. We queried member institutions of the CCISC (Wayne State University) regarding RLNI and VCP following PDA closure, LPA stenting or both procedures. Eleven centers submitted data demonstrating a signi cantly lower inci- dence of VCP following PDA closure (N=3680) or LPA stent- ing (N=1208) vs the reported surgical incidence. When both procedures were eventually performed in the same patient (N=15), VCP incidence was signi cantly increased compared to the reported surgical incidence, isolated PDA closure or LPA stenting. VCP incidence was signi cantly increased post LPA stenting vs PDA closure. Symptoms resolved in 8/9 pts by 2 yrs.
PDA+L- Surgery Exact odds 0.04 (0.01, 0.0006
Proce- dure
Proce- dure
Statistics
OR
95% Conf Interval
P-Value
PA (3/15 = 20.0%)
(32/3036 ratio = 1.05%)
0.25)
Proce- dure
Proce- dure
Statistics
OR
95% Conf Interval
P-Value
PDA (1/3680 = 0.03%)
PDA (1/3680 = 0.03%)
LPA (5/1208 = 0.41%)
PDA (1/3680 = 0.03%)
LPA (5/1208 = 0.41%)
LPA (5/1208 = 0.41%)
PDA + LPA (3/15 = 20.0%)
PDA + LPA (3/15 = 20.0%)
Surgery (32/3036 = 1.05%)
Surgery (32/3036 = 1.05%)
Mantel
Mantel Haenszel odds ratio
Mantel Haenszel odds ratio
Exact odds ratio
Exact odds ratio
10.1 (1.54, 884)
479 (45.5, 30001)
41.9 (5.72, 383.1)
39.2 (6.54, 1596)
2.56 (1.00, 8.44)
0.007
< 0.0001
0.0002
< 0.0001
0.05
Although rarely reported as a potential complication fol- lowing transcatheter PDA closure or LPA stenting, the inci- dence of RLNI and VCP is lower than previously reported in the surgical literature. VCP appears to be of greater risk in pts undergoing LPA stenting vs PDA closure. In the unusual patient who requires both PDA closure and LPA stenting, the incidence of VCP appears signi cantly increased which requires further investigation.
49. RIGHT VENTRICULAR REMODELING FOLLOWING TRANSCATHETER FENESTRATED ATRIAL SEPTAL DEFECT CLOSURE
Joseph Vettukattil1,2, Vishal Kaley1, Bennett Samuel1, Yasser Al-Khatib1,2, Reda Girgis3,2
1Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, USA. 2Michigan State University, Grand Rapids, USA. 3Spectrum Health Medical Group, Grand Rapids, USA
Introduction: Complete closure of atrial septal defects (ASD) in the setting of pulmonary hypertension (PH) can be detrimental to the patient due to the progressive nature of the disease. Fenestrated ASD closure is preferable in patients with PH as the fenestration allows a restricted interatrial shunt. The shunt can enhance systemic ven- tricular output at the expense of desaturation if shunt reversal occurs when progressive PH ensues. Improved hemodynamics after the fenestrated ASD closure may lead to remodeling of the right ventricle (RV). We present our experience of two patients with ASD and severe PH treated percutaneously using the Occlutech® Fenestrated Atrial Septal Defect (FASD) device.
Case Description: A 56-year-old female with 24mm ASD and mean pulmonary artery pressure (MPAP) of 47mmHg presented with NYHA Class III symptoms despite dual med- ical therapy consisting of Tadala l and Macitentan.
A 41-year-old female with 27mm ASD and severe PAH with MPAP of 60 mmHg was initially treated with one drug for PH followed by dual medical therapy consisting of
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206