Page 37 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
Sildena l and Ambrisentan. She had NYHA Class III symp- toms despite being on dual medical therapy for 6 years.
As per the recommendations of a multi-disciplinary team, both patients underwent FASD implantation using a 27mm device with a 6mm fenestration. Both patients were discharged to home the following day after con rmation of device position and patency using transthoracic echo- cardiogram (TTE). PH medications were continued. Cardiac catheterization with TTE was scheduled at 6 months fol- lowing implantation to monitor hemodynamics and right ventricular (RV) and left ventricular (LV) dimensions.
Results: Both patients were noted to have signi cant symptomatic improvement. Case 1 status post 18 months after implantation had RV/LV ratio improve from pre-im- plantation value of 1.8 to 0.74 at follow-up. Case 2 status post 7 months after implantation had marked improve- ment in the RV/LV ratio from pre-implantation value of 1.2 to 0.77 at follow-up.
Conclusion: RV remodeling following fenestrated ASD clo- sure suggests the FASD device may be bene cial in patients with ASD associated PH. However, PH medications may need to be continued as it is a chronic, progressive disease.
50. TRANSCATHETER FONTAN COMPLETION IN A CYANOTIC ADULT CONGENITAL PATIENT WITH CLASSIC GLENN SHUNT
E. Oliver Aregullin1,2, Vishal Kaley1, Stephen Cook1,2, Samuel Lacina1, Bennett Samuel1, Joseph Vettukattil1,2
1Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, USA. 2Michigan State University, Grand Rapids, USA
Introduction: Patients with single-ventricle physiology require staged palliation. Additional interventions maybe required due to Fontan failure, formation of collater- als or pulmonary arteriovenous malformations (PAVMs). Transcatheter interventions are preferable in this setting to avoid the risks of redo-sternotomy, and cardiopulmo- nary bypass. We present our experience with transcathe- ter Fontan completion in a cyanotic adult congenital heart patient born with hypoplastic left heart syndrome (HLHS).
Case description: A 31-year-old female born with HLHS underwent stage-1 palliation as a neonate followed by classic-Glenn shunt at age 6 months. Intracardiac Fontan procedure with inferior vena cava connected to the left pulmonary artery was performed at age 2 years. Prior hemodynamic evaluation revealed Glenn and Fontan cir- culation mean pressures of 11 and 15mmHg, respectively. PAVMs were noted in the right lung, presumably due to
lack of hepatic ow in this area. Eventually, she also devel- oped Fontan-associated liver cirrhosis. Anticipating the potential bene ts of decreasing cyanosis, and ultimately improving end-organ function, a multi-disciplinary team recommended transcatheter Fontan completion to con- nect both systems with even distribution into the lungs.
Intervention: After hemodynamic and angiographic assessment, an 8.5 Fr SL2-transseptal sheath with 21 gauge transseptal Brockenbrough needle was advanced from the right internal jugular vein into the roof of the Fontan baf- e. Once the needle was placed into the Fontan ba e, a 0.014 inch Mailman wire was advanced and then snared from the femoral vein, creating a veno-venous loop. Using V-18 control wire as a buddy, 0.035 Amplatzer super-sti wire was placed between the Glenn and Fontan circuits. Subsequently, a 28mm Cheatham-Platinum (CP) covered stent pre-mounted on 20mm balloon-in-balloon catheter was deployed in between the two circuits. Unobstructed ow was noted with immediate decrease in Fontan mean pressure from 15 to 13mmHg.The patient had no com- plications during overnight observational stay and was discharged to home the next day. Computed tomogra- phy scan 6-weeks after the procedure showed Glenn and Fontan circuits connected by in-situ CP stent.
Conclusion: Transcatheter Fontan completion may be a feasible option in selected patients in the setting of high risk for redo-sternotomy or co-morbidities contraindicated for surgical intervention with optimal outcomes.
51. TRANSCATHETER TREATMENT OF SEVERE PULMONARY VEIN STENOSIS IN PATIENT WITH 3-P DELETION SYNDROME
E. Oliver Aregullin1,2, Vishal Kaley1, Chad Hopkins1, Bennett Samuel1, Joseph Vettukattil1,2
1Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, USA. 2Michigan State University, Grand Rapids, USA
Introduction: Pulmonary vein stenosis is a rare condition with prevalence of about 1.7/100,000 children. Often pul- monary vein stenosis has syndromic association and can be di cult to manage due to multiple vein involvement. We present our experience of managing pulmonary vein stenosis in a patient with 3p deletion.
Case description: A 19-month-old female was diagnosed with atrial septal defect (ASD), pulmonary vein stenosis, and 3p deletion. She was born at 26-weeks gestation, weighing 650 grams requiring care in intensive care unit. Ventilatory support was needed for 7-days with discharge on supple- mental oxygen after 97-days hospital stay. At 8-months
Hijazi, Z
21st Annual PICS/AICS Meeting