Page 38 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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of age, she was diagnosed with moderate ASD and ow turbulence was noted in the right lower pulmonary vein (RLPV). Computed tomography (CT) scan con rmed the diagnosis of pulmonary vein stenosis with near-complete disconnection of the right upper pulmonary vein (RUPV) and discrete narrowing of the RLPV.
Intervention: Cardiac catheterization was performed at the age of 9-months. Pulmonary artery wedge injec- tion demonstrated the exact site of stenosis in the RLPV. The left-sided veins were normal and the RUPV could not be accessed. Using a right Judkins catheter and a whis- per guidewire, pressures in the RLPV were measured at 22mmHg. Balloon angioplasty was performed using a 5x30mm coronary balloon. Post procedure the pressures were noted to have decreased to 11mmHg. She was dis- charged to home with a plan to monitor the pulmonary veins.
At 18-months of age she underwent catheterization for concerns of increasing pressure gradients. Injection into the right lower pulmonary artery demonstrated a good sized pulmonary vein without any evidence of obstruction. However, the wedge injection into the right upper lobe showed a severely obstructed pulmonary vein. The RUPV was dilated using a 4x30mm coronary balloon. Angiogram after the balloon dilatation revealed unobstructed ow. She was discharged the following day and is stable from a cardiac point 6-weeks post-dilatation.
Conclusion: Pulmonary vein stenosis should be sus- pected in infants with syndromes presenting with refrac- tory hypoxemia, persistent respiratory distress, and unexplained pulmonary hypertension. Frequent monitor- ing and transcatheter interventions may be required in selected patients.
52. TRANSCATHETER STENTING OF NEAR-
INTERRUPTED AORTA
E. Oliver Aregullin1,2, Vishal Kaley1, Bennett Samuel1, Paul
Nelson1, Joseph Vettukattil1,2
1Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, USA. 2Michigan State University, Grand Rapids, USA
Introduction: Transcatheter stenting is preferred over the surgical interventions for treating coarctation of aorta in adolescents and adults. However, percutaneous recon- struction of an interrupted or near-interrupted aortic arch is technically challenging. We describe our experience with transcatheter stenting in a patient with near-interrupted aorta.
Case Description: A 43-year-old male with history of long standing severe hypertension, and embolic stroke with residual left-sided weakness presented with complaints of nausea, diaphoresis, and passing bright red blood per rectum. On examination, he was noted to be hypertensive in upper limb with blood pressures of 176/101 mmHg as compared to lower limb blood pressure of 120/87 mmHg with diminished pulses in the lower limbs. Computed tomography demonstrated severe narrowing in the prox- imal part of the descending aorta measuring about 2mm in diameter along with an extensive network of collaterals joining the distal segment.
Interventions: Right radial artery and right femoral artery were catheterized. Simultaneous pressure measurements revealed a peak-to-peak gradient of 60 mm Hg across the coarctation. The angiogram demonstrated nearly inter- rupted segment in the proximal part of the descending aorta that appeared to connect through a pinhole to the distal thoracic aortic segment. Subsequently, via a radial artery access a 0.014 inch coronary whisper wire was snug- gly passed into the descending aorta. The coronary wire was snared from the femoral artery to create an arterio-ar- terial loop. The narrowest segment was dilated using a 4x20mm Advance balloon to pass a 0.035inch Amplatzer sti wire. Once the sti wire was secured in an acceptable position, a 12F long sheath was passed from the femoral artery across the coarctation. Finally, a 39mm Cheatham Platinum covered stent was deployed using a pre-mounted balloon-in-balloon catheter. Post-deployment angiogram showed good antegrade ow through the descending aorta measuring 15mm at the narrowest point. The stent was in-situ without any evidence of extravasation of the contrast or aneurysmal formation.
Conclusion: This case suggests that transcatheter stenting can be a safe and e ective intervention even in patients with near-interruption of aorta. However, the physician expertise, accurate hemodynamic measurement, and ana- tomic assessments are critical for optimal outcomes.
53. MEDIUM- AND LONG-TERM OUTCOMES OF STENT IMPLANTATION FOR COARCTATION OF AORTA IN SMALL PATIENTS (≤ 20 KG)
Brian Boe1, Emefah Loccoh2, Katie Stockmaster1, Ralf Holzer3, Sharon Cheatham1, John Cheatham1, Aimee Armstrong1, Darren Berman1
1Nationwide Children's Hospital, Columbus, USA. 2The Ohio State University, Columbus, USA. 3Weill Cornell Medicine, New York City, USA
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206