Page 41 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
congenital heart defects which were closed with ADO II. Also our ADO II occluded VSD case series is one of the larg- est series in the literature with almost 6 years’ follow-up.
We believe in that ADO II device may be an alternative in percutaneous closure of various rare heart defects. It is used successfully for non-ductal defects with low compli- cation and high compliance rates.
57. SHOULD THE NORMAL RANGE OF PULMONARY VASCULAR RESISTANCE BE RE-DEFINED IN PATIENTS WITH FONTAN CIRCULATION?
Ashish Shah1, Kelly Rohan2
1St Boniface Hospital & the University of Manitoba, Winnipeg, Canada. 2Universit of Manchester, Manchester, United Kingdom
Background: The Fontan operation provides a palliative cure to those born with anatomical or physiologically single ventricle. The long-term outcomes are poor and survivors are at a high risk of constellation of medical prob- lems, described as “Fontan failure”. Adult patients with Fontan circulation have limited exercise capacity, mainly due to inability to augment the cardiac output, predom- inantly secondary to limited venous return. Studies have suggested that pulmonary vasodilator therapy results in marked improvement in hemodynamics. Normal range of pulmonary vascular resistance (PVR) is de ned in those with bi-ventricular physiology, and pulsatile pulmonary ow. We evaluated observed PVR in a cohort of patients with Fontan circulation from a tertiary adult congenital heart disease centre.
Materials and Methods: We retrospectively reviewed data from a large tertiary adult congenital heart disease centres in UK. Clinical and procedural details were obtained by reviewing electronic charts, with special emphasis on hae- modynamic data.
Results: From a cohort of 4454 patients with complex ACHD conditions, 154 had Fontan circulation; of whom 70 patients with failing Fontan were investigated by car- diac catheterization. Thirty-four (48.6%) were male, mean age of 30.1±6.2 years (17-43), and mean body mass index of 24.1±5.3 kg/m2 (16.6-47.7). Mean Fontan pressure was 16±4 mmHg (7-29), mean wedge capillary pressure was 11±3 mmHg (4-19), and mean trans-pulmonary gradient (TPG) was 5±3 mmHg (0-15). Mean cardiac output was 4.1±2.7 L/min and calculated PVR was 1.7±1.2 Wood units (0.25-5.3). Although cardiac output was well maintained, Fontan pressure was signi cantly correlated with capillary wedge pressure (P<0.0001) and PVR (P<0.0001). Rise in
Fontan pressure was observed earlier than increase in PVR; however, 3/4th of patients with failing Fontan were noted to have normal PVR.
Conclusions: In this large series of patients with Fontan circulation, rise in PVR above the normally accepted range was observed only after moderate rise in Fontan pressure. In patients without sub-pulmonic ventricle and passively lling pulmonary circulation, range of normally accepted PVR should be re-de ned, as patients can be treated in a timely fashion.
58. RELIABILITY OF THE CARDIAC OUTPUT MEASUREMENTS DURING CATHETERIZATION: COMPARISON OF VARIOUS COMMONLY USED FORMULAE CALCULATING ASSUMED O2 CONSUMPTION.
Ashish Shah1, Guy Kendall2
1St Boniface Hospital & the University of Manitoba, Winnipeg, Canada. 2Universit of Manchester, Manchester, United Kingdom
Background: Cardiac output (CO) measurement guides management of various medical conditions, including adult congenital heart diseases (ACHD), and pulmonary hypertension. It is mandatory to calculate patients’ oxygen consumption (VO2), to measure CO. Ideally VO2 consump- tion should be measured by using a metabolic facemask apparatus; however, due to complexity in their routine use, various formulae derived assumed VO2 are incorporated to obtain CO values. The most commonly used formula in catheter laboratories treating adult patients was reported by LaFarge and Miettinen (1970). However, it was based on data from paediatric population, and their use in adult population is not validated. Moreover, these individual for- mulae were compared with true VO2 consumption; how- ever, limited information exploring agreement between these formulae is available. Such a comparison is very important, as individual catheter laboratories use these formulae at their discretion to derive cardiac output, in u- encing patients’ management.
Materials and Methods: We sought to compare cardiac output measurement based upon four commonly used formulae, (1) LaFarge and Miettenen, (2) Dehmer, Firth & Hills, (3) Bergstra, Van Dijk, Jillege, and (4) Seckeler, Hirsch, Beekman methodology, in 112 ACHD patients who under- went diagnostic catheterization at the Manchester Royal In rmary, UK between 1st January 2015 to 31st March 2017.
Results: CO measured by various formulae is reported here with. LaFarge and Miettenen: 4.31±1.43 L/min; Dehmer,
Hijazi, Z
21st Annual PICS/AICS Meeting