Page 42 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
144
Firth & Hills: 4.91±1.50 L/min; Bergstra, Van Dijk, Jillege: 6.1 ±2.22 L/min; and Seckeler, Hirsch, Beekman: 2.96±0.88 L/min. LaFarge and Miettenen formula derived CO was signi cantly lower than Dehmer and Bergstra formulae (P<0.0001 for each), whereas signi cantly higher than the formula by Seckeler.
Conclusion: There is no agreement between the formulae derived assumed VO2 and resultant CO. Such assumed for- mulae derived CO may be misleading. Every cardiologist should be cognizant of these limitations. Metabolic face- mask apparatus should be routinely used in catheter labo- ratories to obtain true VO2, especially, when such a value is likely to in uence major management decisions.
59. SPLITTING OF SURGICAL PULMONARY VALVE RING WITH HIGH PRESSURE BALLOONS INCREASES PULMONARY VALVE ANNULUS DIAMETER FACILITATING TRANSCATHETER PULMONARY VALVE IMPLANTATION
Farhouch Berdjis1, Sharib Ga ar2,3,4, Michael Recto3
1Children's Hospital Of Orange County, Orange, USA. 2University of California Irvine, Irvine, USA. 3Children's Hospital Orange County, Orange, USA. 4Miller Children's and Women's Hospital Long Beach, Long Beach, USA
Background: Melody valve implantation is an accepted therapy for patients who have previously undergone placement of prosthetic right ventricular out ow tract (RVOT) conduits in the setting of signi cant conduit ste- nosis or insu ciency. This abstract documents our expe- rience splitting pulmonary valve rings with high pressure Atlas Balloons (Bard Peripheral Vascular) in patients with Tetralogy of Fallot
Methods: 4 patients (3 males, 1 female) with mean age 11.6 years (range 9-15 years) and mean weight 47.1 kg (range 31-77 kg) developed severe pulmonary valve insu ciency (2 patients) or moderate pulmonary valve stenosis with severe insu ciency (2 patients). All patients had initially undergone complete repair with transannular RVOT patch. They developed signi cant right ventricular enlargement secondary to pulmonary valve regurgitation. The pulmo- nary valve ring was measured pre- and post- splitting. A 20 mm Atlas Balloon was utilized for the 19 mm valve, 22 mm balloon was utilized for the 21 mm valve, and 24 mm balloon utilized for the 23 mm valve. The balloons were in ated to 22 atm with successful splitting of the valve ring. Mean gradient across the pulmonary valve ring decreased from 16.8 mmHg to 4.5 mmHg. All 4 patients subsequently
underwent successful placement of a 22 mm Melody valve on a 22 mm Ensemble. There were no complications.
Conclusion: Splitting of a surgical pulmonary valve ring with a high-pressure balloon prior to Melody Valve place- ment decreases pulmonary valve stenosis and increases the maximum diameter of the pulmonary valve, facilitating successful placement of the Melody valve.
Patient #1: 19mm valve
Pressure gradient
Ring
Pre-split
Post-split
Change
Patient #2: 21mm valve
Pre-split
Post-split
Change
Patient #3: 21mm valve
Pre-split
Post-split
Change
Patient #4: 23mm valve
Pre-split Post-split Change
PA: 21/7 RV: 30/7 Gradient 9mmHg
PA: 19/13 RV: 20/5 Gradient 1mmHg
(-) 8mmHg
Pressure gradient
PA: 18mmHg RV:41mmHg Gradient 23mmHg
PA: 16mmHg RV: 21mmHg Gradient: 5mmHg
(-) 18mmHg
Pressure gradient
10mmHg
3mmHg
(-) 7mmHg Pressure gradient
PA: 20/11 RV: 45/11 Gradient: 25mmHg
PA: 33/16 RV: 42/10 Gradient: 9mmHg
(-) 16mmHg
16.7mm
18.3mm
(+) 1.6mm
Ring
19.9mm
21.7mm
(+) 1.8mm
Ring
19.9mm 21.1mm (+) 1.2mm Ring
19.7mm 21mm
(+) 1.3mm
60. CATHETER-DIRECTED THERAPY IN ACUTE PULMONARY EMBOLISM IN CHILDREN
Jyothsna Akam Venkata1, Thomas Forbes1, Theodore Schreiber2, Amir Kaki2, Mahir Elder2, Daniel Turner1, Daisuke Kobayashi1
1Children's Hospital of Michigan, Detroit, USA. 2Detroit Medical Center, Detroit, USA
Background: Acute pulmonary embolism (PE) is a poten- tially life threatening condition requiring prompt man- agement in children. The safety and e cacy of catheter
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206