Page 43 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
60.
directed therapy (CDT) in pediatric patients are not well established. We report a single centered experience in the management and outcome of catheter-directed therapy in acute PE in children.
Methods: This is a retrospective study of patients, aged ≤21 years, who had no underlying congenital heart dis- ease and underwent CDT for management of acute PE at Children's Hospital of Michigan during 12 years (2005 to 2017). Demographic and clinical data associated with PE were collected along with the outcome.
Results: Nine patients (median age 16 years: range 12-20, Table) received CDT for submassive (n=6) and massive PE (n=3). One patient received ANGIOJET thrombectomy and balloon angioplasty, whereas 8 pts received catheter directed thrombolysis using tPA through infusion cathe- ters (n=3) or EkoSonic ultrasound accelerated thrombolysis system (n=5). In 4/5 patients treated with EkoSonic, a sig- ni cant clinical improvement was noticed within 24 hours. Two patients had minor gastrointestinal bleeding among 7 patients who survived (median hospital stay 8 days: range 5-24). Two patients with massive PE died possibly due to the delayed institution of CDT.
Conclusion: CDT with/without EkoSonic is an emerging alternative therapy for submassive and massive PE in chil- dren. A timely institution of CDT appeared important to improve the outcome.
61. EROSION OF FIGULLA FLEX II DEVICE AFTER CLOSURE OF ATRIAL SEPTAL DEFECT PRESENTING AS CARDIAC TAMPONADE
Tadaaki Abe, Shinya Tsukano, Yuko Tosaka
Niigata City General Hospital, Niigata City, Japan
Transcatheter device closure of atrial septal defect (ASD) is a minimally invasive technique that o ers an alternative to conventional surgical repair. In Japan, transcatheter device closure of ASD with AMPLATZER Septal Occluder has been started since 2005, and Figulla Flex II (FF II) has been avail- able since 2016. There has never been death related to transcatheter closure of ASD, and the ratio of device related cardiac erosion was 0.17% in our nationwide. We present a case of 8 years boy su ering from sudden-onset terrible chest pain and cardiogenic shock due to cardiac tampon- ade caused by erosion of a FF II device 4 days after place- ment. The transcatheter ASD closure was performed under general anesthesia. His ASD was about 7 mm round shape and had no aortic rim in a range of 90 degrees by a trans- esophageal echocardiography (TEE) resulting in a Qp:Qs of 2.0:1.0. The stop- ow diameter with sizing balloon was 11.0 mm by TEE. We chose a 15 mm FF II device intending to make the aortic side device ared shape. However, the aor- tic side device was closed shape after placement and the device was located along the atrial septal primum which was mal-alingment position to left atrium side. As a result, the right atrial disc of the device pressed the aortic wall perpendicularly after detachment. Four days later, he sud- denly complained of severe chest pain, and then became hypotensive and unconscious due to pericardial tampon- ade. Emergent pericardiocentesis, followed by emergent operation was performed. A right atrial incision was car- ried out and the device lay in an appropriate position. The device was removed easily, and a perforation site was seen at antero-superior wall on right atrium and another pinhole perforation was also seen at the opposite aortic wall. Surgical direct closure of the ASD and repair of the perforation sites were performed successfully. Fortunately, he was discharged without sequelae. Although there has been few reports about erosion of this exible device, in
Hijazi, Z
21st Annual PICS/AICS Meeting