Page 45 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
artery, 7/25=left carotid artery cutdown, 2/25=left axillary, 2/25=umbilical artery, and 1/25=femoral vein.
There were no procedural or interstage mortality or need for extracorporeal membrane oxygenation.
Complications:
• 1 attempted stenting had ductal spasm requiring urgent BT shunt,
• 1 left carotid artery contained dissection (with no long- term sequelae),
• 3 arterial thrombus at catheterization site, and
• 7 PRBC transfusion.
Conclusions: Ductal stenting as palliation for neonates with ductal-dependent pulmonary blood ow is safe and e ective, with low reintervention rate. Stenting the tortu- ous duct is feasible if there is not a 360° loop or 180° hairpin turn. A more acute angle of entry into the PDA is techni- cally more challenging; therefore, access site should be chosen to make the straightest angle of entry possible.
64. SUCCESSFUL TRANSCATHETER OCCLUSION OF PERSISTENT DUCTUS VENOSUS IN A PATIENT WITH HEPATOPULMONARY SYNDROME USING AMPLATZER VASCULAR PLUG II.
Amr Matoq, Wolfgang Radtke
Alfred I.duPont Hospital for Children, Wilmington, USA
Background: Ductus Venosus is the vascular structure that connects the umbilical vein to the inferior vena cava in the fetal period. It closes at birth, with complete obliteration around 2-3 weeks of life. Persistent Ductus Venosus is a form of portosystemic venous shunts that leads to pulmo- nary hypertension, hepatopulmonary syndrome, pulmo- nary arteriovenous malformation, and encephalopathy. Liver transplantation is the treatment of choice in the pres- ence of signi cant liver disease or intrahepatic portal vein hypoplasia. Surgical ligation of the abnormal shunt is con- sidered treatment of choice in an otherwise healthy portal venous system. Only few cases of transcatheter occlusion of persistent ductus venosus have been reported. Objective: We present a case of a rare portosystemic venous shunt, successfully closed by Amplatzer Vascular Plug II (AVP II).
Case: Three months old female born at 35-week of gesta- tion. Presented with failure to thrive, murmur and hypox- emia requiring supplemental oxygen. Noted to have a patent ductus arteriosus, which was surgically ligated. Continued to have hypoxemia postoperatively. Multiple investigations were done for lung diseases, re ux and
chronic aspiration. At 5 months of age, she underwent cardiac catheterization revealing pulmonary venous desaturation, pulmonary hypertension and evidence of intra-pulmonary right-to-left shunt by injection of agi- tated saline into main pulmonary artery. Ultrasound and three-phase CT scan of the liver showed persistent ductus venosus.
Procedure: She underwent cardiac catheterization. Through right internal jugular access, a 5 French balloon wedge catheter that was advanced into the persistent duc- tus venosus and portal vein pressure was measured and was normal. Test occlusion of the persistent ductus venosus was performed and portal vein pressure did remain within normal limits. A decision was made to place a 6 mm AVP II (AGA medical) into the persistent ductus venosus. Device was deployed successfully. Repeat angiogram showed no residual shunt. Repeat ultrasound showed normal ow in left hepatic vein and portal vein.
Conclusion: Persistent Ductus Venosus in an otherwise normal portal venous system can be safely closed by AVP. Measuring portal venous pressure with test occlusion is necessary to rule out portal hypertension.
65. TRANSCATHETER COVERED STENT PLACEMENT FOR NATIVE COARCTATION WITHOUT ANGIOGRAPHY IN A PATIENT WITH CHRONIC KIDNEY DISEASE
Amr Matoq, Wolfgang Radtke
Nemours/Alfred I.duPont Hospital for Children, Wilmington, USA
Background: Coarctation of the aorta represents approxi- mately 7% of live births with congenital heart disease. The best intervention for aortic Coarctation as regard safety and e ectiveness remains debatable, due to lack of su - cient randomized trial and long term follow up. However, stent placement is considered a reasonable approach in the older child, adolescent, or adult presenting with a sim- ple, juxtaductal, native Coarctation. Contrast is necessary for endovascular interventions like stent placement, but chronic kidney disease (CKD) is a major limitation for its use. CKD increase the risk for developing Contrast induced nephropathy (CIN).
Case: 17-year-old with male presents to ED with hyper- tension. Echocardiogram showed Juxta-ductal discrete Coarctation of the aorta, with peak gradient 45 mmHg, bicuspid aortic valve and moderate aortic root and ascend- ing aorta dilatation. Screening labs showed elevated BUN and Creatinine at 38 mg/dL and 2.8 mg/dL respectively. Based on renal ultrasound and other laboratory ndings,
Hijazi, Z
21st Annual PICS/AICS Meeting