Page 50 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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Results: 51 patients had Fontan operation at age 4.7 (4-5.7) years. Duration to fenestration closure was 0.9 (0.7-1.5) years. The majority (84%) were closed with Amplatzer sep- tal occluders. Following occlusion, systemic O2 saturation increased from 87 (84-89)% to 95 (94-97)%, p<0.05. Cardiac index decreased from 4 (3-5) to 2.9 (2.6-3.5) L/min/m2 and systemic oxygen transport decreased from 718 (568-851) to 591 (504-640) mlO2/min/m2, p< 0.05. Fontan pressure (13 [11.5-14] to 13 [12.3-15] mmHg) and pulmonary vas- cular resistance (1.8 [1.2-2.2] to 1.9 (1.6-2.5) WU x M2) were not signi cantly changed. 9 (18%) patients had follow up cardiac catheterization; one for residual fenestration that was closed with an additional device, one for recurrent cyanosis 3 years following fenestration closure, at which time a veno-venous collateral was successfully occluded. Clinical follow up duration for all patients was 8.1 (5.3-10.6) years. Oxygen saturation at last follow up was 96 (94-98)% and did not decrease over time (p<0.05). One patient (2%) developed protein losing enteropathy 1.8 years after fen- estration closure, 1 (2%) had heart transplant 4.1 years after fenestration closure, and 1 (2%) patient expired 9.4 years following fenestration closure. No patient required fenestration creation to decompress the Fontan circuit.
Conclusions: Transcatheter Fontan fenestration closure leads to sustained increases in systemic arterial oxygen saturation and a low incidence of adverse outcomes such as death and transplant. Further study comparing fenestra- tion closure to non-closure and longer follow up duration are required to determine if there is a survival bene t to fenestration closure.
73. RADIATION FREE CARDIAC CATHETERIZATION WITH MRI GUIDANCE – FIRST TEN CASES
Yousef Arar, MD1, Riad Abou Zahr, MD1, Tarique Hussain, MD, Ph.D1, Jennifer Hernandez, MD1, Gerald Greil, MD, Ph.D1, Sébastien Roujol, Ph.D2, Mari Nieves Velasco Forte, MD2, Surendranath R. Veeram Reddy, MD1
1UT Southwestern, Dallas, USA. 2King’s College London, London, United Kingdom
Introduction: Cardiac MRI (CMR)-guided right heart cathe- terization is feasible and safe in children and adults. During this presentation, we describe our early institutional expe- rience performing real-time interventional CMR (iCMR) procedures in the Phillips Ingenia 1.5 Tesla Magnet (Philips Healthcare, Best, NL). We also report our experience with the MRI compatible wire (angled-tip Emeryglide MRWire, Nano4Imaging, Aachen, Germany), which we have uti- lized in right and left heart catheterization (RHC and LHC, respectively).
Methods: 10 [7 single ventricle (SV) and 3 bi-ventricular (BiV)] patients underwent an iCMR procedure in the Phillips Magnet co-located adjacent to the Phillips AlluraClarity catheterization laboratory (Philips Healthcare, Best, NL). A dilute gadolinium- lled balloon-tip catheter (1 part gad- olinium to 100 parts saline) was used for RHC and LHC under real-time MRI visualization. A novel passive catheter tracking technique with a partial saturation (pSAT) pulse between 30-40 degrees was used to visualize the gadolini- um- lled balloon and cardiac structures.
Results: 10 CHD patients with a median age of 5 years (3months-17years) and weight of 19.1 kgs (7.6-54.2kgs) underwent an iCMR procedure. 7 of 10 patients had SV anatomy: 1 BT shunt patient for pre-Glenn evaluation, 4 post Glenn patients for pre-Fontan evaluation, and 2 post Fontan patients for PLE/cyanosis evaluation. 2 of the 3 BiV were TOF patients for RV volume and branch pulmonary artery stenosis evaluation and the remaining BiV patient had severe coarctation with suspected transverse arch hypoplasia.
Real time MRI-guided RHC and LHC with aortic pull back was successfully performed in 9 and 5 patients, respec- tively. Technical di culty in completing RHC occurred in one post Glenn patient (a 4-year old) due to poor visualiza- tion of the gadolinium- lled balloon in the Glenn pathway. The MRI compatible wire was used successfully in one SV (prograde LHC) and one BiV (retrograde LHC). No compli- cations were encountered.
Conclusion: We have demonstrated that diagnostic right and left heart iCMR procedures are safe and feasible in both single and two ventricle pediatric CHD patients. The pSAT pulse facilitates simultaneous visualization of the cathe- ter balloon tip, MRI compatible wire, and cardiac anatomy during iCMR procedures.
74. TRANSCATHETER CLOSURE OF SINUS VENOSUS ASD
Edwin Francis, Annu Jose, Bijesh Viswambaran
Lisie Hospital, Cochin, India
Atrial septal defects accounts for 8-10% of congenital heart defects of which sinus venosus type of ASD constitutes 5%. Surgical closure has been the norm for sinus venosus ASD till recent attempts at transcatheter closure of the same by deploying a stent in the superior vena cava. We report two cases of transcatheter closure of sinus venosus ASD
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206