Page 54 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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of a 60-year-old woman with a history closed mitral valvot- omy at 18 years of age, Mitral Valve (MV) replacement at 53 year of age in Feb 2016 at 60 year of age. She presented with shortness of breath and chest pain since for 2 weeks. Echocardiography (Echo) revealed left ventricle pseudo- aneurysm with neck size of 12mm. Cardiac MRI showed a large left ventricle pseudoaneurysm ( 36x32 mm) that was lling from a small leak in the anterolateral aspect of the ventricle. Considering high-risk candidate for surgi- cal treatment in view of three previous sternotomies, the pseudoaneurysm was closed percutaneously with use of a 16-mm AMPLATZER muscular VSD occlude sucessfully. The patient was discharged from the hospital the next day and was asymptomatic on followup.
80. EXPERIENCE IN TRANSCATHETER INTER-ATRIAL DEFECTS DEVICE CLOSURE IN PATIENTS WITH PULMONARY ATRESIA AND INTACT VENTRICULAR SEPTUM
Marhisham Che Mood1,2, Keijiro Ibuki1, Mazeni Alwi1
1National Heart Institute, Kuala Lumpur, Malaysia. 2
Background: Pulmonary atresia and intact ventricular septum (PA-IVS) is a rare congenital heart defect comprises of membraneous atresia of pulmonary valve or RVOT mus- cular atresia and intact ventricular septum. Those with membraneous atresia will require radiofrequency valvot- omy + ductal stenting depending on the right ventricular size. Those with muscular atresia and borderline RV size may require RVOT reconstructive surgery + cavo-pulmo- nary shunt. In this group, inter-atrial communications are often left open during the treatment process. There are limited reports about the inter-atrial defect device closure for PA-IVS patients. The objective is to describe the results of transcatheter closure of inter-atrial communication in PA-IVS patients.
Methods: A total of 18 patients were enrolled (14 ASD cases and 4 PFO cases). The major indication was cyanosis for 14 patients. Two of these patients with low oxygen sat- uration underwent the procedure during early period after surgery (post-operative day 1 and 19 respectively).
Results: 14 patients had achieved 2 ventricular circulation and 4 patients with one and half ventricular circulation. 2 device complication were reported (1 device malposition and 1 device embolization) and both had successful device retrieval and re-implantation procedure. Median follow up was 14 months (3 months-129 months). All defects were completely closed without residual shunt. All patient were asymptomatic for heart failure and echocardiography in all
patients showed good ventricular function on subsequent follow up.
Conclusion: Transcatheter inter-atrial defect occlusion for PA-IVS patients is e ective procedure with high success rate. On the other hand, judicious consideration is neces- sary to decide on appropriate device size due to high risk of device embolization.
81. PERCUTANEOUS RE-TREATMENT OF PATIENTS WITH STENTED AORTIC COARCTATION AT EARLY AGE.
Manuel Pan, Miguel Romero, Soledad Ojeda, Francisco Hidalgo, Javier Suárez de Lezo, Adrián Lostalo, Aurora Luque, Rafael González, Ernesto Martín, Francisco Mazuelos, José Segura, Cristina Pericet, Elena Gómez
Reina Sofía Hospital, Córdoba, Spain
The aim of our paper is to assess the e cacy and safety of the re-treatment in patients with stented aortic coarc- tation at early age, several years after the stent implanta- tion,when the aorta reached a near de nitive size.From 1993 to 2018, 177 patients with coarctation of aorta were treated in our center by stent implantation. For our study,we selected those patients who were treated by stent implan- tation younger than 12 years and required re-treatment because of their rate of growth (n=33).The age at the rst procedure was 6.6±3.5 years and at the second procedure 18.7±7.2 years.So, the time between stenting of the aorta and re-treatment was 13 ± 5 years.In this time interval, the aorta grew from 8.3±3.3 mm to 12.3±4.5 mm at the level of isthmus below the subclavia and from 10.9±2.7 mm to 17.4±4.9 mm at the level of the diaphragm.At the second procedure, 15 (45%) patients were treated with balloon re-expansion and 18 (55%) by re-stenting. Stent fracture was a frequent nding before re-treatment (n=13, 39%). Primary success was obtained in 32 patients (97%).An immediate reduction of the peak gradient across the coarc- tation was obtained in all of them.The nal residual gradi- ent was 6±6 mmHg. In the patient without primary success the stent remained unexpanded despite repeat dilations. There were no major complications.After the coarctation re-treatment, the minimal lumen diameter at the level of the coarctation changed from 3.5±1.8 mm to 10.6±5.6 ( p<0.05).The mean follow-up time after the second pro- cedure was 5±4 years. A third procedure was required in 3 patients (9%) in whom the stent was implanted when they were younger than 2 years.Only 1 additional patient continued with controlled hypertension (treatment with 1 drug) despite a successful re-treatment procedure. The remaining patients are currently asymptomatic and free of
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206