Page 57 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
Inclusion Criteria: Body weight > 8 Kg, No severe aortic valve prolapse, No moderate to severe AR, True defect <= 6 mm, No other cardiac abnormalities.
Procedure:
Echo: Pro ling the VSD and to determine the distance of the VSD from aortic and pulmonary valve.
LV Angiography: In LAO 60-80° with cranially tilted view instead of standard LAO 45-55° & cranial 20°.
Approach: These VSDs can be crossed both retrogradely and antegradely .
Hardware: Judkin’s RCA catheter (for crossing the defect antegradely) or cut Pigtail catheter (for crossing retrogradely)
Selection of device: If the VSD is located close proximity to the aortic valve or if it is associated with AR, low pro le device like duct occluder-II is used.
Results: Antegrade approach was used for 12 of them and VSD closure was done using duct occluder-I device. Retrograde technique was used for other 6 patients & duct occluder-II was used. Predominant patients (10) had mild, AVP, 7 patients no AVP, 1 patients had moderate AVP. Mean follow up period was 9 months (3- 12) months. 12 out of 18 patients had no AR, 6 patients had Trivial AR. Technical suc- cess in 18/20 (90%). Two patient developed moderate AR post device deployment for which patient sent for surgery. Post device closure showed small residual shunt in 4 (18) patients. Median duration of follow up is 12 months (6-34 months). AR at 6 months follow up: Trivial/Mild:4/18 (22%), Moderate 0/18.
Conclusion: Closure of doubly committed VSDs can be done by transcatheter technique is possible in certain patients. Proper selection of patient is important for suc- cessful device closure. Long duration of follow up should be evaluated to look for the feasibility of device closure in these type of defects.
87. PERCUTANEOUS PULMONARY VALVE IMPLANTATION WITH OVEREXPANSION OF THE DIFFERENT TYPE AND SMALL CONDUITS
Ahmet Celebi, Ilker Kemal Yucel, Mustafa Orhan Bulut Siyami Ersek Hospital for Cardiology and CV Surgery, Istanbul, Turkey
Background: Percutaneous pulmonary valve replacement (PPVR) has not been feasible in patients with small right ventricular out ow trackt conduits. It is also not recom- mended to dilate more than 2 mm than the nominal size of the conduits. We present our results of PPVR in patients with a small conduits dilated beyond its nominal diameter.
Methods: Between 2012 and 2017, 62 patients with severe conduit dysfunction underwent angiography for PPVR. 21 of them needed dilation to a nal diameter of 23 mm, since the nominal conduit diameter was small (either ≤16 mm or between 17-19 mm). To avoid conduit rupture, a cov- ered stent was employed and PPVR was performed after gradual dilation of the covered stent with non-compliant balloons.
Results: The mean age and weight were 11.3 years (5-18) and 38 kg (18-60), respectively. The mean nominal diam- eter of the conduits was 15.7 ± 1.4 (13-19) mm. The initial diameter was ≤ 16 mm in 14 patients. The type of con- duits was Contegra in eight, Labcor in ve, Homograft in three, Shelhigh in three, Hemashield in one, and PTFE in one. PPVR was abandoned upon detection of coronary compression in two. A Melody valve was implanted in 16, while a Sapien valve (20 and 23 mm) was used in three. Melody valves were implanted using 22 mm balloons in 11 and 20 mm in ve. The mean narrowest diameter of the conduit increased from 12.3 (6.4-15.8) mm to 20.2 (17-23). The mean diameter of the conduits increased by 4.8 mm (1-8). There was no complication related to the procedures. The mean right ventricle (RV) pressure and RV-pulmonary artery pressure gradient were decreased from 80 (61-116) mmHg and 51 (20-96) mmHg to 37 (27-50) and 8.3 (0-16) mmHg, respectively. Infectious endocarditis responded to medical treatment was seen in one during the follow-up of 27 months. The last echocardiographic examination revealed a pressure gradient of 25 ± 11 mmHg across the conduits.
Conclusion: Di erent types of conduits can be dilated gradually even beyond their nominal diameters. The use of a covered stent eliminates the risk of rupture and ensure implantation with larger valves.
88. TRANSCATHETER CLOSURE OF CONGENITAL VENTRICULAR SEPTAL DEFECTS
Ana Maria de Dios1,2, Julio Cesar Biancolini1,2, Maria Fernanda Biancolini1,2, Victorio Lucini1,2, Judith Ackerman1, Adelia Marques1, Jesus Damsky Barbosa1, Ignacio Lugones1
1Pedro Elizalde, Buenos Aires, Argentina. 2Sanatorio Trinidad Mitre, Buenos Aires, Argentina
Hijazi, Z
21st Annual PICS/AICS Meeting