Page 58 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
160
Material and Methods: Transcatheter device implantation was accepted in 77patients (p) with congenital VSD until 2016. All patients have transthoracic echocardiography ini- tially, and TEE during all the time. The criteria for inclusion were clinical and/or echocardiographic evidence of a sig- ni cant left to right shunt.
The rst cycle (35p): The median age was 9.7±7 years. Devices was: 21p Amplatzer device (7p PM, 14p M) y 1p PDA device.14 Nit Occlud VSD devices (13 PM, 1 M). The attempt to place device was successful in 34 patients (96.5%).
Complications: 21p con Amplatzer PmVSD occluder: 1p tricuspid regurgitation (no surgery)), 3p light disritmia, 3p complete block atrio-ventricular (2p VSDpm y 1 infundibu- lar muscular (2p transitory, 1 pace maker); 2p left anterior hemiblock (2 CIV M). 14p NIT OCCLUD device: 1p emboliza- tion, 1p ligh aortic regurgitation, 2p transitory haemolysis. Cox proportional hazards regression analysis showed that the age (<5 years) and weight (<5 Kg) was the variable sig- ni cantly associated with of complication during the pro- cedure (P=0.025; relative risk 0.22).
The second cycle (47p): 51 procedures were performed in 47p. Median age was 7 years old (range 0,33 to 15y). Median weight was 26 Kg (range 4,3-83Kg); 5 procedures in p less than 10Kg. 3p had residual POP VSD, the rest were native. 2p had multiple VSDs: 1p had 2 VSDs closed in the same procedure; the other needed 3 di erent proce- dures. 43 procedures were successful (84,3%), 41 in the rst attempt and 2 needed a second procedure.
Size of the VSD: Median diameter of left ori ce was 9.3mm, right ori ce 4.7mm and median length of 7.12mm. 12 VSDs had more than one right ori ce.
Complications: 3p major complications (6,3%): 1p tricus- pid stenosis, 1p hematuria with decrease in blood count; 1p, <10kg with muscular VSD and no aortic prolapse, had severe aortic insu ciency immediately post procedure and died. 6p required surgery (11,7%).
Conclusion: Transcatheter closure of congenital VSD o ers encouraging results. Complications are limited; the most relevant one is complete atrioventricular block in perimembranous VSD. More experience and long-term fol- low-up are mandatory to assess its safety and e ective
89. NOVEL USE OF A COVERED CP STENT TO CONVERT HEPATIC VEIN EXCLUSION FONTAN TO A COMPLETE (FENESTRATED) FONTAN
Sarosh Batlivala1, Makram Ebeid2
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 2University of Mississippi Medical Center, Jackson, MS, USA
Background: This is a 4 year old patient with heterotaxy, dextrocardia, mitral atresia, pulmonary atresia, d-malposed great vessels, and supracardiac totally anomalous pulmo- nary venous return (TAPVR). She underwent TAPVR repair and central shunt placement in the rst week of life, then bidirectional Glenn procedure at 5 months of age. Patient did well in the interstage and post-Glenn periods. Pre- Fontan catheterization demonstrated normal PVRi of 1.8 WUi though Glenn pressures were 16mmHg and pulmonary arteries were mildly hypoplastic di usely. One right-sided hepatic vein was left draining directly to the atrium, with the other hepatic veins draining normally to the IVC. Given the dextrocardia and borderline PA anatomy, an extra-car- diac Fontan (18mm) was performed, excluding the one hepatic vein. Patient had a tenuous post-operative course related acute conduit obstruction related to her dextro- cardia. Placement of a conduit stent was needed in imme- diate post-op period with a slow recovery. Patient then developed slowly progressive and profound hypoxemia related to massive right-to-left shunting via hepato-he- patic venous collaterals (SpO2 65% and Hb 22.4 gm/dL). These collaterals allowed systemic venous blood to bypass the pulmonary arteries and ow directly into the atrium, eventually resulting in limited antegrade pulmonary blood ow. An 8zig, 22mm long covered CP stent was modi ed by cutting a small hole (~1mm) in the ePTFE lining one- third from the stent edge. During catheterization, an 0.018” wire was advanced into the largest hepatic vein connected to the IVC. The back-end of this wire was placed through the side-hole of the CP stent, and the stent then mounted on an 18mm BIB. The stent was deployed, then 4mm and 6mm Sterling balloons were used to dilate the side-hole, creating a functional “fenestration”. The procedure was well tolerated, with SpO2 rising to 85% in room air immediately, and symptoms improving over coming months. Follow-up echocardiography demonstrated ~4mmHg fenestration gradient and normal hepatic venous Doppler signals (i.e. no stasis). Hepatic elastography will be followed serially.
Conclusion: CP stents can be modi ed to serve unique needs of maintaining access to “jailed” vessels and creating fenestrations for decompression.
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206