Page 64 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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were retrieved and an alternative device used for closure. Another patient required implantation of a second device 12 months later due to a signi cant residual shunt. In all cases, sPAP decreased after closure. Median length of stay following intervention was 3 days (1-6). Median follow up (FU) is 6 years (2-11). FU echo revealed no evidence of aor- tic or branch pulmonary artery obstruction.
Seven children with isolated APW underwent uneventful pericardial patch repair. Median age and weight was 6.8 years (1-25) and 17.8 Kg(7-54) respectively. Defects were classi ed as type I in 2 patients but considered extremely large (>20mm) for TDC, type II (n=2) and type III (n=3). Median length of stay was 7 days. All children remain symptom-free upon latest FU
Conclusions: In selected cases, TDC of APW can be consid- ered safe and e ective. However, risk of device emboliza- tion is worth considering. Furthermore, excellent surgical outcomes play out in the decision-making process where TDC of APW seems distant from taking a leading role.
98. TRANSCATHETER DEVICE CLOSURE OF PARAVALVULAR LEAK: SHORT AND MEDIUM-TERM OUTCOMES.
Tatiana Molina, Piero Custodio, José Garcia Montes, Jose A Arias, Jorge Cervantes, Carlos Zabal, Juan Pablo Sandoval Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico
Background: Paravalvular leak (PVL) is not an unusual complication of surgical valve replacement (SVR) occur- ring between 5 and 17%. Reoperation (i.e. leak repair and/ or valve replacement) has been considered the standard treatment modality, yet it is associated with signi cant morbidity and mortality. Transcatheter PVL device occlu- sion represents an attractive less invasive approach.
Methods: Retrospective, single institution review of patients with clinically relevant (i.e. heart failure, hemoly- sis) patients with PVL that underwent transcatheter device closure between 2006 and 2016. Clinical and interven- tional aspects were reviewed.
Results: Nineteen patients (female n=8); mean age 45±18 y.o. underwent transcatheter PVL closure. Indications for closure included: congestive heart failure n=13(68%); hemolytic anemia n=5 (26%), other n=1(5%). Mean time from index SVR to PVL intervention was 9.4 years. Nine (47%) patients were in NYHA functional class III prior to intervention. Mitral (n=15); aortic (n=5) and tricuspid
(n=1) PVL were all intervened under uoroscopic and 2D or 3D (more recently) transesophageal echo guidance. Seventeen (81%) leaks were associated to mechanical prostheses. A retrograde approach was used for all aor- tic PVL and 2 (13%) cases of mitral PVL. An antegrade approach was performed in 13(87%) mitral PVL via stan- dard transeptal needle puncture. Fifteen (79%) patients underwent closure using a single device while 4(21%) required an additional device to achieve occlusion. The most commonly used device was the Amplatzer Vascular Plug III in 13 (52%) PVL. Procedure success rate was 95%. None to mild residual leak was achieved in 80%. No pro- cedure related mortality was encountered. Device embo- lization occurred in one patient. He underwent uneventful device retrieval and eventually had SVR 21 days later. Two additional patients underwent SVR for persistent hemoly- sis at 4 and 6 months respectively. Median latest follow-up is 24 months (6-60). Seventeen (85%) patients remain in NYHA functional class I.
Conclusion: Transcatheter device closure of PLV is a safe and e ective procedure. This approach should be consid- ered as an alternative to surgical valve replacement, partic- ularly in the setting of surgical high risk patients.
99. STENTING OF RIGHT VENTRICULAR OUTFLOW TRACT OBSTRUCTION IN INFANTS WITH UNIVENTRICULAR PHYSIOLOGY
Hiroaki Kise, Yosuke Kono, Masashi Yoshizawa, Takako Toda University of Yamanashi hospital, Chuo-city, Japan
Background: Right ventricular out ow tract (RVOT) stent- ing has been reported as a feasible alternative to other forms of intervention in the high-risk Tetralogy of Fallot (TOF). Furthermore, this strategy has been reported to promote better pulmonary artery growth compared with BTS. In univentricular physiology with pulmonary steno- sis, RVOT stenting may become a feasible option in early infancy due to its many bene ts.
Methods: RVOT stenting was performed in two cyanotic infants with univentricular physiology. Case 1 with asple- nia, right single ventricle, RVOT stenosis and absent ductus (weight 3,100g) underwent RVOT stenting at 3 d/o due to hypercyanotic spell. Case 2 with tricuspid stenosis, hypo- plastic RV, pulmonary stenosis and absent ductus (weight 4,530g) underwent RVOT stenting at 3 m/o.
Results: In case 1, two stents (Express Vascular SD 5mm/15mm, 5mm/19mm) were percutaneously placed in tandem. In case 2, one stent (Express Vascular SD
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206