Page 66 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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Conclusion: we found that this system of NO delivery by HUD is a simple delivery system with wide applicability. We have shown that it has similar e cacy as that of BIPAP to deliver NO and O2. Its safety pro le appears is comparable to that of standard, more complicated, delivery systems.
102. STENT PLACEMENT IN AN OCCLUDED LEFT SUPERIOR VENA CAVA TO RIGHT ATRIAL BAFFLE AIDED BY TRANSHEPATIC ACCESS IN A PATIENT WITH HETEROTAXY AND AN INTERRUPTED INFERIOR VENA Abraham Rothman1,2, Alvaro Galindo1,2, William Evans1,2, Humberto Restrepo1,2
1Children's Heart Center Nevada, Las Vegas, USA. 2University of Nevada Las Vegas, School of Medicine, Pediatric Cardiology, Las Vegas, USA
We describe covered stent placement in a completely occluded left superior vena cava to right atrial ba e in a patient with heterotaxy and an interrupted inferior vena cava. Left coronary angiography and transhepatic access were used to guide the Brockenbrough needle across the obstruction.
Case Report: A 9-year-old girl with a history of heterotaxy, dextrocardia, transitional atrioventricular septal defect, interrupted inferior vena cava to left sided superior vena cava and hepatic veins to right atrium underwent surgical rerouting of the left superior vena cava to right atrium and repair of the atrioventricular septal defect at 9 months of age. A catheterization at 7 years of age revealed obstruc- tion of the left superior vena cava to right atrial ba e and markedly dilated abdominal venous collaterals from the inferior vena cava, which eventually drained into hepatic veins and right atrium. A CTA showed close proximity of the left coronary artery to the occluded ba e. At the catheterization procedure, performed with general anes- thesia in a hybrid room, she weighed 23 kilograms. Left internal jugular (8F) and transhepatic venous (5F) access were obtained. Left coronary angiography was performed. An angled glide catheter advanced through the hepatic sheath was placed in the right atrium near the obstruction; small contrast injections delineated the target for punc- ture with a Brockenbrough needle, advanced through the jugular sheath. Complex right atrial morphology made it di cult to snare a wire from the hepatic vein. An 0.035 exchange wire was placed in a pulmonary artery branch. The obstruction was dilated with a 10mm x 3cm Evercross balloon followed by a 15 mm x 3 cm Zmed balloon, with simultaneous left coronary angiography. There was no coronary compression. A 4.5 cm Cheatham covered stent on a 14 mm balloon was delivered and was post-dilated
with a 16 mm x 2 cm Atlas balloon. A week later the stent was wide open on echocardiography. Six months later, the patient was doing well clinically and was due for a repeat echocardiogram.
Conclusion: Transhepatic access and simultaneous left coronary angiography were key to successful covered stent implantation in this patient with complex anatomy.
103. LEFT SUBCLAVIAN ARTERY TEST BALLOON OCCLUSION PRIOR TO COVERED STENT IMPLANTATION FOR RELIEF OF RE-COARCTATION AND EXCLUSION OF AN ANEURYSM
Abraham Rothman1,2, Michael Ciccolo1,3, Alvaro Galindo1,2,
William Evans1,2, Humberto Restrepo1,2
1Children's Heart Center Nevada, Las Vegas, USA. 2University of Nevada Las Vegas, School of Medicine, Pediatric Cardiology, Las Vegas, USA. 3University of Nevada Las Vegas, School of Medicine, Pediatric Surgery, Las Vegas, USA
A frequent conundrum during coarctation intervention is the potential compromise to ow in the left subclavian artery (LSCA). We describe temporary balloon occlusion of the LSCA prior to covered stent implantation for re-coarc- tation with a coexistent aneurysm.
Case Report: A 57-year-old man had coarctation patch repair at 3 years of age and presented with a dilated and dysfunctional left ventricle (ejection fraction in low 30s). A CTA revealed obstruction in the distal arch and proximal descending aorta with a diameter of 11 mm and a saccular aneurysm near the origin of the LSCA measuring 30 x 23 x 20 mm. Surgical repair was deemed high risk. A hybrid procedure was performed. Under general anesthesia, a left radial arterial line and femoral venous and arterial sheaths were placed. The left ventricular end-diastolic pressure was 17 mmHg, the ejection fraction 32%, and the gradient from ascending to descending aorta was 35 mmHg. Coronary angiography revealed no signi cant lesions. A 5F Berman catheter was used to test balloon occlude the LSCA; the left radial arterial pressure decreased from near systemic level to 40/38 mmHg. The surgical team placed an 8mm Dacron graft from the left common carotid artery to the LSCA. Through a 14F femoral arterial sheath, a 4.5cm Cheatham covered stent was implanted with an 18 mm BIB balloon in the distal arch and proximal descending aorta, exclud- ing the aneurysm. The minimum diameter increased from 11.5 to 16.4 mm. The gradient from ascending to descend- ing aorta was 3 mmHg and from ascending aorta to left radial artery 20 mmHg. A CTA 6 months later showed no stent re-stenosis; the aneurysm and proximal LSCA were
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206