Page 68 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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TEE evaluation was done that showed severe MS with E ective Ori ce area (EOA) of 0.6 cm2 and ASD of 22 mm. After QP/QS measurement (4.1:1), underwent successful PBMV from left Femoral vein approach using 23-26 Accura Balloon with increase in EOA to 2.1cm2. Patient improved symptomatically and after 3months underwent success- ful ASD device closure using 26 Amplatzer Septal Occluder. PCWP checked before and after procedure that showed baseline value of 10 mm Hg increased to 14 after the proce- dure. TR which was severe before ASD occlusion decreased to mild after the procedure. Discharged on diuretics and dual anti platelets. 6 months follow up showed mitral valve area of 2.3 cm2 with absence of any symptoms.
Conclusion: This case highlights the importance of metic- ulous assessment of haemodynamics while managing Lutembacher syndrome. Left sided femoral venous access helped in catheter and balloon alignment while perform- ing PBMV and ASD device closure. Staging of procedure with PBMV rst followed by ASD device closure is a good strategy for such patients. ASD closure is possible if mitral valve EOA is good without signi cant regurgitation. One interesting observation is that TR even if severe tends to decreased in absence of organic abnormality after ASD device closure.
106. CARDIAC STRANGULATION CAUSING REFRACTORY CARDIAC ARREST DURING ELECTIVE PACEMAKER REVISION: A CAUTIONARY TALE
Colm Breatnach, Rebecca Weedle, Matthew Coughlan, Damien Kenny, Lars Nolke, Paul Oslizlok
Our Lady's Children's Hospital, Dublin, Ireland
Case Report: A seven year old girl was admitted for elec- tive pacemaker revision with a transvenous pacemaker. She originally had an epicardial system sited on day 2 of age for complete heart block. During the procedure, she had a sudden loss of cardiac output and uoros- copy demonstrated cardiac standstill. Cardiopulmonary resuscitation (CPR), multiple rounds of ephinephrine and 8 de brillations proceeded extracorporeal life support (ECLS). Aortography following ECLS suggested normal coronary arterial ow. On day two post paediatric inten- sive care unit (PICU admission she was decanulated with a shortening fraction of 30%. She again deteriorated and was recanulated following a brief run of CPR. Selective coronary angiography demonstrated dynamic collapse of the left anterior descending (LAD) and left circum ex (LCx) coronary arteries. A CT thorax con rmed compression of the LAD and LCx just after the bifurcation by the original epicardial pacing lead. The cardiothoracic surgical team
identi ed the epicardial lead covered by a calci ed cap- sule encircling the heart, with a 2cm ssure on the surface of the right ventricle. The pacemaker box and leads were removed and the patient is doing well.
Cardiac strangulation by epicardial pacemaker leads is an extremely rare event with only 10 cases reported in the lit- erature. In our patient it is likely that the anaesthetic agent led to a reduction in myocardial perfusion and the com- pressing lead resulted in a spiral of worsening coronary blood ow, myocardial dysfunction, ventricular brilla- tion and cardiac arrest. The impinging lead inhibited the e ectiveness of the resuscitation e ort with very limited ow to the LAD and LCx. Some groups advocate for serial chest x rays to assess lead position in these patients. Given ourexperiencewiththispatient,ourgroupagreewiththe need for radiological review. Aortography failed to demon- strate coronary collapse and if strangulation is suspected selective coronary angiography should be performed. If cardiac strangulation is suspected or con rmed, extreme caution should be taken during anaesthetic induction with an ECMO circuit primed and a surgical team on standby.
107. LEADLESS MICRA PACEMAKER USE IN THE PAEDIATRIC POPULATION: SINGLE CENTRE EXPERIENCE
Colm Breatnach, Khalid Al-Alawi, Paul Oslizlok, Damien Kenny, Kevin Walsh
Our Lady's Children's Hospital, Dublin, Ireland
Background: Pacemaker implantation is an e ective treat- ment strategy for paediatric patients with symptomatic bradycardia. Until recently, device technology has allowed for insertion of epicardial systems, or when weight permits, transvenous devices. While e ective, these devices are not without fault. The main risk is lead fracture or dislocation, resulting in the need for replacement and re-intervention. A leadless Micra pacemaker device has recently become available. Its success in the adult population has been well described although there is a lack of knowledge on its use in children. We review the data on Micra pacemaker insertion in our institution. We hypothesise that use of this device without early complications is feasible in this patient cohort.
Methods: We performed a retrospective case series review of paediatric patients who have undergone transvenous catheter implantation of the Micra leadless device. The medical records of these patients were reviewed to ascer- tain demographic and clinical details. A review of their pacemaker parameters was performed from the Medtronic
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206