Page 70 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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Results: Seven patients with a median age of 1.6 years (range 0.75 – 9.75) and weight of 8.7kg (range 6.8 – 28) were identi ed. In 3 patients, the pulmonary valve was inserted was into the native pulmonary out ow tract, with four insertions into conduits. Three patients underwent PVR with a stent mounted valve (SAPIEN valve) via a sub- xiphoid approach (group 1); two patients had a surgically sutured stent valve (Melody) inserted within a transannular patch with intra-operative balloon dilation of the valve as part of a complex tetralogy repair (group 2); two patients had a perventricular valve inserted with subsequent plica- tion of the right ventricular out ow tract (group 3). Three of the seven patients required bypass including both patients in group 2 and one patient from group 3 who also under- went a left ventricular out ow tract myectomy. No valve related procedural complications occurred and all patients were discharged home without the need for unplanned intervention.
Conclusion: A broad range of approaches to hybrid PVR may be employed as part of a comprehensive RVOT pro- gram. These approaches can be performed safely with a high success rate. Follow-up studies are required to eval- uate the longer term durability of these approaches com- pared to a standard surgical replacement.
110. ACUTE AND SHORT-TERM HEMODYNAMIC IMPACT OF F TRANSCATHETER PULMONARY VALVE IMPLANTATION ON LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTION
Ryan Romans1, Wendy Whiteside2, Lori Harris2, Veronika Dotterman2, Je Zampi2
1Children's Mercy Hospital, Kansas City, USA. 2University of Michigan Congenital Heart Center/C.S. Mott Children's Hospital, Ann Arbor, USA
Background: Transcatheter pulmonary valve implantation (TPVi) is a now widely available option to treat residual or recurrent pulmonary stenosis (PS) and pulmonary insuf- ciency (PI). TPVi acutely increases pulmonary artery size and diastolic pressure in patients with PI and acute pulmo- nary edema has been reported after TPVi, possibly related to acute left ventricular (LV) volume loading. However, the hemodynamic impact of TPVi on LV systolic and dia- stolic function, both acutely and on short-term follow-up, remains unknown.
Methods: We analyzed patients who underwent TPVi from 2010-2017 at our center. Patients were grouped based on indication for TPVi as either PS, PI, or mixed disease using standard TPVi criteria. Subgroup analysis was performed
on those who underwent TPVi for PS versus those with PI or mixed disease as those with PI were more likely to have acute LV volume loading. Intracardiac hemodynamics immediately before and after TPVi -and echocardiographic assessment of LV systolic and diastolic function at base- line, 1-day post TPVi, and 1-year post TPVi were compared between groups and subgroups.
Results: Of the 102 patients included in analysis, TPVi was performed for PS in 29 (28%), PI in 28 (29%) and mixed dis- ease in 44 (43%). There was no di erence in LV function, MV peak E or A velocity, septal and lateral e’, or septal and lateral E/e’ between groups (PS versus PI/mixed) at base- line, 1-day after the procedure, or 1-year post implantation. In all patients, the mean pulmonary artery wedge pressure increased 3 (+/- 3.2) mmHg following TPVi but this was change was observed equally in all groups.
Conclusions: While patients with PI likely have acute LV volume loading following TPVi, this does not appear to be hemodynamically signi cant asTPVi was not associated with any changes in LV systolic or diastolic function either acutely or at 1-year follow-up. While pulmonary artery wedge pressures increase after TPVi, indicating increased LV end diastolic pressures, this was observed in all patients regardless of disease type and was not associated with other measures of diastolic dysfunction. Therefore, this is likely secondary to intraprocedural volume and contrast administration.
111. ABSENT PORTAL VEIN AND BLEEDING HAEMORRHOIDS IN A TWO YEAR OLD CHILD POSTED FOR LIVER TRANSPLANTATION- TRANSCATHETER MANAGEMENT
Sudeep Verma1, Gouthami V2
1Krishna institue of medical sciences, Secunderabad- Hyderabad, India. 2Krishna Institute of Medical Sciences, Secunderbad- Hyderabad, India
Background: Haemorrhoids is rare in paediatric age. We are presenting a case of bleeding per rectum n a two years old due to haemorrhoids secondary to portal hypertension and congenital absence of portal vein (Abernathy malfor- mation I) referred for liver transplantation. Test balloon occlusion of the aberrant vessel demonstrated presence of portal radicals, followed by successful closure of the aber- rant channel. 2 years follow up showed good growth of the portal radical and absence of bleeding per rectum.
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206