Page 71 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
Description: 2 years old, weighing 10.5 kg presented with complaints of recurrent bleeding per rectum. Examination showed severe pallor and splenomegaly. Suspected to have portal hypertension hence CT scan and MRI was done that showed congenital absence of portal vein with abnormal drainage of portal con uence to right iliac vein (Abernathy type I - Morgan classi cation and Kobayashi classi cation type C). Haemoglobin was 7 gm% and LFT were normal. Sigmoidoscopy revealed large venous channel into rectum with multiple internal haemorrhoids. Referred for liver transplantation in view of absence of portal vein. Balloon test occlusion of draining channel using 16x40 Tyhak bal- loon demonstrated presence of native portal radicals to the liver with hepatic staining (suggestive of moderate hypoplasia of portal radicals). Portal pressure measured 19 mm Hg after test occlusion. Device closure of the aber- rant channel was done using 24/26 duct Occluder from right internal jugular venous route. Developed portal vein thrombosis after the procedure resolved within 48 hours of heparin infusion. Two years follow up showed decreased rectal bleeding and stable haemoglobin level of more than 11 gm% in presence of normal liver function test. Follow up angiogram and sigmoidoscopy done 6 months after rst procedure showed good growth of portal veins and absence of internal haemorrhoids.
Conclusion: Bleeding haemorrhoids is a rare presenta- tion of portosystemic shunt. Diagnosis of absent portal vein should always be consider only after balloon occlu- sion test. Surgical ligation or transcatheter closure of aber- rant vessel is feasible option if portal pressure remained less than 25-30 mm Hg. Long term follow up is needed to assess portal venous pressure, growth of intrahepatic por- tal radicals and symptomatic status.
112. PERCUTANEOUS PULMONARY VALVE IMPLANTATION: INITIAL MEXICAN MULTICENTER EXPERIENCE.
Juan Pablo Sandoval1, Alejandro Flores-Arizmendi2, Lorenzo Gutierrez3, Carlos Zabal1, Jose García-Montes1, Antonio Salgado2, Jesus Montalvo2, Jorge Villatoro3, Paola Castro3, Cristina Aguilar1, Carlos Pedra4, Daniel Springmuller5 1Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico. 2CMN 20 Noviembre ISSSTE, Mexico City, Mexico. 3UMAE Pediatria, Centro Medico Occidente, IMSS, Guadalajara, Mexico. 4Instituto Dante Pazzanese, Sao Paulo, Brazil. 5Ponti cia Universidad Catolica de Chile, Santiago, Chile
Background: Percutaneous pulmonary valve implanta- tion (PPVI) has become a well-recognized alternative to surgical pulmonary valve replacement in selected patients
with dysfunctional synthetic right ventricle to pulmonary artery (RV-PA) conduits, bioprosthetic pulmonary valves, or homografts. PPVI has been subject to a slow start in multiple countries in Latin America, ours included, mainly due to complex internal health policies and economic con- straints. We describe the initial Mexican multicenter expe- rience with the Melody® transcatheter pulmonary valve (Medtronic).
Methods: Retrospective review of eligible patients who underwent PPVI for treatment of conduit dysfunction at 3 centers. Standardized implantation protocols were used. Demographic, pre-procedural and interventional data were collected.
Results: Between October 2016 and March 2018, 9 patients were recruited. Median age and weight was 16 years (14- 27) and 46kg (36-61). Primary indication for PPVI was ste- nosis (n=2), regurgitation (n=2) or both (n=5). PPVI was performed in 7 patients with a dysfunctional RV-PA con- duit (Contegra ® n=4; Synthetic Dacron graft / brous peel n=3); 1 with a dysfunctional 19mm bioprosthetic valve and 1 native right ventricular out ow tract. Median time from index RV-PA conduit /prosthetic valve placement to PPVI was 7 years (5-11). Six (67%) patients were in func- tional class III prior to intervention. Vascular access was obtained from a femoral approach in all cases. Pre-stenting with a covered (n=4) and/or bare metal stent(s) (n=5) was performed in all patients prior to Melody® valve delivery & implantation. In addition, 2 patients required previous branch pulmonary artery stent rehabilitation. All patients underwent successful PPVI. RV-PA gradient fell from 26±11mmHg to 8±5 mmHg (p<0.001). All had none or trivial regurgitation immediately following valve implanta- tion. No procedure related deaths or major adverse e ects were encountered. All patients remain in functional class I after a median follow-up of 5 months (2-18). None have required reintervention nor have experienced subacute infective endocarditis.
Conclusion: Our initial multicenter PPVI experience is con- sistent with worldwide reports of safety and e cacy using the Melody® valve. Experience in Latin America is steadily increasing and expanding to continue o ering this treat- ment modality to selected patients with dysfunctional RV-PA conduits.
113. EARLY EXPERIENCE WITH SAPIEN 3 TRANSCATHETER PULMONARY VALVE IMPLANTATION
Jeremy Ringewald
Hijazi, Z
21st Annual PICS/AICS Meeting