Page 73 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
Results: Demographic and procedural information are summarized (Table 1).Pre-TAVR NYHA classi cation was a mean of II (I-III). All patients had ≥ moderate AI and had AS peak gradients of 7-38mmHg). Native valve areas by CT ranged 325-444mm2 and were oversized by 17-30%. All procedures utilized a percutaneous femoral approach. Length of stay was 1.7 days (1-3). Mean follow up was 15.2 months (1-26). At follow up, all patients had no AI, AS peak gradients of 5-25mmHg, and all were NYHA class I.
Discussion: We report the rst use of TAVR for treatment of native AI in pediatric patients. All 3 patients underwent successful TAVR placement. All devices were over-sized to account for non-calci ed aortic annuli. Short-term results are promising with sustained relief of aortic insu ciency and improvement in functional status at most recent fol- low-up. Ongoing investigation and additional follow up are needed.
115. TRANS-JUGLAR PULMONARY VALVE PERFORATION IN A 32 WEEKS, 30 HOURS OLD TWIN PRETERM WEIGHING 1.2 KG FOR DUCT DEPENDENT PULMONARY CIRCULATION (PULMONARY ATRESIA INTACT INTER-VENTRICULAR SEPTUM) USING CTO WIRE
Sudeep Verma1, Gouthami V1, Nagarajan R2
1Krishna Institute of Medical Sciences (Kims), Secunderabad- Hyderabad, India. 2Krishna Institute of Medical Sciences, Secunderabad- Hyderabad, India
Introduction: We are presenting here a case of pulmonary atresia with intact IVS in a 33 weeks one of twin preterm weighing 1.2 Kg, symptomatic just after birth with severe cyanosis requiring PG infusion. Neonate underwent suc- cessful pulmonary valve Perforation on day 2 of life from right internal juglar route using Miracle CTO wire.
Case Description: 33 weeks preterm twin weighing 1.2 kg delivered by emergency LSCS ventilated in view of respi- ratory distress and worsening cyanosis. With diagnosis of hyaline membrane disease one dose of surfactant was given. Cardiac evaluation revealed duct dependant pulmo- nary circulation with pulmonary atresia- intact IVS, moder- ate TR, TV annulus Z score of -1.2 with no sinusoids. Started on Prostaglandin infusion in view of desaturation, acido- sis, low PO2, and haemodynamic instability. Decided to perform pulmonary valve perforation and if required PDA stenting. Internal Juglar and Femoral access were secured in NICU itself. After repeated unsuccessful attempts to enter RV from femoral venous route RV was entered from IJV route using 4Fr JR 1.5 catheter. With catheter in RVOT,
valve was perforated using 0.014 Miracle CTO wire in left lateral view. Subsequently pulmonary valve was dilated serially using PTCA and Tyshak balloons respectively. Post procedure developed retroperitoneal haematoma and persistent bleeding from puncture site which was man- aged conservatively with blood products and inotropes. Baby had uctuating saturation requiring intermittent Prostaglandin infusion. Baby was ventilated for 4 days after procedure and managed in NICU with excellent preterm care and nally discharged home on day 35 of life with room air saturation of 88%. 6 months follow up showed asymptomatic status, good antegrade ow across pulmo- nary valve with no stenosis, moderate to severe PR, good sized RVOT and TV annulus (Z score of +0.04) with room air saturation of 92%.
Discussion: This case highlights the feasibility of doing pulmonary have perforation using internal juglar route in case of di culty in entering RV from femoral route. Also highlights the issue pertaining to puncture site complica- tions and importance of good preterm care in improving outcome for such duct dependant situations presented as early as on day one of life
116. EMERGENCY TRANS-UMBLICAL VERTICAL VEIN STENTING AS AN INTERIM PALLIATION IN A 10 HOURS OLD 33 WEEKS PRETERM FOR OBSTRUCTED SUPRACARDIAC TAPVC
Sudeep Verma1, Gouthami V2, Nagarajan R3, Anil Kumar Dharmapuram3, Raja R4
1Krishna Institute of Medical Sciences (Kims), Secunderabad- Hyderabad, India. 2Krishna Institute Of Medical Sciences(Kims), Secunderabad- Hyderabad, India. 3Krishna Institut Of Medical Sciences (Kims), Secunderabad-Hyderabad, India. 4Krishna Institute O Medical Sciences (Kims), Secunderabad- Hyderabad, India
Introduction: Vertical vein stenting serves as an interim palliation for stabilisation of haemodynamically unstable obstructed supracardiac TAPVC. We are describing a case of supracardiac TAPVC with haemodynamic vise presented with low cardiac output and severe metabolic acidosis , underwent successful left vertical vein stenting from tran- sumblical route at 10 hours of life with improvement in the clinical condition followed by complete surgical correction
Description: 33 weeks preterm with birth weight of 1.8 kg born with emergency cesarean section presented with respiratory distress and cyanosis just after birth. Hyaline Membrane Disease was suspected hence ven- tilated and 2 doses of surfactant were given. In view of
Hijazi, Z
21st Annual PICS/AICS Meeting