Page 74 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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worsening distress baby was shifted to High frequency ventilation but persisted to have low output state and severe metabolic acidosis and desaturation. X ray showed white out lung with reticular pattern consistent with HMD. In view of poor response to surfactant and ventilation, echocardiography was performed that revealed supra car- diac TAPVC draining to left innominate vein with severe obstruction at left vertical vein (haemodynamic vise) . In view of persistent metabolic acidosis, low cardiac output, high ventilatory settings and worsening X ray picture, it was decided to do interim palliation with vertical vein stenting. After securing umblical venous access with 6F Sheath, ductus venous was crossed with 0.032 Terumo J tip wire with 4F JR 1.5 catheter. Vertical vein injection revealed obstruction at con uence to vein junction. Obstructed segment was crossed with 0.014 PTCA wire and obstruc- tion was relieved initially with 1.5x12 and 3x15 PTCA bal- loon respectively followed by successful stenting using 5x15 Renal stent negotiated through 5F JR Guide cathe- ter. Post procedure from second day onwards developed features of third spacing and odema with renal shut down that needed peritoneal dialysis for 5 days after which renal output improves and edema subsided. On day ve of pro- cedure underwent successful surgical correction of TAPVC with good recovery.
Discussion: This case highlights the feasibility of interim palliation for vertical vein obstruction in selected case of critical obstruction and unstable haemodynamics. In pres- ence of patent umbilical vein it is feasible to perform the procedure from umbilical route safely.
117. TANDEM PLACEMENT OF TWO DUCT OCCLUDERS GENERATION II DEVICES IN SUPEROINFERIOR VENTRICLES WITH CRISS CROSS ATRIOVENTRICULAR FLOWS NORMALLY RELATED GREAT ARTERIES AND LARGE MEMBRANOUS VSD Sudeep Verma1, Gouthami V2
1Krishna Institute of Medicalsciences, Secunderabad- Hyderabad, India. 2Krishna Institute of Medical Sciences (Kims), Secunderabad- Hyderabad, India
Introduction: Superior inferior ventricles with criss cross atrioventricular ows associated commonly with dis- cordant Ventricular-arterial relationship. We are presenting a rare case of membranous septal aneurysm with multiple VSD in superoinferior ventricles and criss cross AV connec- tion with AV - VA concordance, closed with tandem place- ment of two duct occluder generation II devices.
Case Details: 15 month old toddler weighing 7.2 kg pre- sented with poor weight gain and recurrent respiratory tract infection referred with diagnosis of CCTGA and VSD. Examination revealed features of large left to right post tricupsid shunt with poor localisation of apex beat. Chest X-ray showed cardiomegaly, di erential vascularity with right lung plethora and left lung oligemia. ECG revealed sinus rhythm, left superior QRS axis and biventricular forces. Echocardiogram revealed situs solitus, levocardia, juxtaposed right atrial appendage, superior inferior ventri- cles, criss cross AV ows, AV-VA concordance, membranous septal aneurysm and multiple VSD's with severe pulmo- nary artery hypertension. Oximetry run showed step up of 17% across right heart with QP/Qs of 2.5:1. PA pressure were 70% of the systemic pressure with mean of 40 mm Hg. Ventricular injections revealed superior position of RV and LV in inferior position with elongated LVOT with- out obstruction. LPA was angulated with physiological oligemia due to preferential streaming from MPA towards RPA. Two Duct Occluder generation II devices ( 6/4 and 5/4 respectively) were deployed in tandem manner across septal aneurysm from retrograde technique with com- plete abolition of shunt. In both cases VSD were crossed using 6Fr JR 3.5 guide catheter with 0.032 Terumo angled wire. Child persisted to have moderate pulmonary arterial Hypertension with absence of symptoms at 2years follow up hence continued on pulmonary vasodilators.
Conclusion: It is challenging to establish diagnosis of Criss Cross AV ows with AV-VA concordance and NRGA. Orientation of the IVS changes hence device closure chal- lenging in such cases. Delineation of the VSD by angiogram is di cult hence meticulous echocardiographic evaluation is needed. Tandem device placement with multiple ADO II is possible in such cases with membranous septal aneu- rysm and multiple defects.
118. PILOT STUDY FOR THE USE OF 3-D PRINTED MODELS TO REDUCE ANXIETY ABOUT CONGENITAL CARDIACCATHETERIZATIONS
Preston J. Boyer1, Jennifer G. Andrews1, Trahern W. Jones1, Michael D. Seckeler2
1University of Arizona, Department of Pediatrics, Tucson, AZ, USA. 2University of Arizona, Department of Pediatrics (Cardiology), Tucson, AZ, USA
Background: Cardiac catheterizations (caths) for congeni- tal heart disease (CHD) can be times of anxiety for patients and families. Pre-procedure meetings are one strategy that could address this anxiety. A variety of educational tools (diagrams, echocardiograms, CT/MR imaging and
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206