Page 76 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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anxiety about the upcoming procedure (each rated 4±0), while angiograms, echocardiograms and CT/MRI scans were less e ective (rated 3.88±0.35, 3.86±0.38 and 3.57±1.13, respectively).
Conclusion: In this pilot study, we have found that pre- cath meetings can produce a measurable decrease in patient and family anxiety before a procedure. Discussions of the procedure, diagrams and 3D printed cardiac models seem to be most bene cial, while CT/MRI scans and angio- grams are less e ective.
119. TRANSCATHETER TRICUSPID VALVE-IN-VALVE REPLACEMENT WITH AN INOVARE® VALVE
Mauricio Jaramillo-Hincapie1, Raul Arrieta2, Paulo Motta3, Maria Cristina Rezende1, Daniel Palmieri1, Barbara Costalonga1
1Brasilia´S Hospital, Brasilia, Brazil. 2Heart Institute, Sao Paulo, Brazil. 3Brasilia´S Hospital, Brasilia, Brazil
In this abstract we describe the case of a 13-year-old woman, 54 Kg, with severe bioprosthetic tricuspid valvu- lar stenosis and regurgitation, 10 years after tricuspid valve replacement. She presents signs and symptoms consistent with right-sided heart failure. Transthoracic echocardiogra- phy revealed severe bioprosthetic TV stenosis and regur- gitation, mean transvalvular gradient was 17 mmHg, peak transvalvular gradient, 27 mmHg; moderate right ventric- ular disfunction and giant right atrium. The heart team consider a very high risk for a new valve replacement, and indicate an VIV procedure. Under general anesthesia, a sur- gical jugular vein access was done, a Judkins right catheter was advanced into de 11F sheath and across the tricuspid bioprosthesis, to the distal right inferior pulmonary artery with an 0.035-in Amplatz Extra-Sti guidewire. Balloon val- vuloplasty of the tricuspid bioprosthesis was performed with a 23-mm × 4.5-cm Cristal ® Balloon Valvuloplasty Catheter (BALT, Inc). Next, the 22-mm Inovare® transcath- eter Valve (Braile Biomedical, SJ Rio Preto, Brazil) mounted on 23mm x 4,5 cm -mm Balloon Valvuloplasty Catheter (BALT, Inc) was inserted over the Amplatz wire in the jug- ular vein trought an 23 cm -24F sheath (Cook Medical Inc.). After two unsuccesfull attempts to across the tri- cuspid bioprosthesis by the jugular vein, the system was removed. Using a percutaneous right femoral vein access, the right Judkins catheter and Amplatz wire was advanced into the right pulmonary artery; next, removed the cath- eter and a 24F sheath (Cook Medical Inc.) was placed on femoral vein. The system 22-mm Inovare® transcatheter Valve (Braile Biomedical, SJ Rio Preto, Brazil) was inserted over the Amplatz wire. Under uoroscopic guidance, the
valve was then advanced into the tricuspid bioprosthesis and positioned in the usual manner, with use of the prior metallic ring as a reference, the balloon was in ated and the valve was deployed with excellent results. Minimal residual tricuspid regurgitation and 10 mmHg peak gra- dient was observed on TEE. The patient's venous sheaths were removed, and hemostasis was obtained. The patient tolerated the procedure well with no complications. She was discharged from the hospital after an uneventful post- operative stay of 3 days.
120. STENTING FOR ANGLED OR BIFURCATED LESIONS ASSOCIATED WITH CONGENITAL HEART DISEASE USING A CURVED BALLOON: PRELIMINARY EXPERIMENT AND LIMITED CASE SERIES
Hiroaki Kise1, Takanari Fujii2, Hideshi Tomita2, Yosuke Kono1, Masashi Yoshizawa1, Takako Toda1, Minako Hoshiai1
1University of Yamanashi hospital, Chuo-city, Japan. 2Showa University Hospital, Shinagawa, Japan
Background: Despite numerous procedural evolutions in surgical techniques, postoperative stenosis may develop especially at the anastomosis site or bifurcated lesion in CHD. Although successful percutaneous interventions for such lesions have been reported, stenting is still chal- lenging due to its angled con guration, which may cause deformity of the stent or the target vessel.
Objective: To determine the e ect of stenting for angled lesions using curved balloon, Goku curve (Tokai Medical Co. Nagoya, Japan).
Methods: In vitro study: A coronary stent (MULTI-LINK coronary stent 4mm/18mm) was placed in vertical (90°) vessel model (ePTFE graftφ4mm). After stenting by the conventional stent-mounted balloon system, post-dilata- tion using curved balloon (Goku curve 4mm/20mm) was performed. The vessels’ angle, stent’s adhesion and resid- ual stenosis were assessed. Clinical utility: Stenting using curved balloon were performed in 2 patients (1 y/o and 5 y/o). The target lesions were anastomotic stenosis of BTS in unilateral absence of pulmonary artery (case 1) and RPS in TOF with absent pulmonary valve (case 2).
Results: In vitro study: Stenting at the angled lesion by ini- tial stent-mounted balloon catheter made the 90°-angled lesion unbend to 140°. Mal-apposition of the stent was revealed at greater curvature and the stenosis was not relieved. Post-dilation using curved balloon made the stent bend to the vessel’s angle and released the ste- nosis. Clinical utility: In case 1, the stent (Palmaz genesis
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206