Page 77 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
4mm/15mm) was placed at the stenosis between BTS and distal pulmonary artery. Stenosis was completely relieved by the rst stent’s in ation. And deformity was revealed at distal end due to the small diameter of RPA, which could not be resolved by post-dilatation using curved balloon (GOKU curve 4mm/20mm). In case 2, the stent (Express vascular LD 8mm/17mm) was placed at the bifurcation of RPA. Although the stenosis was relieved, protrusion and mal-apposition on the edge were revealed on the greater and lesser curvatures, respectively, which were completely resolved by post-dilatation using curved balloon (GOKU curve 8mm/20mm).
Conclusions: Stenting using curved balloon can release the stenosis at angled lesion without deformity and mal-apposition of the stent.
121. INTRAVASCULAR STENTING FOR COARCTATION OF AORTA AND ACQUIRED INTERRUPTION WITH FIBROUS CONTINUITY -INDIAN EXPERIENCE WITH EARLY AND INTERMEDIATE FOLLOW UP
Sudeep Verma1, Rajendra Kumar Jain2
1Krishna Institute of Medical Sciences (Kims), Secunderabad- Hyderabad, India. 2Krishna Institut of Medical Sciences, Secunderabad-Hyderabad, India
Background: Endovascular stent placement for treating coarctation of aorta is a well established treatment modal- ity. We are sharing our experience of treating coarctation of aorta and functional acquired interruption with its tech- nical challenges and e ect of stenting on Aortic regurgita- tion associated with bicuspid valve.
Methods-Observation/Results: Since 2008, 28 patients with median age of 21 years (range 9-58 years) were attempted for Coarctation stenting. Procedure was aban- doned in one due to profounda femoral artery injury. Three patients with interrupted aortic segment was crossed antegrade using CTO wire, while in one interrupted seg- ment was crossed from left subclavian artery access using Guide catheter and balloon support. 11 patients under- went pre-dilatation using peripheral balloon or serial PTCA balloons (in acquired interruption cases). Palmaz / Genesis stent were used in 8 cases, in 2 cases Andra stents were used while in rest CP stents (covered in 6 and uncovered in 12) were used. In two patients due to more horizontal orientation of coarctation stent was deployed keeping traction on wire snared from right radial artery. Median pre procedure gradient was 70 mm Hg (range 30- 200 mm Hg) dropped to 10 mm Hg (range nil - 30 mm Hg). 6 patients had loss of lower limb pulsations with preserved
lower limb circulation. 2 patients developed severe radial artery spasm during the procedure recovered later. One patient developed large puncture site haematoma that is treated with blood products and compression ban- dage. On mean follow up period of 48 months, four out of 5 patients with signi cant residual gradient (mean 33 mm Hg) underwent successful balloon coarctoplasty while in one procedure was abandoned in view of inabil- ity to cross catheter across the residual coarctation. One of the interesting nding is decrease in severe AR in 5 cases (moderate in 4 and mild in one) after stent placement.
Conclusion: Coarctation of aorta and functional inter- ruption of aorta with preserved brous continuity are amenable for stenting considering its technical challenges. Puncture site bleeding issues and radial artery spasm are the major procedure related complications. Interestingly severe AR associated with bicuspid valve tends to decrease after successful coarctation stenting.
122. AXILLARY APPROACH FOR DUCTAL STENTING IN CRITICAL RIGHT VENTRICULAR OUTFLOW LESIONS IN THE NEONATAL PERIOD
Colm Breatnach, Khalid Al-Alawi, Paul Oslizlok, Kevin Walsh, Damien Kenny
Our Lady's Children's Hospital, Dublin, Ireland
Introduction: Patent ductus arteriosus (PDA) stenting has become an excepted early palliative intervention for neo- natal patients with critical right sided obstructive heart lesions. It also has the advantage of promoting branch pulmonary artery growth. Access to tortuous PDA’s may be challenging via the femoral artery, while the carotid artery leads to concerns regarding stroke. Recently, the axillary artery has been utilised to gain access in these patients. We aimed to assess our early experience using this approach.
Methods: We performed a retrospective review of neo- natal patients managed with PDA stenting via the axillary artery. Patients were identi ed from a dedicated National Institute of Cardiology Outcomes Research (NICOR) data- base. The medical records of these patients were reviewed to ascertain demographic and clinical details. Data were summarized using medians (range), means and descriptive evaluation.
Results: Neonatal stenting via the axillary artery was performed in six patients (4 males and 2 females) with a median age of 5 days (range 1 – 8 days) and weight of 3.4Kg (range 3 – 4kg). All 6 patients required PDA stent- ing for right ventricular out ow tract obstruction/atresia.
Hijazi, Z
21st Annual PICS/AICS Meeting