Page 78 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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Five of the six patients required 2 stents to achieve ade- quate ductal cover. Median procedural time was 114 min- utes (range 95 – 133), with a median uoroscopy time of 20 minutes (range 15 – 55) and median radiation dose of 307 Greys (range 136 – 404). Three patients received the XIENCE Alpine stent and 3 the Abbott Vascular multi-link vision stent. There were no procedure related complica- tions in any patients. Mean PICU stay was 40 hours with a mean intubation time of 23 hours. One patient subse- quently died of a non-procedure related cause.
Conclusion: We have demonstrated that stenting of the patent ductus arteriosus via the axillary artery is a viable option in patients with criticial right out ow lesions in the newborn period. This approach has advantages regarding ductal orientation. It avoids the need for carotid artery entry. Larger studies are needed to more accurately de ne complication the rates of this technique.
123. EMBOLIZATION THERAPY FOR GIANT PULMONARY ARTERIOVENOUS FISTULAS
Mauricio Jaramillo-Hincapie, Luciano Liberato, Vinicius Pena, Ailton Dias, Edmur Araujo
Heart Hospital, Brasilia, Brazil
We report a 25 year-old-man referred by the pulmonol- ogist , with notable clinical ndings included cyanosis, clubbing, dyspnea at minimal e orts, frequent headache, left pulmonary bruits, periferal oxygen saturation 70% on room air and 50% after exercises. Abnormal ndings on X ray and giant arteriovenous malformation in the lower left pulmonary lobe were observed on CT scan. Under intra- venous conscious sedation and local anesteshia, a punc- ture in the right femoral vein was done and advanced a 11 cm 6F sheath. Using a Right Judkins catheter and 260 cm hidro lic 0,035 guidewire, selective angiographies was performed in each pulmonary lobe. We found e little arteriovenous stula on distal lower right pulmonary lobe and multiple in the lower left pulmonary lobe. Two of this with moderate ow and dilation of pulmonary veins and one bigger saccular malformation 10 x 7 cm , with proxi- mal artery with 15 mm diameter and important ow and dilation of the inferior pulmonary vein. Selective cathe- terization of each anomalous branch with a slip catheter and 260cm Amplatz extra support 0,035" guide wire, we advanced a 90 cm Destination Hidro lic Sheath (Terumo, Inc) into the each malformations to proceed the proximal branch embolization. We used 3 Amplatzer Vascular Plugs (AVP II) - (Abbott Inc): the rst AV distal stula with an AVP II 6 mm, the bigger anomalous branch with an AVP II 20 mm
and the medial stula with an AVP II 8 mm. Control angiog- raphies showed immediate and dramatic reduction on pul- monary stulas ow with appearance a lot of normal vessels and increased on periferal oxygen saturation until 97%.
No complications were observed during procedure, and hospital discharge after 24 hours no adverse events. As shown in the literature a percutaneous embolization of pulmonary arteriovenous stulas, even in giant malfor- mations , is possible and good results are obtained with low complication rates, of this way, avoiding surgical pro- cedures with higher morbidity like a surgical resection or lobectomy.
124. INITIAL EXPERIENCE OF DRUG ELUTING STENTS IN PEDIATRIC POPULATION WITH DUCT DEPENDENT CIRCULATION
Umamaheshwar K L, Sivakumar Kothandam
Madras Medical Mission, Chennai, India
Background: The use of drug eluting stents (DES) to curb neo-intimal hyperplasia and restenosis associated with Bare metal stents, is well described in coronary interven- tions. However there is limited data on safety, e cacy and long term patency of DES in paediatric interventions.
Objective: This study was undertaken retrospectively to assess safety, e cacy and mid-term outcome of second generation DES in duct dependent pulmonary circulation.
Methods: Between January 2015 and February 2018, 21 patients with duct dependent circulation underwent elec- tive implantation of second generation DES. Patients were followed by clinical examination , echocardiography, and repeat catheterisation prior to surgery.
Results: DES were deployed in ducts of TOF with PA (11), CTGA with PA (4), Tricuspid atresia with PA(3) and PA with intact ventricular septum(3).Mean age was 16+11days (range 3days -3months) and mean weight was 3.26+0.91kg( Range2-5.1kg). Pre procedure left pulmonary artery(LPA) measured 4.35+0.95mm( 2-6mm) while right pulmonary artery(RPA) measured 4.41+1.27(2-7mm). Femoral artery access was chosen in all cases except two requiring axil- lary access. Five cases were done under general anaes- thesia. Mean uoroscopic time was 19.75+/-14.82 min (3.15- 59.31min).7 everolimus eluting, 2 zotarolimus elut- ing and 12 sirolimus eluting stents were used. Two or more stents were used in 6 cases. Size of stents ranged from 3 to 4mm x 8 to28mm.The saturation improved from 72.11+ 10.92 to 87.37+5.1 post procedure. In 2 cases the LPA was jailed. Inotropes were used in 8 cases. Temporary femoral
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206