Page 79 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
pulse loss was seen in 8(38.1%) cases. Two deaths occurred during in-hospital stay due to failure and superimposed respiratory infection. One patient died at home on follow up. The total hospital stay was 7.83+4.2 days with ICU stay of 2.35+2.2 days. During last Echo follow-up, LPA mea- sured 7.78+2.24mm (5-13mm) while the RPA measured 8.57+/-1.83mm (5.5-11mm).Six patients undergone suc- cessful surgery, single ventricular pathway in 5 and biven- tricular pathway in 1 case after 13.33+5.57 months (Range 9-24 months) of stenting. Mild LPA origin narrowing was observed in all cases except one during surgery.
Conclusions: The use of DES is associated with good patency over midterm follow-up with less restenosis.
125. ATRIAL SEPTOSTOMY WITH A PREDEFINED DIAMETER USING A NOVEL OCCLUTECH ATRIAL FLOW REGULATOR IMPROVES SYMPTOMS AND CARDIAC INDEX IN PATIENTS WITH SEVERE PULMONARY ARTERIAL HYPERTENSION.
Rajesh Kumar, Sivakumar Kothandam, Umamaheshwar Kl
Madras Medical Mission, Chennai, India
Background: Atrial septostomy relieves syncope in pul- monary arterial hypertension (PAH) by improving left heart lling, cardiac output and systemic oxygen trans- port despite hypoxia. Symptoms recur when small fenes- trations close spontaneously.
Methods: AFR was implanted after informed consent in patients with severe PAH presenting with syncope and right heart failure. Symptoms, hemodynamics, echo- cardiographic parameters, brain natriuretic peptide (BNP) levels and device patency were serially documented.
Results: Twenty two patients aged 28.3±8.5 years with severe PAH underwent AFR implantation. All procedures were successful without any major complications. All patients had relief of syncope and 6-min walk distance improved signi cantly from 377.3 6 ±33.2 to 423 ± 31.32 m. The cardiac index (2.36±0.52 to 2.89 ± 0.56 L/min/m2) and systemic oxygen transport (367.5 ±75.5 428.0 ±67.1 ml/min/m2) also showed a signi cant improvement. Inferior caval vein congestion and pericardial e usion reduced due to improvement in heart failure, but other echocardiographic parameters of right ventricular func- tion did not show signi cant change. The reduction in BNP levels too did not reach statistical signi cance. The device was patent in all patients at a median follow-up of 189 days
(range 10–296 days) resulting in a signi cant reduction of oxygen saturations from 98±0.18 to 85.26 ±2.86% after exercise.
Conclusions: AFR implantation was feasible and safe in all patients with PAH. There was a signi cant improvement of symptoms, six-minute walk distance, cardiac index and systemic oxygen transport. The device maintained patency in short-term follow-up and the resultant hypoxia was tolerated well.
126. FEASIBILITY, SAFETY, COMPLICATIONS AND MIDTERM FOLLOW-UP OF PATIENTS WITH ATRIAL SEPTALDEFECTS CLOSED NON-SURGICALLY USING VERY LARGE 40-46 MM NITINOL SEPTAL OCCLUDERS Umamaheshwar K L, Sivakumar Kothandam
Madras Medical Mission, Chennai, India
Aims: Atrial septal occluders > 38mm are not rou- tinely used in many countries. Feasibility, safety, com- plications and follow-up of patients with atrial septal defects closed with devices ≥ 40mm are unknown.
Methods and results: Patients with atrial septal defects closed using devices ≥ 40mm in a single center were retro- spectively analyzed. Patients with 40mm devices were com- pared with those with 42-46mm devices on demographic, echocardiographic, hemodynamic parameters, procedural characteristics and complications. Among 48 patients with mean defect size of 36.3±3.7mm (32-42mm), 17 patients received 40mm device and 31 received > 40mm device. There were no signi cant di erences between the groups except larger defect size and higher need for special deploy- ment techniques in the latter. In spite of acute technical suc- cess in all patients, two procedures failed including device embolization at 24 hours in one and restrictive left ventricu- lar physiology resulting in hypotension, multiorgan failure and death in spite of percutaneous device removal in one. Two late deaths on follow-up were unrelated to the device. There were no erosions, aortic or mitral regurgitation, thromboembolic events. One patient developed delayed atrial utter. All survivors reported improved symptoms.
Conclusions: Use of ≥ 40mm devices in appropriately selected patients is feasible in all, successful and safe in majority. Special deployment techniques are more often needed for deploying these large devices. Complications during the procedure and on follow-up were infrequent. Patients with de cient margins should be excluded for per- cutaneous device closure.
Hijazi, Z
21st Annual PICS/AICS Meeting