Page 80 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
182
127. TRANSCATHETER CLOSURE OF SINUS VENOSUS ATRIAL SEPTAL DEFECT: HOW TO SELECT PATIENTS - INSTITUTIONAL EXPERIENCE FROM 15 PATIENTS. Rajesh Kumar1, Sivakumar Kothandam2, Umamaheshwar Kl3 1Mad, C, India. 2Madr, C, India. 3M, C, India
Transcatheter closure of such defects has been described in the literature as an isolated case series. In our institution We have developed an innovative technique to close this defect by transcatheter means after assessing the suitabil- ity by balloon occlusion testing of defect.
Aim: To present our institutional experience of SVASD cov- ered stent exclusion.
Inclusion Criteria:
• Supero-inferior extent of the ASD should not be longer than its transverse diameter
• RUPV should drain in the SVC RA junction
Exclusion Criteria:
• Caudal extension of SVASD into the fossa ovalis is exclu- sion
• RUPV drainage to high SVC or low RA
• Multiple RUPV draining at multiple levels
Patient Data: Among 15 patients, predominant were females with 3:2 ratio (F:M). Mean age group is 29.14+- 8.55(7-41 years). All patients underwent Balloon occlusion testing to delineate the defect and the anatomy of the anomalous pulmonary vein.
In SVASD with PAPVD, posterior wall of RSVC and ante- rior wall of RUPV are common but posterior wall of RUPV is normally connected to LA. This formed the basis of our hypothesis that if we can create a common wall between RSVC and RUPV by placing a covered stent in RSVC, RUPV should normally drain into LA and the defect will be closed.
Results: 15 patients underwent test balloon occlusion, 8 patients found suitable for the procedure, 6 patients suc- cessful closure and 2 failures.
Among the 7 patients whom we referred for surgery, 2 patients had elevation of PV pressure post balloon occlu- sion, 4 patients had unsuitable anatomy with too low or too high RUPV drainage, and 1 patient had accessory RUPV with inability to occlude with balloon.
Choosing the stent:
• Covered CP stents – 8 zig or 10 zig (custom made) • Covered Andra stent
• Optimus CVS XXL – Andratec
• Advanta Atrium V12
• LENGTH SHOULD BE LONG TO ANCHOR IN SVC • DIAMETER SHOULD SNUG FIT THE SVC
Conclusion: Usual treatment of SVASD with anomalous drainage of RUPV is open heart surgery. In our institutional experience of 15 patients only 7 patients were suitable. Carefully selected patients with SV-ASD may have inter- ventional option for correction.
128. PROSPECTIVE RANDOMIZED COMPARISON OF THREE DIFFERENT TYPES OF NITINOL SEPTAL OCCLUDER DEVICES USED FOR TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECTS Umamaheshwar K L, Sivakumar Kothandam
Madras Medical Mission, Chennai, India
Background: Nitinol occluders with modi ed designs from Amplatzer devices are used for nonsurgical closure of atrial septal defects. Trials comparing these designs involved fewer patients, were not randomized and did not use the designs concurrently.
Objective: A randomized prospective comparison of Amplatzer(ASO), Cera(CSO) and Figulla(FSO) septal occlud- ers to study the procedural outcomes and complications
Methods: The principal investigator supervised patient inclusion and monitored the procedure to provide uni- formity in operator performance. The di erent occluders were serially allocated to the included patients in con- secutive order, one after the other, in a cycle of three. All demographic, procedural details and complications were analyzed. After calculating a sample size of 122 patients in each group, additional patients were recruited to ensure at least 80% follow-up.
Results: 450 consecutive patients equally divided between the three designs, were comparable in age, shunt ratio and pulmonary artery pressures. There were no major compli- cations and procedural success was 99.6%. The defect and device sizes were larger with the CSO group; the delivery sheath size was smaller with ASO group. Special deploy- ment techniques were needed less often with FSO group; cobra deformity was noted more often with FSO. However, these di erences did not translate into di erences in out- come or complications.
Conclusions: The new occluders are comparable to Amplatzer septal occluder and the complications are
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206