Page 82 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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for suspected cardioembolic stroke. He was evaluated in neurology clinic for evaluation of recurrent stroke. 2D TTE showed a large cavity next to the left ventricle in the four-chamber view. Color Doppler imaging clearly demon- strated that the cavity had a direct communication with the normal-sized LA and a LAA aneurysm was diagnosed. There was no thrombus within the aneurysm or in the left atrium. The LAA aneurysm measured 10 X 4 cm, and the ostium of the defect measured 1.8 cm. The diagnosis was further con rmed by CT scan which showed a 10.8X5.5 cm LAA aneurysm and the ostium of the defect measured 1.88 cm.
Septal puncture done followed by pigtail catheter was advanced to the level of the LAA, and contrast was injected near the ostium of LAA to prevent any thrombus migration if any from cavity. We have also used Bilateral SpiderFX embolic protection device placed in bilateral carotid to prevent thrombus migration if any from cavity during device deployment. After careful review of images, a 24 mm Amplatzer muscular VSD occluder was chosen to close the aneurysm and was advanced to the defect. Check angiogram done to rule out obstruction to left PV drainage and LCX compression. TEE revealed no signi cant residual ow through the device after release. On follow up serial echo’s showed regression in size of thrombosed cavity. After 1 month patient underwent CT scan showed device in stable position and resolved thrombosed cavity.
Conclusions: Transcatheter closure of LAA aneurysm is possible in certain patients with suitable anatomy. Advanced imaging modalities helpful in decision making. Need to take all protective strategies to prevent thrombus migration during the procedure.
132. PERCUTANEOUS DEVICE CLOSURE OF PARAVALVULAR LEAKS - OUTCOMES AND MAJOR ADVERSE CARDIAC EVENTS WITH MULTIPLE DEVICES AND MULTIPLE ACCESS SITES: A SINGLE CENTRE EXPERIENCE
Umamaheshwar K L, Sivakumar Koyhandam
Madras Medical Mission, Chennai, India
Aim: To study procedural outcomes and major adverse car- diac events in patients undergoing transcatheter paraval- vular leak(PVL) closure our centre.
Methods: Patients who underwent percutaneous repair ofPVLfromAugust2013toMarch2018wereanalyzedfor procedural outcomes and major adverse cardiac events in intermediate term follow up.
Results: Thirty-four patient aged 51.37+15.28 years (Range 12-69 years); 31.25% female formed the study group. The mean hemoglobin was 10.84 + 2.2gm% (range 7-14 gm%). The main symptom was heart failure (85.23%) followed by severe hemolysis warranting blood transfusions (21.88%). Target valve was mitral in 28 (82.35%), aortic in 5 (14.71%) or both in 1 (2. 9%). Aortic paravalvular leaks were closed retrogradely. Transseptal access with arteriovenous loop- ing was done in 25(73.52%) patients. Apical access was taken for crossing the defects in 12(37.5%) and for deploy- ing the device in 2 of those. One, two and multiple devices were used in 17, 18 and 7 cases respectively. Overall 58 devices were used. ADO II was used in 5 cases, AVP II in 13, AVP III in 4, AVP IV in 4, muscular VSD occluders in 9 and Occlutech PVL devices in 12 cases.
Procedure was technically successful, that is a device could be delivered without interference with the valve prosthesis in 96.88% of patients and there was ≥1 grade regurgitation reduction post closure in 90.3% of patients. The mean u- oroscopic time was 44+/- 21min (12-116 min). Two cases had device embolization of which one required surgery. In seven cases upsizing of devices was done due to inade- quate closure. Apical puncture site was closed with either duct occluders (ADO 6/4,6/8mm), ADO II(5/6mm) or vas- cular plugs (AVPII 6,10mm). Three patients had hemotho- rax post apical puncture and required thoracotomy. Four patients required repeat procedures within three months.
Post procedure 5 (12.9%) patients had mild insigni cant residual leaks at last follow up (mean duration 2.23+1.48 years; range: 1month to 4.5 year). One patient died during in hospital stay, whereas 2 patients died late at home.
Conclusions: Transcatheter paravalvular leak-closure procedures are technically demanding but can be accom- plished in a high percentage of cases.
133. PERCUTANEOUS CLOSURE OF PATENT DUCTUS ARTERIOSUS– A SINGLE BRAZILIAN CENTER EXPERIENCE
Célia Maria Camelo Silva, Ana Carolina Faccinetto, Raianne Cord, Priscila Galdeano, Thayana Hadad Farias, Diego D' Albuquerque, Vitor Rolim, Clarice Cunha, João Saba, Luciana Nina, Jamile Campos, Fernanda Rêgo, Antônio Carvalho Unifesp, São Paulo, Brazil
Background: Percutaneous occlusion of patent duc- tus arteriosus (PDA) has proven to be an e ective and safe method in recent years. The aim of this study was to
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206