Page 85 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
Results: Thirty-nine stents (36 bare metal, 3 drug-eluting) in 20 patients were treated with systemic rapamycin; 20 at the time of implantation (prophylactic) and 19 follow- ing documented ISS requiring transcatheter intervention (non-prophylactic). All patients had at least one follow-up catheterization. Treated patients were young (median 2 y/o [0.7-5.7]) and most had PVS associated with congenital heart disease (75%, 15/20; 4/15 with TAPVC). In the pro- phylactic group, 80% (16/20) of the stents (median diam- eter 6mm [4-7]) were without signi cant (<50%) ISS at median of 102 days (range 56-527); the growth rate of ISS in this group was 7.5 +/- 7.1 %/month. The largest series on the use of stents in PVS documented 52% (28/54) of stents were without signi cant ISS at median of 117 days (range 3-1314). In the non-prophylactic group (median diameter 5mm [3.5-10]), most stents had a slower growth rate of ISS after rapamycin therapy (9.5 +/- 5.6 vs. 4.6 +/- 3.8 %/month, p = 0.003; Figure 1). There was no association between the presence of signi cant ISS (prophylactic) or slower growth rate (non-prophylactic) and drug intensity (% time with therapeutic levels), whether a loading dose was given or if there was stenosis distal to the stent. One patient developed pneumonia on drug while concurrently taking another immunosuppressive agent. There were no other serious adverse events related to rapamycin therapy.
Conclusion: Systemic rapamycin may decrease the devel- opment of in-stent stenosis in pulmonary vein stenosis and can be administered safely in pediatric patients with complex heart disease. A prospective study is required to further understand the role of systemic rapamycin in PVS.
137. TREATMENT OF ISOLATED PULMONARY
VALVE STENOSIS WITH BALLOON PULMONARY VALVULOPLASTY IN THE NEONATAL PERIOD.
Célia Maria Camelo Silva, Ana Carolina Buso Faccinetto, Raianne Cord, Clarice Learth Cunha, Thayana Hadad Farias, Priscila Galdeano, Jamile Campos, Fernanda Rego, Diego D'Albuquerque, Vitor Rolim, Luciana Nina, João Saba, Antônio Carvalho
Unifesp, São Paulo, Brazil
Background: Balloon pulmonary valvuloplasty (BPV) has been considered a safe and e ective method for the treat- ment of isolated pulmonary valve stenosis (PVS) in the neonatal population.
Objectives: To evaluate the clinical, angiographic and echocardiographic characteristics of BPV in the neonatal population.
Methods: From January 2016 to February 2018,27 new- borns from a Public Reference Hospital were submitted to BPV for the treatment of pulmonary valve stenosis. A retro- spective study, which analyzed the clinical characteristics (weight and associated genetic syndrome),angiographic (balloon, balloon ring and intercurrent relationship)and echocardiographic characteristics(gradient, ring and mor- phological characteristics)and considered as a therapeu- tic success the reduction of the gradient below 40 mmHg and or decrease in the RV/LV pressure ratio less than 0.50. Statistical analysis used Square Chi-square test with Yates continuity correction and Fisher'stest.
Results: Of the 27 treated patients,17 (63%) were female, mean age 12 days, weight ranged from 2.2 to 5.7 kg, with a mean of 3.2 kg, and no patient had genetic syndrome. There were no deaths during the procedure. All patients had therapeutic success, 4 (14%) of the patients presented transient arrhythmia during the procedure, the balloon diameter was 8, 9 and 10, respectively: 3(11.5%), 13(50%) and 10(38.5%) and ring/balloon ratio> 1.4 in 16 (61.5%) patients. All patients presented with echocardiography after BPV gradients lower than 40 mmHg (ranged from 0-34 mmHg, with an average of 7.8 mmHg). Pulmonary insu ciency (PI) was found in post-procedure echocar- diography in all patients being light (LPI)in 20 pts (74%) moderate (MPI) and in 7 (26%) patients. When compared patients with LPI vs MPI: there was predominance in both groups: female (65 vs 57.1% p = 1.0), with the valve ring between 6-7 mm (63.2 vs. 42.9% p = 1.0), with the ring/ balloon above 1.4 (63.2 vs 57.1% p = 1.0), balloons with diameter 8-9 were the most used (73.7 vs. 28.6% p = 1.0).
Conclusion: BPV is an e ective method with few adverse events. The occurrence of MPI is considerable and may be related to ring/balloon ratio above 1.4, and to morpho- logical aspects of the pulmonary valve, known to be more severe in this age group.
138. PATIENTS WITH REPAIRED TETRALOGY OF FALLOT UNDERGOING PERCUTANEOUS PULMONARY VALVE IMPLANTATION SHOW IMPROVED FLOW HEMODYNAMICS WHEN COMPARED TO SURGICAL PULMONARY REPLACEMENT
Daniel McLennan, Michal Schafer, Gareth Morgan
Children's Hospital Colorado, Aurora, USA
Objective: To compare ow dynamics in proximal pulmo- nary arteries in patients with repaired Tetralogy of Fallot (TOF) before and after either surgical or percutaneous pul- monary valve replacement.
Hijazi, Z
21st Annual PICS/AICS Meeting