Page 86 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
188
Background: TOF is the most common cyanotic congenital heart defect. Once repaired the ow dynamics are di erent from structurally normal hearts. They are often left without a competent pulmonary valve resulting in severe regurgi- tation. Valve regurgitation and ow recirculation through proximal pulmonary arteries causes kinetic energy loss, which elevates RV afterload leading to progressive RV dila- tion and maladaptive remodeling.
Methods: Four-dimensional Flow MRI (4D-Flow MRI) cov- ering the entire right ventricle and proximal pulmonary arteries was performed in age and size matched TOF patient treated with surgical valve, percutaneous valve, and in a patient prior to pulmonary valve intervention. Kinetic energy dissipation mediated by turbulent and recir- culative ow was calculated between the right-ventricular out ow tract (RVOT) to the distal portion of the right pul- monary artery (RPA) and left pulmonary artery (LPA). Flow hemodynamic pattern was further evaluated using inter- active dynamic pathline visualization.
Results: Both patients underwent complete primary repair prior to one year with a transannular patch. Patients treated with percutaneous pulmonary valve implantation presented peak systolic KE loss of 4.9 mW along the RVOT – RPA and along the RVOT – LPA 2.6 mW. The patient who underwent surgically implanted valve showed dramati- cally elevated peak systolic KE loss along both RVOT – RPA tract 8.1 mW, and RVOT – LPA tract 3.9 mW. Furthermore, the patient treated with percutaneous valve implantation presented cohesive laminar ow through the proximal pul- monary arteries, whereas patient treated with surgically implanted valve presented with helical formations typically associated with turbulent ow and energy dissipation.
Conclusions: Prior to valve repair, patients with repaired TOF present extensive KE loss associated with pulmo- nary regurgitation which is typically corrected post valve replacement. Patient treated with percutaneous pulmo- nary valves revealed comparatively reduced KE loss when compared to surgically implanted valves. Quantitative evaluation of hemodynamic ow patterns prior to and post valve intervention in patients with TOF might identify novel prognostic markers of further RV function and help with clinical planning and timing of valvular intervention
139. TEN-YEAR EXPERIENCE OF DUCTUS ARTERIOSUS STENTING IN PATIENTS WITH PULMONARY OR
SISTEMIC DUCTOAL-DEPENDENT CIRCULATION IN AN ECUADORIAN POPULATION.
Boris Barreno Martínez1,2,3, Simón Duque Solórzano1,2, Edwin Rodríguez-Cruz4, María Cecilia Masshu-Coello1,2, Mayra Reyes1,2, Valeria Guevara1,2
1Roberto Gilbert E. Pediatric Hospital, Guayaquil, Ecuador. 2Catholic University Santiago de Guayaquil, Guayaquil, Ecuador. 3Guayaquil University, Guayaquil, Ecuador. 4San Jorge Children´s Hospital, San Juan, Puerto Rico
Background: The use of stents to maintain patency of the ductus arteriosus has been accepted and performed by many cardiac centers as an alternative to the Blalock- Taussig shunt in neonates with congenital heart disease with pulmonary or systemic ductus arteriosus dependent ow (1,2).
Methods: Retrospective review in a period of 10 years (2007-2017) of the clinical records of patients undergo- ing ductal stent placement in the pediatric cardiovascular intervention service of the Dr. Roberto Gilbert Children´s Hospital in Guayaquil, Ecuador. Overall survival and mor- bidity (hospital length of stay, sepsis, procedural complica- tions) were the main study variables.
Results: We identi ed a total of 81 patients, with ages ranging from 1 day to 11 months at the time of the stent placement (mean 68 days, median 30 days), 43 (53%) male and 38 (47%) female.
Eighteen patients (22%) required ductus stent placement on two occasions and and three (3%) patients under- went Blalock Taussig shunt surgery due to ductus stent obstruction.
From the total of patients twenty-two patients advanced to another surgical phase: 13 patients with correction of Tetralogy of Fallot (biventricular correction), in 19 patients with univentricular physiology Glenn surgery was per- formed and 1 case (5%) progressed to Fontan surgery.
Regarding complications, 31 patients presented pulmo- nary artery stenosis, of which in 10 patients (32%) corre- sponded to left branch, 7 (22%) to right branch and in 7 (22%) stenosis of the stent. The average hospital stay after catheterization was 22 days and the main morbidity was sepsis in 16 patients (19%).
Mortality was 32%, corresponding to 28 patients, only in 14 patients (16%) occurred within the rst 30 days after thera- peutic catheterization.
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206