Page 88 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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Conclusion: The ICU admission tool created in this study will be further tested and validated in larger datasets, improving the precision of ICU bed assignment planning and allocation of hospital resources, while generalizabil- ity will be broadened through tool re nement and multi- center collaboration.
141. TRANSCATHETER PULMONARY VALVE IMPLANTATION FOLLOWED BY PFO CLOSURE IN A PATIENT WITH HYPOXEMIA DUE TO RIGHT TO LEFT INTRACARDIAC SHUNT
Akanksha Thakkar, Stephanie Fuentes, Danish Bawa, Eunice Karanja, Gary Monteiro, John Breinholt, Thomas MacGillivray, Alan Lumsden, C. Huie Lin
Houston Methodist Hospital, Houston, USA
Background: Pulmonic valve stenosis (PS) and regurgi- tation (PR) are expected complications after Tetralogy of Fallot (ToF) repair. Perturbation of right heart hemodynam- ics may induce RV remodeling causing functional tricuspid regurgitation (TR) and a vicious circle of maladaptive RV remodeling. PFO in these patients may be hemodynami- cally advantageous, but resulting hypoxemia can be debil- itating in some adults. We report a 44M with ToF repair complicated by RV-PA homograft PS and PR causing RV enlargement and functional TR who presented with hypox- emia due to R to L shunting through a PFO.
Case: 44M with ToF s/p initial repair at age 3 followed by pulmonary homograft repair at age 30 presented with dyspnea on exertion and hypoxemia in the 80s requiring home O2. Pulmonary workup demonstrated no intrin- sic lung abnormality. TTE showed LVEF 55-59%, severe RV enlargement with moderately depressed function, PR and PS. CMR showed RV volume and pressure overload, severe RV enlargement (RVEDVi 152 ml/m2), moderately depressed RV function (RVEF 39%), PFO with R to L shunt (Qp:Qs 0.93), moderate PS, moderate PR and TR. Patient was taken to the cath lab for transcatheter pulmonary valve implantation and possible PFO closure. A Melody valve was successfully deployed in the RV-PA homograft conduit within a P4010 PALMAZ XL stent, and post-dilated to 24mm. Improvement in O2 saturation occurred from the mid-80s (80% FIO2) to the mid-90s immediately post valve deployment, likely secondary to improved RV diastolic hemodynamics causing reduced R to L shunting through the PFO. Intra-cardiac echo demonstrated a continuous shunt by color Doppler, so the PFO was closed using a 25 mm Amplatzer PFO occluder. TTE 1-month post proce- dure showed a well-functioning transcatheter pulmonary valve and PFO occluder. Clinically, patient remained free of
hypoxemic episodes with O2 saturation consistently in the high 90s without supplemental oxygen and improvement in symptoms.
Conclusion: As a PFO may be hemodynamically advan- tageous in RV pressure and volume overload, closure for hypoxemia should only be considered after addressing the underlying pathophysiology. Earlier RVOT intervention may be required to interrupt maladaptive RV remodeling, especially in the presence of functional TR.
142. FREQUENCY OF LPA CATHETER INTERVENTIONS IN PATIENTS WITH TETRALOGY OF FALLOT AFTER SURGICAL PULMONARY ARTERY AUGMENTATION Melissa Webb, Beth Price, Manoj Parimi, Saadeh Al-Jureidini St. Louis University, St. Louis, USA
Background: Patients with Tetralogy of Fallot (TOF) fre- quently undergo surgical augmentation of one or both of the pulmonary arteries and can require intervention on branch pulmonary artery stenosis throughout their life. The goal of this study was to describe the frequency of left pulmonary artery (LPA) catheter reinterventions in patients who have previously undergone di erent augmentation techniques.
Methods: A retrospective chart review was performed on all patients who underwent TOF repair between January 2012 until January 2016. Data obtained included type of TOF, age at time of repair, material and technique used for LPA augmentation (extended versus patch), and indi- cations for and type of LPA reintervention required. The frequency and need for reintervention was then described according to technique used for LPA augmentation.
Results: Eighteen of 117 patients who underwent TOF repair also had LPA augmentation at the time of surgery. Seven of these patients underwent extended LPA aug- mentation using conduit material (3 pulmonary and 1 aor- tic homograft, 3 bovine jugular) and 11 underwent patch augmentation (1 pulmonary homograft, 7 pericardium, 2 bovine pericardium, 1 bovine jugular vein). The mean age of patient was 7 months (12 days to 2 years). Four patients (57%) who underwent augmentation with extension of conduit material and 8 (n=73%) patients who underwent augmentation with patch placement underwent LPA intervention.
Conclusion: Our study suggests that those patients who undergo extended rather than patch augmentation of their LPA may have a lower rate of LPA reintervention.
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206