Page 89 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
Limitations to this study include a low number of patients, the lack of pre-surgical LPA size data, and the variable material used.
143. PERFORATION OF ATRETIC VASCULAR STRUCTURES USING THE HIGH FREQUENCY APPLICATION THROUGH ELECTRIC SCALPEL IN PATIENTS WITH CONGENITAL HEART DISEASES. Giolana Cunha, Marcella Maia, Luiz Kajita, Expedito Ribeiro, Raul Arrieta
Heart Institute - University of São Paulo, São Paulo, Brazil
Introduction: The use of perforation of atretic vascular structures using the radiofrequency system is the treat- ment of choice in cases of imperforate valves or "blind bot- tom" occlusion of vessels, however, cost and availability limit their use, especially in the Public System of Health. We aim to o er an alternative method of treatment using the high frequency through electric scalpel in patients with congenital heart diseases.
Method and Results: Case report. Two patients submit- ted to high frequency electrodissection using Electrical Surgical Unit (ValleyLab Force-Fx TM Scalpel). Technique: "triaxial" system consisting of a JR catheter 5 Fr, 2.3 Fr microcatheter and a 0.014 "chronic occlusion guide. The guide was connected to the electric scalpel being used 50 -60W of cutting power.
Patient 1: female, 4yo, 15 kg, diagnosis of pulmonary atre- sia, VSD, hypoplastic pulmonary arteries and MAPCAs, Blalock Taussig shunts (right: with stenosis; left occluded). Chest angioCT: pulmonary trunk and con uent and hypoplastic pulmonary arteries (2 mm). The perforation: a "retrograde" form - from the pulmonary trunk to the right ventricle - advanced Microcateter Progread (Boston Scienti c) through the BT to the pulmonary trunk posteri- orly a guide of chronic occlusion 0.014 "Hi-Torque Progress 80” was connected to the electric scalpel 50Watts) and perforated the pulmonary valve retrograde; performed arteriovenous loop, where it was advanced and implanted Renal Dynamic stent 5x19mm in the RVOT. After 5 months: patient SO2 75% awaiting angioTC control.
Patient 2. Female, 19yo, 64kg, diagnosis of coarctation of native aorta ("blind bottom"). The microcatheter posi- tioned in a descending aorta, perforated area was drilled with a guidewire of chronic occlusion 0.014 "Progress 80 connected to the electrobisturi (60Watts cut), followed by angioplasty with a 4x12mm balloon and a 45mm cov- ered CP stent implant mounted in a Maxi LD 14x40mm
balloon in the region of CoAo, later expanded with a Maxi LD 18x40mm ask. Hospitalar discharge on the 4th day after procedure. At follow-up 9 months after aortoplasty, asymptomatic patient.
Conclusion: The perforation using of high frequency (Electrosurgical Scalpel) and the "triaxial system" was pos- sible in the two cases presented, and could be o ered as an alternative technique for drilling in selected cases.
144. PERCUTANEOUS TRICUSPID VALVE IMPLANT IN THE LATE POSTOPERATIVE PERIOD OF CONGENITAL HEART DISEASES USING A BRAZILIAN BIOPROSTHESIS: INITIAL EXPERIENCE IN SOUTH AMERICA.
Giolana Cunha, Marcella Maia, Luiz Kajita, Jose Honório Palma, Expedito Ribeiro, Henrique Ribeiro, Raul Arrieta Heart Institute - University of São Paulo, São Paulo, Brazil
Introduction: Primary diseases of the tricuspid valve (TV) are uncommon, either congenital or acquired. These patients (pts) usually require valve replacement and future reinterventions with high morbidity and mortality. We present an alternative on o -label transcatheter tricuspid valve-in-valve implantation (TVIV) using a bioprosthesis developed and manufactured in Brazil. Our aim is demon- strate the initial experience of transcatheter bioprothesis implantation in the tricuspid position.
Methodology: Case report. The procedures were per- formed in a hybrid suit and patients under general anes- thesia. The bioprosthesis used Braile Inovare prosthesis (Braile Biomedical, São José do Rio Preto, Brazil)l). the valve is a balloon-expandable prosthesis with a lozenge cobalt-chromium frame, 20 mm height, three radiopaque markers (identifying base, valve and skirt) and a single sheet of bovine pericardium composing the lea ets in the following diameters: 20, 22, 24, 26, and 28 mm The access was the right jugular vein by dissection; in one case an approach was required via mini-thoracotomy. Pre-dilatation and balloon measurement were performed before implantation of the bioprosthesis. The procedures were guided using 3D transesophageal echocardiography (TEE) and uoroscopy.
Conclusion: In this initial experience, the percutane- ous implantation of the Braile Inovare bioprosthesis in the tricuspid position was e ective and safe for patients with important dysfunction of the previously surgical TV implanted bioprosthesis; the use is capable of providing
Hijazi, Z
21st Annual PICS/AICS Meeting