Page 91 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
146. 3D CARDIAC PRINTING TO PLAN TRANSCATHETER CLOSURE OF AN IATROGENIC PRIMUM ATRIAL SEPTAL DEFECT
Stephanie Fuentes Rojas1, Akanksha Thakkar2, Ponraj Chinnadurai2, Eunice Karanja2, Danish Bawa2, Stephen Little2, C. Huie Lin1
1Houston Methodist Hospital, Houston, USA. 2Houston Methodist, Houston, USA
Background: Primum atrial septal defects (ASD) conven- tionally require surgical repair because of the proximity to the atrioventricular valves. We present the case of a percuta- neous closure of an iatrogenic primum ASD using 3D print- ing to simulate the case during pre-procedure planning.
Case Presentation: A 71-year-old man with aortic dissec- tion and endocarditis status post aortic and mitral valve replacement presented with dyspnea and abdominal distension. Transthoracic echocardiogram (TTE) showed preserved left ventricular (LV) function, depressed RV (RV) function and a transesophageal echocardiogram (TEE) identi ed an iatrogenic primum ASD (iASD, 0.9 x 1.3 cm) with L-R shunt (Qp/Qs 1.7) attributed to suture dehiscence after the most recent mitral valve replacement. He was deemed a poor surgical candidate, hence, 3D reconstruction guided percutaneous closure was planned. A high-resolution car- diac CT was used to print a 3D model of the patient’s anat- omy. Transcatheter closure was then performed on the 3D printed model. A 25 mm GORE® CARDIOFORM Septal Occluder (Gore, Flagsta , Arizona) best apposed the sep- tum and closed the iASD while minimizing impingement of the prosthetic mitral apparatus and tricuspid valve demonstrated by post-procedure rotational angiography and 3D reconstruction (Artis, Siemens, Ho man Estates, Illinois) of the model and occluder. Once we demonstrated anatomic safety and feasibility on the model, patient underwent closure of the iASD using a combination of real time 3D-TEE and uoroscopy with a 25mm CARDIOFORM Septal Occluder. Post-delivery, TEE con rmed adequate position, which was nearly identical to that on the 3D model. On follow up, the patient’s symptoms had resolved.
Conclusion: This case demonstrates the utility of 3D print- ing and in silico modelling and closure of a primum iASD in a patient with a prosthetic mitral valve. Use of the 3D printed model in combination with rotational angiogra- phy and 3D reconstruction allowed determination of the behavior of the occluder device in unusual pathological anatomy in advance of the actual procedure. This strategy may facilitate innovative minimally invasive intervention of cardiovascular defects in the absence of purpose-built
devices and where traditionally surgery has been the only option.
147. LONGITUDINAL IMPROVEMENTS IN RADIATION EXPOSURE WITHIN PROCEDURAL RADIATION RISK CATEGORIES IN CARDIAC CATHETERIZATION FOR CONGENITAL HEART DISEASE: A PROSPECTIVE MULTI-CENTER C3PO-QI STUDY
Priscila Cevallos1, Brian Quinn1, Aimee Armstrong2, David Balzer3, Howaida El-Said4, Susan Foerster5, Andy Glatz6, Andrea Goodman1, Bryan Goldstein7, Michael Hainstock8, Dana Janssen9, Jacqueline Kreutzer10, Larry Latson11, Ryan Leahy12, Christopher Petit13, Shabana Shahanavaz3, Sara Trucco10, Wendy Whiteside7,14, Je Zampi14, Lisa Bergersen1 1Boston Children's Hospital, Boston, USA. 2Nationwide Children's Hospital, Columbus, USA. 3St. Louis Children's Hospital, St. Louis, USA. 4Rady Children's Hospital, San Diego, USA. 5Children's Hospital of Wisconsin, Wauwatosa, USA. 6Children's Hospital of Philadelphia, Philadelphia, USA. 7Cincinnati Children's Hospital Medical Center, Cincinnati, USA. 8University of Virginia Children's Hospital, Charlottesville, USA. 9Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, USA. 10Children's Hospital of Pittsburgh, Pittsburgh, USA. 11Joe Dimaggio Children's Hospital, Hollywood, USA. 12Norton Children's Hospital, Louisville, USA. 13Children's Healthcare of Atlanta, Atlanta, USA. 14CS Mott Children's Hospital, Ann Arbor, USA
Background: E orts to reduce radiation exposure in pedi- atric cardiac catheterization to the lowest reasonable levels achievable are important to decrease the impact of cumu- lative ionizing radiation exposure on long-term health.
Objectives: The Congenital Cardiac Catheterization Project on Outcomes (C3PO) multi-center collaborative sought to improve radiation safety practices and decrease radiation doses by at least 10% for all cases and among three proce- dural categories.
Methods: Data was collected prospectively for all cases performed at C3PO participating sites. Using established quality improvement methodology, a key driver diagram was created with strategic domains of intervention and utilized to implement institution-speci c radiation safety practices. Examples of employed institutional strategies within various domains include: automatic operator radi- ation threshold alerts built into equipment, establish- ing institutional Radiation Reduction Committees with benchmark goals, increased sta education, lowering equipment default uoroscopy rates, and working with equipment vendors to build weight category options. 40 heterogenous procedure types were grouped into 3 radia- tion risk categories according to expected similar radiation
Hijazi, Z
21st Annual PICS/AICS Meeting