Page 93 - Journal of Structural Heart Disease Volume 4, Issue 4

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Meeting Abstracts
limited information is available on long-term results and follow-up in the pediatric population.
Aim of Work: to evaluate safety and e cacy of transcath- eter stenting of native and recurrent coarctation of aorta at short-term and intermediate follow-up in pediatric age group.
Subjects and Methods: It was a prospective cohort study, which included 20 pediatric patients with hemodynam- ically signi cant CoA con rmed by ECHO and MDCT, It was conducted at Cardiology Unit, Mansoura University Children Hospital, From May 2014 to March 2017. Body weight ≥15 kg. M/F ratio 15/5, age ranges 10.1±4.2years, 37 ± 22 Kg. 12 patients have native coarctation and 8 with recurrent ones. Covered CP (Nu-MED) stent was used in 7 patients, Palamz Genesis in 7, Andra stent in 5, and uncov- ered CP stent was used in one. Stent diameters varied from 11±1, length 35±6. Di erent types of balloons were used Zmed 12, Crystal 3, Opta 2, PowerFlex2, BIB 1. Peak to peak pressure gradient decreased from 37±17 to 7±5. In stent stenosis was found in 3 patients, Redilatation of stent was needed in 3 patients after period 15.7months (4-23), stents used were one covered CP stent 2 Bare metal Palmaz gen- esis stent. No stents fracures were found
Conclusion: Transcatheter stenting of native and recurrent coarctation of the aorta in pediatric age group appears to be an acceptable and e ective treatment. This supported by of e ective relief of the CoA pressure gradients in both native and recurrent coarctation. Reintervention is rela- tively uncommon and related to severity of coarctation, type of stent used, early and late aortic wall injury, and need for re-dilation of relatively small diameter stents with growth.
149. ANTIPLATELET THERAPY AFTER PFO CLOSURE IN A BREASTFEEDING MOTHER: EFFECT ON DEVICE CHOICE
Eunice Karanja1, Danish Bawa1, Stephanie Fuentes-Rojas1, Akanksha N. Thakkar1, Michael Pirics2, John J. Volpi3, C. Huie Lin1
1Houston Methodist DeBakey Heart & Vascular Center, Houston, USA. 2Houston Methodist Hospital, Houston, USA. 3Houston Methodist Neurological Institute, Houston, USA
Background: PFO closure in patients with cryptogenic stroke reduces the risk of recurrent events when combined with optimal medical therapy. However, there is limited data on maternal use of clopidogrel during breastfeed- ing and e ect on infants. We report the case of a 31F with
cryptogenic stroke and PFO who underwent PFO closure six weeks post-partum.
Case: A 31F with a history of severe migraines presented with visual changes and a syncopal episode at 12 weeks of gestation. MRI brain showed chronic changes suggest- ing prior stroke. At 28 weeks, she presented with drooping of the right eye, likely secondary to a transient ischemic attack. TTE revealed a PFO with R to L shunt. No other cause for cerebral ischemia was found. Patient was placed on aspirin until delivery and PFO closure was planned for the post-partum period. However, the need for dual anti- platelet therapy post PFO closure presented a problem as maternal clopidogrel use and concentration in breast milk and e ect on the infant isnot characterized. In cur- rently published studies, 1 month of clopidogrel therapy was used after PFO closure using an AMPLATZERTM PFO occluder (RESPECT) versus only 3 days after using a GORE® CARDIOFORM septal occluder (REDUCE). The day prior device implant, the FDA approved the use of the GORE® CARDIOFORM septal occluder for cryptogenic stroke, and so chose this device with a strategy to ‘pump and dump’ breast milk secreted during the time that the patient was on Clopidogrel, in order to minimize the e ect of the drug on the baby. Patient resumed breastfeeding after complet- ing the 3-day post-procedural course of Clopidogrel with no reported e ects on the baby.
Conclusion: PFO closure during lactation presents a chal- lenge due to the insu ciency of data on the e ect of Clopidogrel in breast-feeding mothers. This factor may play a role in device selection to minimize exposure to Clopidogrel until more data is available.
150. CONTRIBUTION OF THREE-DIMENSIONAL ROTATIONAL ANGIOGRAPHY TO RADIATION DOSE DURING CONGENITAL CARDIAC CATHETERIZATION Kurt Bjorkman1, Quirina MB de Ruiter2, Veronika Shabanova1, Martine HG van Alfen2, William E Hellenbrand3, Jeremy D Asnes3
1Department of Pediatrics, Yale School of Medicine, New Haven, USA. 2Philips healthcare, Image guided therapy systems, Best, Netherlands. 3Division of Pediatric Cardiology, Yale School of Medicine, New Haven, USA
Background: The use of three-dimensional rotational angiography (3DRA) during congenital cardiac catheter- ization is increasing. While radiation dose associated with 3DRA has been studied, its impact on and contribution to overall procedure dose has not been characterized.
Hijazi, Z
21st Annual PICS/AICS Meeting