Page 95 - Journal of Structural Heart Disease Volume 4, Issue 4

197
Meeting Abstracts
Background: Coarctation of the aorta accounts for 4-6% of all congenital heart defects and many patients have con- comitant cerebrovascular abnormalities. In addition, the coarctation may involve the left subclavian artery or other arch vessels further complicating development of the cere- bral vasculature and potentially leading to maladaptive response vascular tone. We present a case of abnormal left vertebral perfusion after successful coarctation and left subclavian arterial intervention.
Case Presentation: A 36M presented with bicuspid aor- tic valve, hypertension, asymmetric blood pressure read- ings in upper extremities, lightheadedness, and decreased exercise tolerance. His transthoracic (TTE), showed bicus- pid aortic valve, normal left ventricular ejection fraction and cardiac CTA showed severe aortic coarctation at the take-o of the left subclavian artery associated with collat- eral vascularization as well as ascending aortic aneurysm. Preoperative transcranial Doppler (TCD) demonstrated retrograde ow through the left vertebral artery consis- tent severe subclavian stenosis. He underwent success- ful treatment of the coarctation using a Max LD 36 stent (Medtronic, MN) deployed on a 16 mm Numed Balloon in Balloon (Hopkinton, NY) catheter. The stent was crossed retrograde from the left radial artery, and the ostium of the left subclavian artery then treated with a 7 mm Sterling balloon with resultant brisk ow. Post intervention angiog- raphy showed no or residual stenosis in the aortic arch and there was no gradient from the left subclavian artery to the ascending aorta or across the prior coarc. However, intraop TCD continued to demonstrate retrograde ow through the left vertebral artery.
At routine follow up, patient reports having improved exer- cise tolerance and normalization of blood pressure, and equal blood pressures in both arms. However, left vertebral ow remained retrograde on TCD at one month post-inter- vention suggesting that changes in cerebral microvascula- ture may be xed despite normalization of hemodynamics.
Conclusion: Late intervention of coarctation may be associated with residual cerebrovascular changes as a maladaptive response to chronic malperfusion, especially when the left subclavian artery is involved. Further study is required to determine the contribution of this to risk of stroke in these individuals.
152. APPLICATION OF THE CRISP SCORING SYSTEM TO ASSES THE COMPLEXITY OF CATHETERISMS IN AN EMERGING CARDIOVASCULAR PEDIATRIC CENTER Alberto Zarate Fuentes1, Iñaki Navarro Castellanos1, Jorge Robles Alarcon2, Guadalupe Hernandez2, Claudia Orozco Galicia2
1Issste, Mexico, Mexico. 2Issste, Mexico, Mexico
Background: The CRISP score predicts risk of occurrence of an Severe Adverse Event SAE for individual patients undergoing pediatric cardiac catheterization procedures, The aim of this paper is to determine the frequency of SAE during heart catheterization and show the experience of a recently open Cardiac Center in México, applying the registry based multi-institutional international database of pediatric cardiac catheterization.
Methods: We review the clinical charts of those patients undergoing heart catheterization during two years from 1st May 2016 to 2018, in order to determine the frequency of adverse events presented related to the procedure. Every single procedure was scored according to the CRISP scale to provide a risk assessment. SAE were recorded in special chart.
Results: During the 2 years period, 100 procedures were performed, by two operators. We had 11 serious adverse events in 100 patients. (Infection, Device embolization, stent occlusion, vascular damage)
According to CRISP score we classi ed in groups:
• Group 0-3points proportional cases 51%, Adverse events
0%
• Group 4-7 points proportional cases 26%, adverse events
3%
• Group 8-10 points proportional cases 8%, adverse events
3%
• >10 points proportional cases
5%.
15% adverse events
Comparing these results with the CCISC report we noticed that the proportion of patients with >10 points is higher in our center, and the total SAE are relatively low in the high- est risk patients.
Conclusions: Cardiac catheterization performed in our facility is a safe and e ective procedure, with a percentage of SAE according with the standards of care in the interna- tional database.
Hijazi, Z
21st Annual PICS/AICS Meeting