Page 96 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
198
153. FIRST EXPERIENCE IN MEXICO OF AN HYBRID STRATEGY FOR NEONATES WITH DUCTAL- DEPENDENT SYSTEMIC CIRCULATION, IT WILL BE THE SOLUTION IN DEVELOPING COUNTRIES?
Iñaki Navarro-Castellanos1,2, Alberto Zárate-Fuentes1,2, Carlos Alcántara-Noguez1,3, Alejandro Bolio-Cerdan1,3, Enrique Pazos-Alvarado1,3, Ivan Barrera-Martínez1, Jose Luis Salinas-Selaya1, Manuel Enrique Soriano-Aguilar1
1Hospital Infantil Privado, Cdmx, Mexico. 2Hospital Regional Lic. Adolfo López Mateos Issste, Cd, Mexico. 3Hospital Infantil De Mexico Federico Gómez, Instituto Nacional De Salud - Ss, Cdmx, Mexico
In 2016 approximately 960 newborns had HLHS in the USA. Although we have no statistics of this condition in Mexico, we estimate around 355 newborns for the same period.
Although the rst successful intervention in USA was in 1983, the actual mortality in Mexico of the classic Norwood is near 100%, and almost all the cardiovascular centers of the country lead to palliative treatment o ering no surgery.
Clinical Case: we present the case of a 20-day-old patient, who arrived at a private hospital in cardiogenic shock and was stabilized with prostaglandins and diuretics in the NICU, and a HLHS was diagnosed. The cardiovascular team decided to perform a Hybrid approach. As we do not have a hybrid room, the intervention took place in the cathe- terism laboratory. After sternotomy, a bilateral selective bandage was performed, after which an 8 Fr Sheath was inserted in the main pulmonary artery, and a stent was placed in the arteriosus conduit, a 6Fr sheath was placed in the left atrium through which a catheter balloon was passed to perform an atrio-septoplasty.
The patient was extubated at the second day following the procedure, and discharged home at day 7. The 2nd stage is yet to be carried out.
Conclusion: In many centers the hybrid approach was ini- tially used only for the high-risk infants. The high-risk fac- tors included weight less than 2.5 kg, preoperative shock, non-cardiac/ genetic abnormality, preoperative mechan- ical ventilator or circulatory support, small ascending aorta, intact/restrictive interatrial septum, and the variant of HLHS with aortic atresia and mitral stenosis. However Galantowicz and colleagues made a cohort of patients who had a more typical risk pro le to the usual HLHS patients, with impressive resuts: a hospital survival reaching 97.5% after the rst hybrid stage. The hybrid approach reduces the early insult limiting pulmonary over-circulation and
securing systemic perfusion, thus resulting in an interest- ing approach.
This might be an attractive solution for centers with no access to ECMO, no experience with the classic Norwood procedure, or no hybrid room. The hybrid approach might be the premise in most centers in low and middle-income countries.
154. AORTIC ATRESIA IN A HIGH-PERFORMANCE ATHLETE USING RADIAL ACCESS IN PAEDIATRIC - CASE REPORT
Iñaki Navarro-Castellanos1, Alberto Zárate-Fuentes1, Claudia Orozco-Galicia1, Juan Pablo Sandoval-Jones2, Guadalupe Hernández-Morales1, Jorge Robles-Alarcon1
1Hospital Regional Lic. Adolfo López Mateos Issste, Cdmx, Mexico. 2Instituto Nacional De Cardiología "Ignacio Chavez" Mexico City, Cdmx, Mexico
Background: Patients with functional aortic interruption of the descending thoracic aorta at the isthmus due to severe coarctation are extremely rare. This condition is typ- ically solved by surgery.
Case Presentation: We describe the case of a high-per- formance adolescent athlete, asymptomatic but with high risk of sudden dead, with an aortic atresia. Using a radial access with a Victory sti guide due to the impossibility of reaching the ascending aorta through the femoral arteries, a sequential dilation with coronary catheter balloons, and a successful percutaneous reconstruction using a covered stent (CP) were performed.
Conclusions: This report remarks the importance of an early diagnosis in congenital cardiopaties and highlights the role of a minimally invasive approach in the manage- ment of a severe coarctation of the aorta as well as the util- ity of using the radial access in pediatric patients to avoid morbidity and mortality associated with more invasive procedures.
155. 133 CASES DIAGNOSED AS AORTIC COARCTATION RETROSPECTIVE ANALYSIS AND TREATMENT MODALITIES EVALUATION OF EFFICIENCY, EXPERIENCE OF ERCIYES UNIVERSITY
Ali Baykan1, Emir Gokalp1, Aydın Tuncay2, Ozge Pamukcu1, Suleyman Sunkak1, Onur Tascı1, Cagdas Vural1, Kazim Uzum1, Nazmi Narin1
1Erciyes University Pediatric Cardiology Clinic, Kayseri, Turkey. 2Erciyes University Cardiovascular Surgery, Kayseri, Turkey
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206