Page 98 - Journal of Structural Heart Disease Volume 4, Issue 4

Meeting Abstracts
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under general anaesthesia. The procedure was guided by an 8Fr Siemens Accuson ICE catheter. AFRs were then deployed by a technique similar to that for deploying the Occlutech Figulla Flex II ASD occluder. The pigs had follow up echocardiography at 3 weeks to assess ow and were euthanized at 28 +/- 1 days. Radiographs of the hearts were taken to assess device position. Gross examination was then performed. Plastic histology was undertaken in Spurrs’s resin. light microscopy histology and electron microspcopy were then performed.
Results: At 28 days neointimal overgrowth was mild to moderate, partially covering both surfaces of the AFR in three out of four animals. The lumen of the device remained completely patent in three animals. Of the other two animals one had partial lumen overgrowth, remaining lumen was 4-5mm. The other animal showed closure of the AFR ori ce. This was the only device that showed right and left atrial surface of the device to be completely covered by neointimal tissue.
Conclusions: The Occlutech AFR is a safe device to implant, with the technique similar to the implantation of an ASD device. This device should allow the creation of an atrial communication of set size, allowing better and safer treatment options for patients with PAH or Left ventricular diastolic failure
158. RETROGRADE DEVICE CLOSURE OF CLINICALLY RELEVANT PERIMEMBRANOUS VSD’S IN SMALL INFANTS VIA CAROTID CUTDOWN
Damien Kenny1, Jonathan McGuinness1, McCrossan Brian2, Oslizlok Paul1, Colin McMahon1, Franklin Orla1, Terence Prendiville1, David Coleman1, Lars Nolke1, Mark Redmond1, Kevin Walsh1
1Our Lady's Children's Hospital, Dublin, Ireland. 2Royal Belfast Hospital for Sick Children, Belfast, Ireland
Background: Despite resurgence in percutaneous closure of perimembranous ventricular septal defects (PMVSD) in older children, clinically relevant PMVSD’s in small infants remain a surgically treated defect. We describe a novel approach to retrograde device closure of clinically relevant PMVSD’s in small infants via carotid cutdown.
Methods: Prospective data collection of all infants under- going attempted transcatheter PMVSD closure using the approach described above in a single center. Data are expressed as median with ranges.
Results: Twelve infants with median weight 6.6kgs (range 5.0-9.5kgs) and clinically relevant PMVSD under- went attempted retrograde closure via carotid cutdown. Device delivery was successful in 9 patients. Median right ventricular:aortic systolic pressure ratio was 72% (range 40-100%). Median defect size was 8.6 mm (range 5-10mm) and median device size was 8mm (range 5-10mm). In one patient, the deployed device impinged on the tricuspid valve and was removed. In another with no aortic rim, it was not possible to achieve stable device position without impinging on the aortic valve. In the nal patient, with a multifenestrated defect, attempted retrograde crossing lead to distortion of the tricuspid valve and decision to revert to open surgery.
All nine patients receiving a device recovered well with median hospital stay 1 day (range 1-3 days). There were no complications related to carotid cutdown. Complete closure is present in 8 patients with mild residual leak in the remaining patient at a median follow-up of 10 months (range 1-18 months). There has been no heart block noted on follow-up.
Conclusions: Retrograde device closure of hemodynami- cally signi cant PMVSD’s is feasible and e ective in small infants. Defect characteristics on transesophageal echo- cardiography, in particular aortic and tricuspid tissue rims, are key to successful patient selection.
159. 3D SCANNING AND PRINTING ENHANCES
SURGICAL AND TRANSCATHETER PLANNING IN
CONGENITAL HEART DISEASE
Danish Vaiyani MD1,2, R. Allen Ligon MD1,2, Christopher Petit MD2,1
1Children's Healthcare of Atlanta, Atlanta, USA. 2Emory University, Atlanta, USA
Patients with congenital heart disease (CHD) require indi- vidualized treatment before and after surgical repair and palliation. Traditionally, procedural planning has relied on 2-dimensional modalities such as echocardiography, angiography, computed tomography (CT) and magnetic resonance imaging (MRI) which require re-creation of 3-dimensional constructs from ‘stacks’ of 2-dimensional images. 3D models can aid in determination of the opti- mal approach or type of cardiac intervention, be it surgical or transcatheter. 3D models are limited by the resolution inherent to the parent imaging modality. The quality of 3D models, then hinges on the resolution of ultrasound, MRI or CT source images.
Journal of Structural Heart Disease, August 2018
Volume 4, Issue 4:114-206