Page 22 - Journal of Structural Heart Disease Volume 2, Issue 6

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Meeting Abstracts
for high blood pressure. Seven patients required percutaneous rein- tervention (36.1 ± 19.0 months after initial treatment) due to aortic aneurysm (1), residual stenosis above the stent (1) and adjustment to somatic growth (5). One patient required surgery due to residual hypoplasia of aortic arch (15.1 months later). All of reinterventions have been carried out successfully, with no SAE.
Conclusion: Stenting for treatment of CoAo in children was feasi- ble, safe and effective in reducing blood pressure levels and gra- dient. A significant rate of reintervention was observed because of the previously known need to stent adjustment to somatic growth in most cases (SAE were rare). On the same way, post dila- tion of stents for CoAo in children has proved to be feasible and effective.
#0020
PARTICLE EMBOLIZATION OF SYSTEMIC-TO- PULMONARY COLLATERAL ARTERY NETWORKS IN CONGENITAL HEART DISEASE: TECHNIQUE AND CONSIDERATIONS
Sarosh Batlivala, William Briscoe, Makram Ebeid University of Mississippi Medical Center, Jackson, MS, USA
Background: Systemic-to-pulmonary artery collateral (SPC) networks commonly develop in patients with single ventricle physiology and chronic hypoxemia. Though these networks augment pulmonary blood ow, much of the ow is ine ective which contributes to cardiac volume loading. This volume loading can have detrimental e ects, especially for single ventricle patients. Some data suggest that occluding these collaterals may improve outcomes after sub- sequent operations, especially when the volume of collateral ow is signi cant. For other patients—e.g. with hemoptysis—collateral occlusion is a crucial therapy. Traditional practice has been to coil occlude the feeding vessel, but this technique has limitations.
Cases & Technique: We reviewed all procedures that included SPC embolization from August 2013 to June 2016. We perform particle embolization utilizing a co-axial catheter system to deliver 510-700 micron particles deep into feeding arteries ( gures).
Results: We performed particle embolization during 42 catheteriza- tions on 34 patients. The majority of patients had single ventricle physiology; a few patients presented with hemoptysis or had inci- dentally noted SPCs. Particle embolization was acutely successful with the majority (93%) having no residual ow. No complications occurred.
Discussion: Traditional coil occlusion of SPCs is suboptimal for mul- tiple reasons. First, occlusion of stulous connections is ideally per- formed as distally as possible. Coil occlusion generally occludes the most proximal source. Second, SPCs tend to recur from the same feeding vessel. Coil occlusion prevents re-access of the feeder, impeding occlusion of recurrent SPCs. Particle occlusion avoids both these limitations as the technique occludes distal connections while maintaining patency of the feeder vessel. The occlusion is therefore more immediately e ective—by occluding distal connections—and avoids problems with re-accessing feeders. Thus, embolization with particles may be a superior technique than coil occluding the proxi- mal feeding vessel.
#0021
RETRIEVAL OF A FIGULLA OCCLUTECH SEPTAL OCCLUDER EMBOLIZED DEVICE FROM RIGHT VENTRICLE USING ITS NATIVE DELIVERY SYSTEM. CASE REPORT OF A NOVEL APPROACH
Amjad Mehmood, Nadeem Sadiq, Maad Ulla
AFIC & NIHD, Rawalpindi, Pakistan
A 27-year-old lady was diagnosed as having a large secundum atrial septal defect and moderate pulmonary artery hypertension on echocardiogram. She was planned for transcatheter device clo- sure of atrial septal defect as transesophageal echocardiography revealed ASD secundum (31 mm × 29 mm) with adequate rims. The patient was taken to the catheterization laboratory for transcathe- ter closure under local anaesthesia. A 14 F Cook sheath was selected to deliver 33 mm device. The device was loaded on to the delivery system and delivered across the defect using the right upper pulmo- nary vein technique. The device tted nicely on to the septum and nal position con rmed on TOE and released. The next morning to con rm position of device on TTE before discharging the patient, it was revealed that the device had embolized in to RV. The patient was again taken to the cath lab and after multiple attempts with a 15 mm Amplatz gooseneck snare (eV3 Endovascular Inc., Plymouth, MN, USA) the device could not be pulled in to the sheath satisfac- tarily. Finally we used native delivery cable within 14 F sheah. After few attempts we were able to retrieve the 33 mm ASD device with locking mechanism of delivery cable. Then we closed the same ASD with 36 mm occlutech septal occluder with no further complication. The patient was discharged next day with advise of tab loprin 150 mg daily for 6 months.
Conclusion: In certain situations of embolized occlutech devices, native delivery cable with two prongs can be very e ective and safe with stability to retrieve when snare is unable to capture and stabilize. However the capturing area of prongs is much less than snare.
#0022
SUCCESSFUL HEMOSTASIS OF ACUTE LUNG BLEEDING USING AMPLATZER VASCULAR PLUG AND COILS IN A PATIENT WITH PULMONARY HYPERTENSION
Kenji Suda, Yoshiyuki Kagiyama, Yusuke Koteda, Shintaro Kishimoto
Kurume University School of Medicine, Kurume, Japan
Lung bleeding is the dreadful complication of cardiac catheterization that can directly result in demise in patients with pulmonary hyper- tension. We report successful hemostasis achieved by combined occlusion of Amplatzer Vascular Occluder and coils.
Case: A 61-year-old female patient who is known to have pulmonary hypertension with mean pulmonary artery pressure of 66 mmHg underwent follow-up diagnostic catheterization. She had a large pat- ent arterial duct with a diameter of 12 mm treated with Amplatzer Septal Occluder 7 months ago and her past history includes pulmo- nary tuberculosis resulted in chronic respiratory insu ciency that required home oxygen treatment.
Hijazi, Z
20th Annual PICS/AICS Meeting Abstracts