Page 41 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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appearance (5%). Seven TPVs were excluded from analysis as they were not implanted in the pulmonary valve position. Only one TPV (Type C) had >mild regurgitation on the rst post-procedural echocardio- gram. Over a median follow-up of 1.9 years (range 0.02-7.8 years), 9 TPVs developed complications with 7 requiring re-intervention. The majority of complications were not attributed to the valve morphology including right ventricular out ow tract obstruction (RVOTO)/valve stent fracture (n=4, 1 with pre-stent), and ventricular arrhythmia (n=1). Endocarditis was diagnosed in 3 patients (2- Type B and 1- Type A), one resulting in death. Two TPVs (2- Type A) had >mild regurgitation over the follow-up period and both were secondary to stenosis associated with a complication (endocarditis and RVOTO). There was one patient death of unclear etiology (Type B). There was no signi cant di erence in outcomes based on TPV lea et morphology type.
Conclusions: The Melody® TPV can be classi ed into one of four cat- egories based on lea et morphology. In this cohort, there was a low incidence of complications which were not associated with lea et morphology. Implanters should be aware of the variation in TPV mor- phology, and documentation may lead to better understanding of associated outcomes.
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NOVEL APPROACH TO TRANSVENOUS PACING IN THE FONTAN CIRCULATION
Jess Randall, Osamah Aldoss, Ian Law, Abhay Divekar University of Iowa Childrens Hospital, Iowa City, IA, USA
Introduction: The need for pacing in the Fontan circulation increases with age. Although epicardial pacing is most common, transvenous pacing is required in some.
Objective: To describe a novel approach to transvenous pacing in a patient with non-fenestrated Fontan circulation.
Methods: An 18 year-old male with hypoplastic left heart syndrome was palliated with an intracardiac lateral tunnel. His surgical fenes- tration and intracardiac ba e leaks were previously occluded. Due to progressive high grade AV block, an epicardial system was placed, upgraded to a cardiac resynchronization system, and revised three times for lead failure. During the last revision, his sixth sternotomy, dense adhesions limited surgical access and adequate pacing sites. He presented with need for pacemaker revision secondary to increasing impedance thresholds; a surgical approach was deemed prohibitive. A novel approach to gain access to the systemic circulation for ventricu- lar pacing was proposed. A left-sided pre-pectoral pocket was created. The left subclavian vein was accessed using Seldinger technique. An 8 Fr Bard Channel steerable sheath was advanced to the oor of the pul- monary artery, where it is adjacent to the roof of the systemic atrium. An arterial catheter was advanced retrograde across the AV valve into the systemic atrium. Simultaneous angiograms were performed in the branch pulmonary arteries and the systemic atrium. Based on the information from a preoperative CT scan, catheter positions and the angiograms, the trajectory for the puncture was de ned; the esti- mated soft tissue distance to be traversed was 6-7 mm. The steerable sheath directed and maintained the trajectory of a coaxial 4 Fr verte- bral catheter - Nykanen Baylis RF wire system. Three applications of energy (5 watts/2 seconds each) resulted in successful access to the systemic atrium from the oor of the pulmonary artery. The system was
exchanged over a guidewire and the tract was balloon dilated allowing placement of a delivery sheath into the systemic ventricle and a bipolar active xation lead was placed and an atrial lead was placed on the free wall of the lateral tunnel.
Results: The patient made an uneventful recovery and has excellent pacing thresholds. He is anticoagulated and in the short term (3 months) has not su ered a thromboembolic event. There is no signi cant systemic AV valve regurgitation.
Conclusion: This innovative method provides an option for trans- venous pacing in patients with non-fenestrated intracardiac or extracardiac Fontan connections when epicardial leads are not fea- sible. The long term risk of thromboembolism and AV valve function- ing will need to be evaluated.
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NOVEL TECHNIQUE IN RIGHT VENTRICULAR OUTFLOW STENTING IN AN EXTREMELY SMALL PREMATURE INFANT WITH TETRALOGY OF FALLOT Salim Jivanji, Robert Yates, Graham Derrick,
Great Ormond Street Hospital NHS Trust, London, UK
Right ventricular out ow tract stenting has had signi cant advances since the rst stents were placed into surgically placed right ventri- cle to pulmonary artery conduits in the early 1990s. Catheter and stent technology have made it increasingly possible to treat smaller infants, more recently with echocardiography guidance. There have been multiple series reports of successful palliations using these car- diac procedures in larger patients, using easily available equipment. Smaller patients present an additional challenge to an already com- plex situation.
We discuss a case of a 1.3kg premature infant who underwent com- plex right ventricular out ow tract stenting as an emergent proce- dure by employing a novel technique using neurovascular catheters, to aid wire exchanges.
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PREDICTORS OF PROCEDURE TIME PROLONGATION DURING PERCUTANEOUS TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT; A RETROSPECTIVE STUDY
Milad El-Segaier1, Shehla Jadoon1, Tariq Javid1, Tariq A. Wani2, Mohammed Omar Galal1
1Department of Paediatric Cardiology, King Fahad Medical City, KSHC, Riyadh, Saudi Arabia
2Clinical and Translational Research Department, King Fahad Medical City, Riyadh, Saudi Arabia
Background: Percutaneous transcatheter closure (PTCC) of atrial sep- tal defect (ASD) may convert to a long procedure. We aimed to iden- tify predictors of prolonged procedure.
Methods: Under transesophageal echocardiography and uoroscopy guidance, 81 children with ASD underwent PTCC. Retrospectively,
Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306