Page 51 - Journal of Structural Heart Disease Volume 4, Issue 3

Meeting Abstracts
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25-30 mmHg, and Qp:Qs of 1:1; PA angiography demon- strated moderate pulmonary insu ciency and PVL. The PVL was localized by balloon occlusion of the valve and simultaneous contrast injection into the PA. The defect was sized using an Armada balloon (8x4 mm; Figure 2A). After careful hemodynamic and angiographic evaluation, a 12 mm Amplatzer vascular plug II (AVP II) was deployed in the tunnel-like leak without any complications or residual leak (Figure 2B). The diastolic PA pressure improved from 6 to 20 mmHg after PVL closure. The patient recovered well and was discharged without arrhythmias on follow-up.
Learning Points: Although transcatheter closures of pul- monary PVL are reported using AVP II and ventricular septal defect occluders, successful closure is dependent on appropriate case selection and operator expertise. Transcatheter intervention is a feasible treatment option with lower complication rates than surgery and must be considered in the setting of pulmonary PVL.
31. DIFFERENT MANAGEMENT FOR THROMBOSIS COMPLICATIONS IN POST FONTAN SURGERY: REPORT OF TWO CASES
Sisca Natalia Siagian1, Poppy S Roebiono2, Oktavia Lilyasari3 1 Universitas Indonesia Jakarta Indonesia; Ncchk Jakarta Indonesia; Pediatric Cardiology Division
2 Pjnhk Jakarta; Cardiology and Vascular Fkui; Pediatric Cardiology
3 National Cardiovascular Center Harapan Kita, Jakarta - Indonesia; Non-Invasive; Pediatric Cardiology
History and Physical: We reported two cases of silent thrombus formation after fenestrated extra-cardiac conduit Fontan procedure which detected on routine trans-thoracic echocardiography (TTE) evaluation and its management. The rst case is a 5-year-old girl with DORV, non-committed muscular VSD, severe PS, smallish LV and PDA. She underwent an uneventful fenestrated extra-car- diac Fontan procedure after bidirectional cavo-pulmonary shunt (BCPS) and atrial septectomy done a year earlier. The second case is an 11-year-old girl with dextrocardia, pul- monary atresia with the aorta arises from the RV, hypoplas- tic LV, large muscular VSD, PFO and MAPCAs. Fenestrated extra-cardiac Fontan procedure was also done after previ- ous BT shunt and BCPS with atrial septectomy, and MAPCAs embolization. They were both had no clinical symptoms or abnormal hemodynamic data.
Imaging: For the rst patient, multiple large thrombi of 8x6mm and 5x4mm were seen inside the extra-cardiac conduit on TTE evaluation 6 months after the operation,.
There was also a mild stenosis found at the anastomosis of IVC to extra-cardiac conduit and a good anastomosis of right SVC to RPA. TTE evaluation on second patient at 8 days post Fontan procedure revealed a long large throm- bus of 10x14mm in the IVC. The anastomosis of IVC to extra-cardiac conduit and right SVC to RPA were good.
Indication for Intervention: The rst patient was on achieved theurapeutic anticoagulant treatment, and the second one was still under heparin infusion, but thrombus was found on routine TTE evaluation after the operation.
Intervention: Percutaneous balloon angioplasty and stent- ing implantation were planned in the rst case after 5 days of intravenous heparin was given. Unfortunately, due to the unavailability of the suitable stent and vena cava lter, we have to postpone the procedure. She was then on oral anticoagulation and no thrombus seen any more on TTE evaluation after 2 days and 1 months later. For the second case, a direct catheter thrombosuction and thrombolysis with TPA was performed. It was followed by intravenous TPA with 4 hourly brinogen level evaluation. The TPA was stopped after 10 hours since the brinogen level drop to 40 mg/dL. It was continued with intravenous heparin for 5 days and oral warfarin subsequently. Thrombus is not found any more on TTE evaluation after 4 hours, 5 days , and 2 months above the procedures.
Learning Points of the Procedure: Patients who have undergone the Fontan operation are at a high risk for thromboembolism.
Thromboembolism complication in Fontan surgery can occur despite of anticoagulation treatment with achieved APTT and PT level or therapeutic international normalized ratio (INR). Routine TTE evaluation can detect this compli- cation clearly so treatment can be performed immediately. Aggressive anticoagulation infusion and catheter direct thrombosuction followed by thrombolysis reestablish the patency of Fontan circuit and save the risks of re-surgeries.
32. DUMBBELL-SHAPED CONTROLLED INFLATION OF STENT FOR FENESTRATION OF FONTAN TRACT
Kenji Suda
Kurume University School of Medicine; Pediatric Cardiology; Intervention
History and Physical: A 20-year-old male patient with lat- eral tunnel Fontan procedure had su ered from intractable protein losing enteropathy (PLE) for 13 years that required 14 times of hospitalization.
Journal of Structural Heart Disease, April 2018
Volume 4, Issue 2:85-113