Page 127 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
Results: 772 patients underwent aortic balloon or stent angioplasty at our Institution over the last 15 years. Of these, 27 (3.5%) patients where considered to have an extreme/near-atretic coarctation and underwent aortic stenting at a median age of 20 years (7-49) and weight of 61kg (20-84). Male to female ratio was 2.3:1. Successful recanalization of the coarctation was achieved in all cases from an antegrade approach (from ascending to descend- ing aorta) through the radial artery in 17 (62%) patients and the brachial artery in the remaining 10 (38%) patients. All but one patient (who required radiofrequency assisted per- foration) where managed with mechanical guidewire-as- sisted crossing of the coarctation. Once the coarctation was crossed, wires were snared from the femoral access enabling the long sheath to be advanced retrogradely in usual fashion. Peak systolic gradient across the coarc- tation fell from 49mmHg (±23) to 5mmHg (±6) p <0.001. Predilatation with standard PTA balloons prior to stent implantation was performed in all cases. Covered stents were used in 13 (48%) patients (Atrium n=7, CP Covered Stent n=6) and bare metal stents were deployed unevent- fully in the remaining 14 (52%) patients. There were no deaths related to the procedure. One patient developed a small hematoma at the site of brachial artery entry with no sequelae. Acute aneurysm formation was encountered in one (3%) patient who developed a small contained verte- bral artery aneurysm, interestingly after deployment of a covered stent. Follow up was available in 92% at a median time from intervention of 19 months (IQR 7-90). Two (8%) patients have required reintervention for additional stent angioplasty (one of them due to previous stent fracture). Fourteen (56%) patients remain hypertensive despite medication. Follow-up imaging was available in 11 (44%) patients showing an intact stent and no evidence of aneu- rysm formation.
Conclusions: Extreme/near-atretic coarctation of the aorta represents a complex lesion. Our experience shows stent angioplasty in this setting can be performed safely and effectively. Adequate management of coarctation can be achieved with both bare metal and covered stents. A significant proportion of patients will remain hypertensive despite obstruction relief.
167. TRANSCATHETER THERAPY FOR TREATMENT OF PULMONARY EMBOLISM IN CHILDREN: SINGLE TERTIARY CENTER EXPERIENCE WITH FOCUS ON CATHETER DIRECTED THROMBOLYSIS (CDT)
Varun Aggarwal, Athar M. Qureshi, Asra Khan, Henri Justino,
Srinath T. Gowda
Texas Children's Hospital and Baylor College of Medicine, Houston, USA
Purpose: Acute pulmonary embolism (PE) is a life-threat- ening condition and rarely occurs in children. In adults, catheter-directed thrombolysis (CDT) emerges as a poten- tially safer and an effective therapeutic option. However, there is a paucity of data on the safety and efficacy of CDT for pulmonary embolism in children. We report a sin- gle-center experience of various transcatheter therapy including CDT for acute PE in children.
Materials and Methods: This is a retrospective study of children who had acute PE and underwent transcatheter therapy at Texas Children’s Hospital and Baylor College of Medicine, Houston, TX during 8-year period from April 2010 to January 2019. Demographics, clinical data, tran- scatheter treatment, and complications associated with pulmonary embolism were collected along with the out- come. The PE was categorized as massive (hemodynamic instability) or submassive. Transcatheter therapy included; various mechanical thrombectomy techniques and CDT with EkoSonic ultrasound accelerated endovascular sys- tem (EKOS).
Results: A total of 17 patients of median age 13.2 years with the range from 8 days to 20.7 years received transcath- eter therapy for acute PE. Among 17 patients, two patients had osteosarcoma and two were postoperative pulmonary artery stenosis (leading to thrombus formation in the dis- tal PA); and therefore, were excluded from the review. 8/13 patients had massive PE and the rest were submassive. Among the 13 patients, seven received CDT using tissue plasminogen activator (tPA) through infusion catheters via the EkoSonic ultrasound-accelerated thrombolysis system (0.5-2mgs/hrs for 8-36hrs); and six underwent mechanical thrombectomy using various techniques (one Angiojet, one Angiojet and balloon angioplasty, four using Pronto catheter) and anticoagulation. All patients (n=7) treated with EKOS showed significant clinical improvement within 24 hours. Only three of six patients had successful mechan- ical thrombectomy. Of the three patients with unsuccessful mechanical thrombectomy, two patients had resolution of PE with systemic anticoagulation. The third patient died due to rejection of the transplanted heart and multiple comorbidities. Among 12 patients who survived, there was no major procedure related or systemic / local bleeding complications with median hospital stay of 13 days with the range from 4-184 days.
Conclusions: CDT is an emerging alternative therapy for massive and sub-massive pulmonary embolism in chil- dren. In our experience, CDT was found to be a relatively safe and effective treatment option for acute massive or submassive PE without any procedural morbidity or
Hijazi, Z
22nd Annual PICS/AICS Meeting