Page 71 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
47%), systemic vein or Fontan tunnel dilation (20/46; 43.5%) or coarctation treatment (62/149; 42%).
Conclusions: A substantial percentage of cardiac pro- cedures in patients with CHD may benefit from 3D guid- ance. In our eight years experience we noticed increasing frequency of utilization of any 3D guidance; including a tendency for more frequent fusion of pre-operative CT/ MRI datasets. Three-dimensional imaging was significantly more commonly used during interventional procedures; with similar frequency among single and biventricu- lar patients. Utilization of 3D guidance was operator dependent.
94. SUCCESSFUL COIL EMBOLIZATION FOR MASSIVE PULMONARY ARTERIOVENOUS FISTULA IMMEDI- ATELY AFTER ELECTIVE CAESAREAN SECTION ON THE BASIS OF PRENATAL DIAGNOSIS
Satoshi Yasukochi, Kiyohiro Takigiku, Kouta Takei, Ryusuke Numata, Kimiyo Takagi
Nagano Children's Hospital, Azumino, Japan
Massive pulmonary arterio-venous fistula (PAVF) is a life-threatening disease especially in a fetus developing heart failure prenatally. Case was referred to us because of fetal distress and cardiomegaly at 36 weeks of gestation. Fetal echocardiogram showed a cardiomegaly (CTAR of 52%) with huge PAVF occupied more than 80% space of left lung. The origin of PAVF was near the proximal left pul- monary artery and running tortuously to huge vascular sac (14-16mm in diameter) via multiple channels then drain- ing through marked dilated venous vessel to left lower pul- monary vein.
Because of its high risk of severe desaturation, low output syndrome, and pulmonary hypertensive crisis, we under- went an emergent coil embolization immediately after the elective caesarean section. She was born by C-section at 37 weeks of gestation with SpO2 of 45% and transferred to cath-lab immediately after intubation. 6F Wedge balloon catheter was introduced to left PAVF and occluded by bal- loon inflation, which improved her SpO2 up to 97% and maintained BP of 60mmHg in systole. After balloon occlu- sion, PAVF was embolized by coils ( TargetTM) including packing coil. After coil embolization, blood pressure could be maintained as 70-80/40mmHg and SpO2 as 95-97% under 100% oxygen and 20ppm nitric oxide inhalation.
Strategic and team approach of catheter intervention on the basis of exact fetal diagnosis for critical heart disease is essential to rescue a life-threatening case.
95. SUCCESSFUL SEQUENTIAL CLOSURE OF CONGENITAL AND IATROGENIC ASDS FOLLOWING MITRACLIP: A CASE REPORT
Margaret Mary Steele, Jignesh Bhavsar, Gene Chang
Penn Medicine, Philadelphia, USA
Background: Symptomatic patients with congenital atrial septal defects (ASD)s and severe degenerative mitral regurgitation have traditionally been referred for surgical closure of ASD and repair or replacement of mitral valve. When lung disease is present, increasing the risk of sur- gical morbidity and mortality, these patients may instead be referred for transcatheter intervention with Mitraclip and ASD occluder device placement. However, the large sheaths required for transseptal puncture with the Mitraclip system create iatrogenic ASDs. Patients undergo- ing Mitraclip procedure are at risk for persistent iatrogenic ASDs and associated interatrial shunting, leading to worse clinical outcomes and higher mortality rates.[1]
Case Summary: We present the unusual case of a 73-year- old gentleman with 1 cm ostium secundum ASD and severe degenerative mitral regurgitation. He was deemed not a surgical candidate due to his advanced age, severe COPD and moderate pulmonary hypertension. The Mitraclip 24 Fr steerable guide required creation of a second ASD for optimal system positioning. Following placement of 2 Mitraclips, mitral regurgitation and left atrial pressure were markedly reduced. 10 mm Amplatzer septal occluder device was placed across the congenital ASD under trans- esophageal guidance. The patient tolerated this proce- dure well and was discharged to home the following day. Follow-up echocardiogram revealed persistent iatrogenic ASD with a large left-to-right shunt. He subsequently underwent placement of overlapping 10 mm Amplatzer septal occluder device 3 months following initial interven- tion. Echocardiogram revealed mild mitral regurgitation, no residual interatrial shunting, decreased pulmonary arte- rial pressure and decreased right ventricular dilation. He was discharged to home the following day and reported improvement in heart failure symptoms.
Discussion: This case offers a novel approach to per- sistent iatrogenic ASD in a patient with a history of previ- ous Mitraclip and congenital ASD closure with Amplatzer occluder device. As indications for Mitraclip interventions extend from degenerative to functional mitral regurgi- tation, increasing numbers of patients will present for Mitraclip intervention with pre-existing structural heart disease. Additionally, incidence of persistent iatrogenic ASDs may also rise. More research is needed to optimize transcatheter intervention management in these patients
Hijazi, Z
22nd Annual PICS/AICS Meeting