0176: Intraoperative pulmonary artery stenting for management of pulmonary artery stenosis in children with congenital heart diseases: a single center 5-year experience

IntroductionPatients with Congenital Heart Diseases (CHD) often suffer from severe pulmonary artery (PA) stenosis. Management of PA stenosis is challenging for surgeons. The purpose of this study was to assess the results of intraoperative pulmonary artery stenting, performed additionally to, or instead of, conventional surgical angioplasty.Methods and resultsBetween January 2008 and August 2013, 31 children with hypoplastic or stenosed PA, median age of 23 months (range 6 days to 15 years), and median weight of 11,8kg (range 2,8 to 63kg), underwent intraoperative placement of stents in PA. Patients had pulmonary atresia (15) tetralogy of Fallot (10) troncus arteriosus (4), and complex CHD (2). The aim of the concomitant surgical procedure was palliative surgery (10), complete repair (12), or improvement of right ventricular outflow tract after complete repair (9). A total of 42 balloon-expandable stents were deployed in left or right PA. Maximum balloon diameters ranged from 3 to 16mm (mean=9). Post-operative mortality was 9,6% (3 patients) and 2 patients did not have complete follow-up. Eighteen patients underwent angiographic control, at a mean follow-up of 15 months (± SD 10 months) after surgery. Mean PA diameter increased from 5,19 to 7,57mm (p<0,001). Eight patients did not have angiography to date because routine echocardiography follow-up showed patent pulmonary arteries, with low residual gradient. Two patients (7,6%) needed a reoperation for severe intra-stent stenosis. Nine patients (34,6%) had repeated dilatation, performed percutaneously or during further intervention to complete repair of their CHD.ConclusionIntraoperative stenting of PA is an effective option to prevent recoil and external compression. However, smaller stents seem to be at higher risk of intra-stent proliferation

Preliminary Experience With the New Amplatzer™ Trevisio™ Delivery System in Transcatheter Atrial Septal Defect Closures in Children

Objectives: To evaluate safety, efficacy, and technical advantages of Amplatzer™ Trevisio™ intravascular delivery system (ATIDS) in percutaneous atrial septal defect (ASD) closure in children.Background: The Trevisio™ is a novel delivery system designed for accurate and facilitated implantation of Amplatzer™ devices. There are no published clinical reports so far.Methods: During September 2020, 9 children with anatomically challenging ASDs underwent attempted transcatheter closure using ATIDS to deliver Amplatzer™ Septal occluders (ASO). All interventions were performed under general anesthesia, trans-esophageal echocardiography (TOE), and fluoroscopic guidance. Standard safety, immediate, and 60-days outcomes were prospectively assessed.Results: The median age was 8.1 (5.1–16.9) years and the median bodyweight was 30 (18–63) kg. Six patients had isolated secundum-type ASDs with absent anterosuperior rims including one with an aneurysmal septum. Three patients had unclassical defects associated with complex congenital heart anomalies. Eight devices were delivered from the femoral vein and the jugular vein was accessed in one patient with interrupted inferior caval vein and azygos continuation. All implantations were successful. The shape, position, and orientation of the ASO were identical before and after release on TOE and fluoroscopy. There was no device embolization or serious complication following closure. Complete shunt closure was confirmed on follow-up.Conclusions: We report the first clinical experience with ATIDS in transcatheter ASD pediatric closures. Safety and efficacy were witnessed in our case-series. The major advantage of reduced-tension deployment and reliable precision in device positioning is highly beneficial in challenging anatomies and unusual access.</jats:p

0523: Feasibility and accuracy of left ventricular volumes and ejection fraction measured by different echocardiographic methods in congenital heart diseases involving the right ventricle

BackgroundIn CHD with RV volumetric or barometric overload, LV shape is altered. Little is known about the accuracy in this population of left ventricular (LV) volumes and ejection fraction (EF) measurement by standard echocardiographic methods using geometrical assumption: Teicholz, biplane Simpson and real-time 3D echocardiography (RT-3DE). Three-dimensional knowledge-based reconstruction (3D-KR) derived from two-dimensional echocardiographic imaging is a novel technique that has no geometrical assumption. The aim of our study is to assess the accuracy of several echocardiographic methods for measuring LV volumes and EF compared to cardiac magnetic resonance (CMR) measurements (gold standard) in this population.Methods68 patients (mean age 13,3±4 years) with Congenital Heart Diseases (CHD) involving the RV and referred for cardiac MRI, were included. Among them, 13 patients had barometric overload, 37 patients had volumetric overload, and 18 patients had mixed overload. Echocardiographic images acquisition was performed using a standard ultrasound scanner linked to a Ventripoint Medical Systems unit. Analyzed parameters were end-diastolic volume (EDV), end-systolic volume (ESV), and LVEF measured by Teicholz, Simpson’s modified formula and RT-3DE (GE Vingmed QVG Auto-4D). The method of disks was used for CMR LV volumes. Intra-observer, inter-observer, and inter-technique variability was assessed using intraclass correlation coefficient (CC), Pearson’s CC, coefficients of variation, and Bland-Altman analysis.ResultsFeasibility was 98% for Teicholz Method and 3D-KR, 71% for Simpson’s modified formula, and 73% for RT-3DE. We found globally poor correlation and agreement for volumes and EF between the different methods and MRI. The agreement was better when RV volumes were lower than 120ml/m2 (and thus, LV shape was less altered).ConclusionsLV volumes and EFs cannot be measured accurately by echocardiography in patients with dilated right ventricles

Transcatheter Management of Pulmonary Sequestrations in Children&mdash;A Single-Center Experience

Background: A pulmonary sequestration (PS) is an area of bronchopulmonary tissue with aberrant arterial supply. Transcatheter occlusion of PSs is an appealing treatment option, but data on outcomes remain scarce. We aim to describe our experience with transcatheter management of PS in infants and children. Methods: Retrospective review of clinical data of all patients with suspected PS sent for diagnostic and/or interventional cardiac catheterization at our institution between January 1999 and May 2021. Procedural considerations, techniques, standard safety, and outcomes were assessed. Results: We identified 71 patients (52.1% males), with median age and weight of 4.9 months (IQR, 2.1&ndash;26.6) and 4.2 kg (IQR, 3.9&ndash;12.1), respectively. Sixty-one (86%) patients had associated congenital heart defects (CHDs). Forty-two (59%) patients had pulmonary arterial hypertension (PAH) at the time of diagnosis. Fifty-three (74.7%) patients underwent embolization of the PS feeding vessel using microcoils and/or vascular plugs, and eight (15.1%) of these were neonates who presented with severe PAH and cardiac failure. Two patients had large feeding vessels and were treated surgically. Sixteen (22.5%) patients with small feeding vessels received conservative management. At median follow-up of 36.4 months (IQR, 2.1&ndash;89.9), seven patients had died, 24 patients had CHD corrective surgeries, 26 patients had redo catheterizations, and five patients had persistent PAH. No PS surgical resection was needed, and no infection of the remaining lung tissue occurred. Conclusions: Transcatheter assessment and treatment of PSs is a safe and effective procedure. Neonates with large PSs are severely symptomatic and improve remarkably after PS closure. PS embolization and surgical repair of associated CHDs generally leads to the normalization of pulmonary pressures