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PT265 Survival Analysis and Associated Factors in Patients With Atrioventricular Septal Defect. Children's Hospital of Mexico. Federico Gomez. 2003-2013
PT264 Perventricular Pulmonary Valvotomy as a Successful Therapeutic Measure in a Case of Pulmonary Atresia With Intact Ventricular Septum and Iatrogenic Perforation of Right Ventricular Outflow Tract A. Sanchez*1 1 Pediatric Cardiology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico Introduction: Pulmonary atresia with intact ventricular septum includes a spectrum of disease ranging from simple membranous valvular atresia with a well-developed RV to a severe hypoplastic RV. Objectives: An 8 day new born patient with central cyanosis in poor clinical conditions is admitted with a diagnosis of pulmonary atresia and intact ventricular septum with confluent pulmonary arteries. The patient is taken urgently to cath lab finding a right intraventricular pressure of 90mmHg above systemic pressure. While trying a transcatheter mechanical valvotomy with a hydrophilic guide wire a false way is created to the pericardial cavity, suddenly deteriorates presenting hemodynamic compromise: hypotension and bradicardia. The patient required adrenaline infusion but persisted unstable. An transthoracic echocardiogram is realized in the cath lab finding important pericardial effusion with left cavity collapse. The patient is transferred to the OR, to perform an hybrid procedure. A midline thoracotomy was performed and a purse string stitch is made on the free wall of the right ventricle, finding an hematoma in the infundibulum without active bleeding and 15 ml hemopericardium. Posteriorly a guided puncture towards the pulmonary valve plan is done achieving its perforation. A Tyshak mini 10x20mm balloon mounted on angioplasty guide wire is passed across the valve performing a pulmonary valvotomy. In the control angiography, contrast material could bee seen passing to the pulmonary circulation. In the posterior pressure records right ventricle pressure was 49/2/9mmHg. The patient was transferred to the intensive care unit, with a favorable clinical progress, discharged 2 weeks after. Methods: Its a case report. Results: Its a case report. Conclusion: The percutaneous interventional technique of pulmonary valve perforation is a therapeutic option that provides pulmonary blood flow to patients with pulmonary atresia with intact ventricular septum. Cardiac tamponade is the major complication of this type of procedure following perforation of the pericardial space. Even though it is an unusual complication, it’s a serious one in these types of procedures, in which 3% of patients require urgent surgical management. Disclosure of Interest: None Declared PT265 Survival Analysis and Associated Factors in Patients With Atrioventricular Septal Defect. Children’s Hospital of Mexico. Federico Gomez. 2003-2013 L. Sandoval*1, R. Hernandez1, A. Zamorano2, J. Ulloa1, A. Magaña1, J. Erdmenger1, R. Becerra1, T. Tamayo1, B. Segura1 1 Pediatric Cardiology, Children’s Hospital of Mexico, 2Pediatrics, ABC Santa Fe Hospital, Mexico DF, Mexico Introduction: The atrioventicular septal defect is a congenital heart disease that affects the atrial septum, the ventricular septum and the atrioventricular valves. The current standard in the atrioventricular septal defect is the complete repair at an early age. Objectives: Analyze associated factors with survival of patients with atrioventricular septal defect in the Children’s Hospital of Mexico Federico Gomez (HIMFG) in the years 2003-2013. Methods: Retrospective study, we reviewed charts from 2003-2013 of all the patients with atrioventricular septal defect. Results: 88 patients with atrioventricular septal defect were admitted to a 10-year period analyzed in the HIMFG. Patients according to the type of atrioventricular septal defect were distributed according to Rastelli classification. Subsequently distributed by type of total correction surgery 48 (53.4%), pulmonary artery banding 18 (20.5%), has not undergone any surgery 23 (26.1%). Of the 48 patients whom underwent total correction, 10 (20.8%) of these patients had previously undergone banding of the pulmonary artery and in a second surgical time underwent total correction. Of the 88 patients 14 (15.9%) died, with an early mortality of 9
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patients (64.3%) and late mortality of 5 patients (35.7%). We analyzed the patient with atrioventricular septal defect and Down syndrome have a higher chance of mortality 2.8 times, HR 2.85 95% CI (0.98-8.22) p value 0.053, which is not statistically significant but with high trend. The relationship between duration of extracorporeal circulation and the risk of death and this was statistically significant with a Spearman correlation of 0.448 p value of 0.001. Hypothermia is a factor associated with mortality with p value 0.022. Conclusion: At Children’s Hospital of Mexico, the time of diagnosis of patients is late, it’s usually by late reference. There is still a high performing palliative surgery (20.5%) which should make us insist on corrective surgery at an earlier age. The associated factors with mortality are duration of extracorporeal circulation and hypothermia. Disclosure of Interest: None Declared PT268 Intraoperative Transesophageal Echocardiography Impact During Surgical Repair of Congenital Mitral Valve Anomalies M. C. Sanchez Cornelio*1, C. A. Vázquez Antona1, E. Colin Ramirez2, S. Ramirez Marroquin3, J. Vargas Barron4 1 Echocardiography, 2Sociemedicine, 3Surgery of Congenital Heart Disease, 4Research Division, Instituto Nacional de Cardiología México, México City, Mexico Introduction: Transesophageal echocardiography(TEE) has become a key part in the perioperative approach of congenital mitral anomalies. Objectives: We analyze our results in use of intraoperative TEE and congenital mitral surgery. Methods: We retrospectively reviewed records of 58 patients operated for congenital mitral valve disease who underwent intraoperative TEE to assess the outcome of surgical repair and their evolution over a period from January 2007 to June 2012. Results: 58 surgical procedures were performed as initial: 49 mitral and 9 valve replacements. The mean age was 3.9 5.5 years. Intraoperative TEE showed 62% residual lesions, only 8.5% were severe and required immediate reintervention; in 3% of the intraoperative TEE severe residual lesions were missed. A sensitivity of 75%, a negative predictive value of 96.1%, specificity 100% and a positive predictive value of 100% was found. During follow-up, 31% of the patients showed progression of residual lesions, but only 7% required reintervencion. Early mortality was 8.6%, in all patients who died, TEE showed ventricular dysfunction. Actuarial freedom from cardiac event was 63.8% at 6 years. Patients who received a prosthesis had increased risk of death (RR 7.8; p ¼ 0.46) compared with those who underwent mitral repair. Conclusion: Intraoperative TEE has a considerable impact on surgery of congenital mitral valve lesions. Disclosure of Interest: None Declared PT273 Determinant Variables of Immediate Postsurgical Failure in Fontan. Eleven Years Experience in the National Institute of Cardiology C. Gilles*1, A. Juanico1, J. E. Calderon1, J. A. Garcia-Montes1, J. L. Cervantes1, E. S. Ramirez1 Pediatric Cardiac Intensive Care, National Institute of Cardiology “Ignacio Chavez”, Mexico City, Mexico 1
Introduction: The immediate mortality of the Fontan Procedure is due to ventricular dysfunction, arrhythmias, cerebrovascular accident, thromboembolism and multi organic dysfunction. It has been analyzed and reported numerous factors related with the mortality, as well as the complications at medium and long term, however it hasn’t been precisely determined the indications for dismantling the Fontan as well as the prognostic factors that lead up to this decision. Objectives: Describe the associate factors to an unsuccessful Fontan considering death and dismantling. Short and medium term complications in this group of patients as well as identifying the risk factors for its morbi-mortality. Methods: We studied all patients that underwent a Fontan procedure in the 2003 to 2004 period in a retrospective study. Results: 115 patients underwent a Fontan procedure from 2003 to 2004 period with a mean age of 4 years. The most frequent pathology was tricuspid atresia and pulmonary atresia. 63% percent have previous surgery background (bidirectional cavopulmonary derivation 43%, systemic pulmonary shunt 43%, pulmonary banding 8.5%), 38 patients were taken to catheterization in the immediate post surgical period due to a poor evolution, 41 interventionist catheterizations were made, and the most frequent were: stent application in a fenestration (20 patients), angioplasty of branch pulmonary arteries (9 patients). Thirteen percent mortality was obtained (15 patients). From these patients, 4 didn’t have previous surgeries (26%) and the rest had previous surgery (47% total cavopulmonary derivation, 20% Systemic pulmonary fistula and 7% pulmonary banding). Six patients were dismantled (5%). The associate mortality to a dismantling was 83% and the main indication for the dismantling was related to ventricular dysfunction. The risk factors associated to dismantling are ventricular failure, pulmonary hypertension, and adjoining Nakata & MacGoon parameters; dismantling mortality has a direct relation to the time interval between both surgeries, as well as the degree of atrioventricular valvular insufficiency. Conclusion: Determine whether or not to dismantle a patient after a Fontan procedure is a difficult decision to take. The high mortality associated to the dismantling is influenced by the time interval between both surgeries, dominant right ventricle and atrioventricular valvular insufficiency. Disclosure of Interest: None Declared
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ruled out by CCTA. In a per vessel analysis we studied differences between patients with and without hypertension. Results: In our population mean age was 57 10 years 54% were male, 61% hypertensive, 59% dyslipidemic, 40% active smokers, and 20% diabetic, LVEF was 69% 10, and BMI was 28 5 kg. We did not find any statistically significant difference among hypertensive and healthy patients in baseline characteristics. We did not find a statistically significant difference among hypertensive patients when compared to healthy patients in MBF during rest (1.1 0.4 ml/gr/min vs. 1.0 0.3 ml/gr/min, respectively, p¼ NS), nor stress (2.0 0.8 ml/gr/min vs. 2.1 0.7 ml/gr/min, respectively, p¼NS). However, MFR was significantly lower in hypertensive patients (2.4 1.2 ml/gr/min vs. 2.9 1.0 ml/gr/min, p ¼ 0.005). Multiple regression analysis showed hypertension as the only significant predictor for decreased MFR (p¼0.002). Conclusion: Our results demonstrate that a low MFR does not necessarily mean a reduction in stress MBF or increase in rest MBF. Our study support the use of MFR measured by 13N-Ammonia/PET, even in the absence of CAD ruled out by CCTA, in order to demonstrate endothelial dysfunction in patients with hypertension. Disclosure of Interest: None Declared
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patients (64.3%) and late mortality of 5 patients (35.7%). We analyzed the patient with atrioventricular septal defect and Down syndrome have a higher chance of mortality 2.8 times, HR 2.85 95% CI (0.98-8.22) p value 0.053, which is not statistically significant but with high trend. The relationship between duration of extracorporeal circulation and the risk of death and this was statistically significant with a Spearman correlation of 0.448 p value of 0.001. Hypothermia is a factor associated with mortality with p value 0.022. Conclusion: At Children’s Hospital of Mexico, the time of diagnosis of patients is late, it’s usually by late reference. There is still a high performing palliative surgery (20.5%) which should make us insist on corrective surgery at an earlier age. The associated factors with mortality are duration of extracorporeal circulation and hypothermia. Disclosure of Interest: None Declared PT268 Intraoperative Transesophageal Echocardiography Impact During Surgical Repair of Congenital Mitral Valve Anomalies M. C. Sanchez Cornelio*1, C. A. Vázquez Antona1, E. Colin Ramirez2, S. Ramirez Marroquin3, J. Vargas Barron4 1 Echocardiography, 2Sociemedicine, 3Surgery of Congenital Heart Disease, 4Research Division, Instituto Nacional de Cardiología México, México City, Mexico Introduction: Transesophageal echocardiography(TEE) has become a key part in the perioperative approach of congenital mitral anomalies. Objectives: We analyze our results in use of intraoperative TEE and congenital mitral surgery. Methods: We retrospectively reviewed records of 58 patients operated for congenital mitral valve disease who underwent intraoperative TEE to assess the outcome of surgical repair and their evolution over a period from January 2007 to June 2012. Results: 58 surgical procedures were performed as initial: 49 mitral and 9 valve replacements. The mean age was 3.9 5.5 years. Intraoperative TEE showed 62% residual lesions, only 8.5% were severe and required immediate reintervention; in 3% of the intraoperative TEE severe residual lesions were missed. A sensitivity of 75%, a negative predictive value of 96.1%, specificity 100% and a positive predictive value of 100% was found. During follow-up, 31% of the patients showed progression of residual lesions, but only 7% required reintervencion. Early mortality was 8.6%, in all patients who died, TEE showed ventricular dysfunction. Actuarial freedom from cardiac event was 63.8% at 6 years. Patients who received a prosthesis had increased risk of death (RR 7.8; p ¼ 0.46) compared with those who underwent mitral repair. Conclusion: Intraoperative TEE has a considerable impact on surgery of congenital mitral valve lesions. Disclosure of Interest: None Declared PT273 Determinant Variables of Immediate Postsurgical Failure in Fontan. Eleven Years Experience in the National Institute of Cardiology C. Gilles*1, A. Juanico1, J. E. Calderon1, J. A. Garcia-Montes1, J. L. Cervantes1, E. S. Ramirez1 Pediatric Cardiac Intensive Care, National Institute of Cardiology “Ignacio Chavez”, Mexico City, Mexico 1
Introduction: The immediate mortality of the Fontan Procedure is due to ventricular dysfunction, arrhythmias, cerebrovascular accident, thromboembolism and multi organic dysfunction. It has been analyzed and reported numerous factors related with the mortality, as well as the complications at medium and long term, however it hasn’t been precisely determined the indications for dismantling the Fontan as well as the prognostic factors that lead up to this decision. Objectives: Describe the associate factors to an unsuccessful Fontan considering death and dismantling. Short and medium term complications in this group of patients as well as identifying the risk factors for its morbi-mortality. Methods: We studied all patients that underwent a Fontan procedure in the 2003 to 2004 period in a retrospective study. Results: 115 patients underwent a Fontan procedure from 2003 to 2004 period with a mean age of 4 years. The most frequent pathology was tricuspid atresia and pulmonary atresia. 63% percent have previous surgery background (bidirectional cavopulmonary derivation 43%, systemic pulmonary shunt 43%, pulmonary banding 8.5%), 38 patients were taken to catheterization in the immediate post surgical period due to a poor evolution, 41 interventionist catheterizations were made, and the most frequent were: stent application in a fenestration (20 patients), angioplasty of branch pulmonary arteries (9 patients). Thirteen percent mortality was obtained (15 patients). From these patients, 4 didn’t have previous surgeries (26%) and the rest had previous surgery (47% total cavopulmonary derivation, 20% Systemic pulmonary fistula and 7% pulmonary banding). Six patients were dismantled (5%). The associate mortality to a dismantling was 83% and the main indication for the dismantling was related to ventricular dysfunction. The risk factors associated to dismantling are ventricular failure, pulmonary hypertension, and adjoining Nakata & MacGoon parameters; dismantling mortality has a direct relation to the time interval between both surgeries, as well as the degree of atrioventricular valvular insufficiency. Conclusion: Determine whether or not to dismantle a patient after a Fontan procedure is a difficult decision to take. The high mortality associated to the dismantling is influenced by the time interval between both surgeries, dominant right ventricle and atrioventricular valvular insufficiency. Disclosure of Interest: None Declared
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ruled out by CCTA. In a per vessel analysis we studied differences between patients with and without hypertension. Results: In our population mean age was 57 10 years 54% were male, 61% hypertensive, 59% dyslipidemic, 40% active smokers, and 20% diabetic, LVEF was 69% 10, and BMI was 28 5 kg. We did not find any statistically significant difference among hypertensive and healthy patients in baseline characteristics. We did not find a statistically significant difference among hypertensive patients when compared to healthy patients in MBF during rest (1.1 0.4 ml/gr/min vs. 1.0 0.3 ml/gr/min, respectively, p¼ NS), nor stress (2.0 0.8 ml/gr/min vs. 2.1 0.7 ml/gr/min, respectively, p¼NS). However, MFR was significantly lower in hypertensive patients (2.4 1.2 ml/gr/min vs. 2.9 1.0 ml/gr/min, p ¼ 0.005). Multiple regression analysis showed hypertension as the only significant predictor for decreased MFR (p¼0.002). Conclusion: Our results demonstrate that a low MFR does not necessarily mean a reduction in stress MBF or increase in rest MBF. Our study support the use of MFR measured by 13N-Ammonia/PET, even in the absence of CAD ruled out by CCTA, in order to demonstrate endothelial dysfunction in patients with hypertension. Disclosure of Interest: None Declared