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Successful Percutaneous Closure of Large Patent Ductus Arteriosus with Ventricular Septal Defect Device
Abstracts
S234
http://dx.doi.org/10.1016/j.hlc.2017.06.438 438 Successful Percutaneous Closure of Large Patent Ductus Arteriosus with Ventricular Septal Defect Device D. Blusztein, S. Peters ∗ , W. Wilson Royal Melbourne Hospital, Melbourne, Australia Introduction: Large patent ductus arteriosus (PDA) is usually closed via surgical approach. This case demonstrates a successful device closure of a very large PDA using a bileaflet closure device. Methods and Results: A 28-year-old female nurse developed heart failure during her first pregnancy in her native East Timor. Examination revealed a continuous thrill and normal oxygen saturations (hands and feet). Transthoracic echocardiogram demonstrated a large PDA with continuous flow into the PA, associated with marked LV dilatation and mild LV dysfunction. A CT scan confirmed a large window-like PDA (type B), measuring 14-15 mm. Cardiac catheterisation demonstrated severe pulmonary hypertension (PA pressure 65/35 (mean 48) mmHg) with a large left-to-right shunt (Qp:Qs 5.3:1 via oximetry). Pulmonary vascular resistance was normal and, in the absence of Eisenmenger physiology, closure was felt to be safe and beneficial. Intraprocedural sizing of the defect was very difficult with aortography owing to high volume flow across the PDA, thus balloon sizing was performed using a 24 mm Amplatzer sizing balloon (measured ∼14 mm). Given the window-like morphology and the presence of severe pulmonary hypertension, a bileaflet device was selected; successful PDA closure was achieved using an 18 mm Amplatzer muscular VSD device, delivered through a 9Fr venous sheath. The device was well-seated with a small residual shunt on echocardiography post procedure. The patient was discharged day 1 post procedure. Minor haemolysis resolved after 4 weeks. Conclusion: Bileaflet devices such as the Amplatzer muscular VSD device can close very large PDAs that may otherwise require surgical repair. http://dx.doi.org/10.1016/j.hlc.2017.06.439
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439 Successful STEMI Thrombolysis Post Reversal of Dabigatran (Pradaxa® ) C. Mengel 1,2 , S. Tatavarty 1,2,∗ , R. Gluer 1,2,3 , N. Aroney 1,2 , D. Murdoch 1,2 , B. Bell 1 , N. Gaikwad 1,2 , D. Walters 1,2 1 The Prince Charles Hospital, Brisbane, Australia 2 University of Queensland, Brisbane, Australia 3 Toowoomba Base Hospital, Toowoomba, Australia
A 75-year-old female presented to a peripheral centre with two hours of typical ischaemic chest pain. ECG showed inferior ST elevation in leads II, III and aVF with reciprocal depression in lead I, aVL and anterior precordial leads (Figure 1). She had been prescribed dabigatran 110 mg BD for non-valvular atrial fibrillation, with CHADS2 -VASC score 3. Her last dose was 11 hours prior to presentation. She weighed 60 kg. In consultation with our centre, she had reversal of dabigatran with idarucizumab (Praxbind® ) 5 g over 10 minutes followed by half dose thrombolysis (0.5 mg/kg tenecteplase) and subcutaneous enoxaparin. ST segment elevation reduced by 50% at 60 minutes, with improvement of chest pain. She was transferred within 12 hours to an interventional centre. On admission ST segments had normalised and she remained pain free. Coronary angiography (Figure 23) revealed smooth coronary arteries. The right coronary had a high bifurcation, and a thrombus was seen in the mid PDA which was treated with POBA only. Presumably the thrombus embolised from proximal RCA into the PDA post thrombolysis. This is the first recorded case of thrombolysis for STEMI facilitated by idarucizumab. Although anticoagulation is a relative contraindication for lysis, rapid reversal of anticoagulation was thought to be safer than failing to reperfuse a STEMI on this elderly patient at a remote location. The patient remains well without re-admission or morbidity 2 months into follow-up.
http://dx.doi.org/10.1016/j.hlc.2017.06.440
S234
http://dx.doi.org/10.1016/j.hlc.2017.06.438 438 Successful Percutaneous Closure of Large Patent Ductus Arteriosus with Ventricular Septal Defect Device D. Blusztein, S. Peters ∗ , W. Wilson Royal Melbourne Hospital, Melbourne, Australia Introduction: Large patent ductus arteriosus (PDA) is usually closed via surgical approach. This case demonstrates a successful device closure of a very large PDA using a bileaflet closure device. Methods and Results: A 28-year-old female nurse developed heart failure during her first pregnancy in her native East Timor. Examination revealed a continuous thrill and normal oxygen saturations (hands and feet). Transthoracic echocardiogram demonstrated a large PDA with continuous flow into the PA, associated with marked LV dilatation and mild LV dysfunction. A CT scan confirmed a large window-like PDA (type B), measuring 14-15 mm. Cardiac catheterisation demonstrated severe pulmonary hypertension (PA pressure 65/35 (mean 48) mmHg) with a large left-to-right shunt (Qp:Qs 5.3:1 via oximetry). Pulmonary vascular resistance was normal and, in the absence of Eisenmenger physiology, closure was felt to be safe and beneficial. Intraprocedural sizing of the defect was very difficult with aortography owing to high volume flow across the PDA, thus balloon sizing was performed using a 24 mm Amplatzer sizing balloon (measured ∼14 mm). Given the window-like morphology and the presence of severe pulmonary hypertension, a bileaflet device was selected; successful PDA closure was achieved using an 18 mm Amplatzer muscular VSD device, delivered through a 9Fr venous sheath. The device was well-seated with a small residual shunt on echocardiography post procedure. The patient was discharged day 1 post procedure. Minor haemolysis resolved after 4 weeks. Conclusion: Bileaflet devices such as the Amplatzer muscular VSD device can close very large PDAs that may otherwise require surgical repair. http://dx.doi.org/10.1016/j.hlc.2017.06.439
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439 Successful STEMI Thrombolysis Post Reversal of Dabigatran (Pradaxa® ) C. Mengel 1,2 , S. Tatavarty 1,2,∗ , R. Gluer 1,2,3 , N. Aroney 1,2 , D. Murdoch 1,2 , B. Bell 1 , N. Gaikwad 1,2 , D. Walters 1,2 1 The Prince Charles Hospital, Brisbane, Australia 2 University of Queensland, Brisbane, Australia 3 Toowoomba Base Hospital, Toowoomba, Australia
A 75-year-old female presented to a peripheral centre with two hours of typical ischaemic chest pain. ECG showed inferior ST elevation in leads II, III and aVF with reciprocal depression in lead I, aVL and anterior precordial leads (Figure 1). She had been prescribed dabigatran 110 mg BD for non-valvular atrial fibrillation, with CHADS2 -VASC score 3. Her last dose was 11 hours prior to presentation. She weighed 60 kg. In consultation with our centre, she had reversal of dabigatran with idarucizumab (Praxbind® ) 5 g over 10 minutes followed by half dose thrombolysis (0.5 mg/kg tenecteplase) and subcutaneous enoxaparin. ST segment elevation reduced by 50% at 60 minutes, with improvement of chest pain. She was transferred within 12 hours to an interventional centre. On admission ST segments had normalised and she remained pain free. Coronary angiography (Figure 23) revealed smooth coronary arteries. The right coronary had a high bifurcation, and a thrombus was seen in the mid PDA which was treated with POBA only. Presumably the thrombus embolised from proximal RCA into the PDA post thrombolysis. This is the first recorded case of thrombolysis for STEMI facilitated by idarucizumab. Although anticoagulation is a relative contraindication for lysis, rapid reversal of anticoagulation was thought to be safer than failing to reperfuse a STEMI on this elderly patient at a remote location. The patient remains well without re-admission or morbidity 2 months into follow-up.
http://dx.doi.org/10.1016/j.hlc.2017.06.440