- Email: [email protected]
Transcatheter closure of patent ductus arteriosus: single center experience with radiation doses
6
Archives of Cardiovascular Diseases Supplements (2016) 8, 4-7
PCJ6 – Table I: Dose area product in mGy.cm2 Our results
Ghelani et al.
Age in years
Number of patients
Mean
Median
Minimum
Maximum
Median
75e percentile
95e percentile
<1
12
3.509
3.768
1.249
6.350
5.000
8.000
22.000
1à4
41
3.749
3.180
1.005
10.190
7.000
12.000
49.000
5à9
14
8.461
6.950
1.252
24.655
13.000
22.000
48.000
10 à 15
5
10.325
10.325
10.000
10.650
33.000
85.000
207.000
>15
4
25.671
28.047
2.868
43.725
96.000
151.000
253.000
All procedures but 3 were done under general anesthesia guided by TTE in 25 patients and TEE in the others. Balloon stretched diameter was assessed in 37 patients and it was 4mm larger than the echocardiographic one (18.25 versus 14.5mm). Deficient rims besides the anterior one were described in 33% of cases. Device implantation succeeded in 38 patients. Two patients required a device larger than the one initially implanted. Mean fluoroscopic and procedures time was 7.93 and 57.2 minutes respectively. Complications occurred in 4 cases (transient grade 2 atrioventricular block (AVB) in 2 patients, complete AVB in one patient resolved after the surgical extraction of the device, thrombosis in the inferior vena cava in one patient). During follow-up, two patients had trivial residual shunt, no case of erosion or embolization was described, and pulmonary hypertension disappeared in all patients. The patient with failed procedure died later of respiratory failure and pulmonary hypertension. Conclusion Percutaneous closure of large ASD in symptomatic small children with device/weight ratio ≥1.5 is safe and effective. It allows clinical improvement with low rate of complications. Disclosure of interest The authors have no competing of interest to disclose.
PCJ6 Transcatheter closure of patent ductus arteriosus: single center experience with radiation doses
artery transient thrombosis. Two patients presented with headache a while after the procedure. Conclusion Transcatheter PDA closure in our center gives good results with a low rate of complication and levels of radiation less than or equal to literature data. Disclosure of interest The authors have no competing of interest to disclose. References [1] SJ Ghelani, AC Glatz, S David, R Leahy, R Hirsch, LB Armsby, et al. Radiation dose benchmarks during cardiac catheterization for congenital heart disease in the United States. JACC Cardiovasc Interv. 2014;7(9):1060-9.
PCJ7 Pediatric Ventricular Assistance Device (VAD): 11 years of Berlin Heart Excor experience. Angèle Boet*, Emir Mokhfi, Michel Hamann, Mohamedou Ly, Régine Roussin, Emmanuel Le Bret, Nabil Jbilou, Serge Demontoux, Lucile Houyel, Jurgen Horer. University Paris-Sud, Hospital Marie Lannelongue, Department of congenital heart disease, 92350, Le Plessis-Robinson. France.
Marion Follenfant1*, Stéphanie Douchin1,2, Hélène Bouvaist2, Damien Bedague3, Gérard Blaysat1 1 CHU Grenoble Alpes-Pédiatrie-38000-Grenoble-France. 2 CHU Grenoble Alpes-Cardiologie-38000-Grenoble-France. 3 CHU Grenoble Alpes-Anesthésie-38000-Grenoble-France.
* Corresponding author: [email protected] (Angèle Boet)
* Corresponding author: [email protected]
Methods All consecutive patients who underwent BH implantation between January 2006 and April 2016 were included into this retrospective study. During this period, 7677 patients were admitted to our institution: 2% needed mechanical circulatory support, 11.7% of them underwent BH implantation. Edmonton anticoagulation protocol was applied
Purpose Evaluate the results of transcatheter closure of patent ductus arteriosus (PDA) and the radiation dose in our center. Method We analyzed retrospectively all procedures of cardiac catheterization realized between January 2005 and February 2016 in our center with the aim of PDA closure. We studied: • procedure’s results: success rate, type of device, residual shunting, adverse effects; • administrated X-ray doses: fluoroscopy time and dose area product (DAP). Results 76 procedures were realized, with a raise by the years. Patient’s mean age was 5.6 years (28 days to 67 years), mean weight was 17.8kg (1.2 to 88kg). Sex ratio was 2.5 female for 1 male. 30% were preterm and 18% had congenital associated malformation. 29% were symptomatic. A device was implanted in 70 cases (92%): 17 coils before 2010 and 53 Amplatzer® devices. The ductus couldn’t be closed in 6 cases: 1 already closed, 1 too wide closed by surgery, 4 too thin couldn’t be crossed by the catheter. After a device was installed, complete occlusion was obtained in 81% at day 1, 90% at a month and 97% at 8 months. Mean fluoroscopy time was 12min. The results of DAP are presented in Table I, compared with those published by Ghelani et al. [1]. No death or major adverse effect occurred. Four patients (5%) presented with early complications: 1 hematoma at puncture site, 1 transfusion, 1 junctional bradycardia and 1 with renal failure to contrast product and femoral
© Elsevier Masson SAS. All rights reserved.
Purpose The Berlin Heart (BH) Excor is the only assist device used in adults, children and neonates. We report our 11 years’ experience, focusing on patient characteristics and outcomes.
Results Among the 18 patients who received BH implantation (Table 1), 10 were subsequently transplanted, 1 with acute myocarditis was successfully weaned, 6 died under BH support and 1 is currently waiting for transplantation. Hospital survival rate was 53%. Two patients died after transplantation. Cause of death under support was bleeding, infection and stroke. One patient died 10 months after transplantation from stroke and one patient died suddenly 4 months after weaning. Survival rate to final follow up at 2 to 5 years was 41%. Postoperative characteristics are summarized in Table 1. One patient with a failing Fontan was transplanted successfully following BH support, 4 required dialysis and 3 membran oxygenation. The 2 major complications on BH support were infections (15 patients) and thromboembolic or bleeding events (16 patients). Conclusion The Berlin Heart is efficient as bridge to transplantation, allowing the patient to be in favorable conditions for transplantation. Main complications are infections and thromboembolic or bleeding events. The Edmonton anticoagulation protocol may not be appropriate for all patients. Customized anticoagulation management may be required. Disclosure of interest: The authors have no competing of interest to disclose.
Archives of Cardiovascular Diseases Supplements (2016) 8, 4-7
PCJ6 – Table I: Dose area product in mGy.cm2 Our results
Ghelani et al.
Age in years
Number of patients
Mean
Median
Minimum
Maximum
Median
75e percentile
95e percentile
<1
12
3.509
3.768
1.249
6.350
5.000
8.000
22.000
1à4
41
3.749
3.180
1.005
10.190
7.000
12.000
49.000
5à9
14
8.461
6.950
1.252
24.655
13.000
22.000
48.000
10 à 15
5
10.325
10.325
10.000
10.650
33.000
85.000
207.000
>15
4
25.671
28.047
2.868
43.725
96.000
151.000
253.000
All procedures but 3 were done under general anesthesia guided by TTE in 25 patients and TEE in the others. Balloon stretched diameter was assessed in 37 patients and it was 4mm larger than the echocardiographic one (18.25 versus 14.5mm). Deficient rims besides the anterior one were described in 33% of cases. Device implantation succeeded in 38 patients. Two patients required a device larger than the one initially implanted. Mean fluoroscopic and procedures time was 7.93 and 57.2 minutes respectively. Complications occurred in 4 cases (transient grade 2 atrioventricular block (AVB) in 2 patients, complete AVB in one patient resolved after the surgical extraction of the device, thrombosis in the inferior vena cava in one patient). During follow-up, two patients had trivial residual shunt, no case of erosion or embolization was described, and pulmonary hypertension disappeared in all patients. The patient with failed procedure died later of respiratory failure and pulmonary hypertension. Conclusion Percutaneous closure of large ASD in symptomatic small children with device/weight ratio ≥1.5 is safe and effective. It allows clinical improvement with low rate of complications. Disclosure of interest The authors have no competing of interest to disclose.
PCJ6 Transcatheter closure of patent ductus arteriosus: single center experience with radiation doses
artery transient thrombosis. Two patients presented with headache a while after the procedure. Conclusion Transcatheter PDA closure in our center gives good results with a low rate of complication and levels of radiation less than or equal to literature data. Disclosure of interest The authors have no competing of interest to disclose. References [1] SJ Ghelani, AC Glatz, S David, R Leahy, R Hirsch, LB Armsby, et al. Radiation dose benchmarks during cardiac catheterization for congenital heart disease in the United States. JACC Cardiovasc Interv. 2014;7(9):1060-9.
PCJ7 Pediatric Ventricular Assistance Device (VAD): 11 years of Berlin Heart Excor experience. Angèle Boet*, Emir Mokhfi, Michel Hamann, Mohamedou Ly, Régine Roussin, Emmanuel Le Bret, Nabil Jbilou, Serge Demontoux, Lucile Houyel, Jurgen Horer. University Paris-Sud, Hospital Marie Lannelongue, Department of congenital heart disease, 92350, Le Plessis-Robinson. France.
Marion Follenfant1*, Stéphanie Douchin1,2, Hélène Bouvaist2, Damien Bedague3, Gérard Blaysat1 1 CHU Grenoble Alpes-Pédiatrie-38000-Grenoble-France. 2 CHU Grenoble Alpes-Cardiologie-38000-Grenoble-France. 3 CHU Grenoble Alpes-Anesthésie-38000-Grenoble-France.
* Corresponding author: [email protected] (Angèle Boet)
* Corresponding author: [email protected]
Methods All consecutive patients who underwent BH implantation between January 2006 and April 2016 were included into this retrospective study. During this period, 7677 patients were admitted to our institution: 2% needed mechanical circulatory support, 11.7% of them underwent BH implantation. Edmonton anticoagulation protocol was applied
Purpose Evaluate the results of transcatheter closure of patent ductus arteriosus (PDA) and the radiation dose in our center. Method We analyzed retrospectively all procedures of cardiac catheterization realized between January 2005 and February 2016 in our center with the aim of PDA closure. We studied: • procedure’s results: success rate, type of device, residual shunting, adverse effects; • administrated X-ray doses: fluoroscopy time and dose area product (DAP). Results 76 procedures were realized, with a raise by the years. Patient’s mean age was 5.6 years (28 days to 67 years), mean weight was 17.8kg (1.2 to 88kg). Sex ratio was 2.5 female for 1 male. 30% were preterm and 18% had congenital associated malformation. 29% were symptomatic. A device was implanted in 70 cases (92%): 17 coils before 2010 and 53 Amplatzer® devices. The ductus couldn’t be closed in 6 cases: 1 already closed, 1 too wide closed by surgery, 4 too thin couldn’t be crossed by the catheter. After a device was installed, complete occlusion was obtained in 81% at day 1, 90% at a month and 97% at 8 months. Mean fluoroscopy time was 12min. The results of DAP are presented in Table I, compared with those published by Ghelani et al. [1]. No death or major adverse effect occurred. Four patients (5%) presented with early complications: 1 hematoma at puncture site, 1 transfusion, 1 junctional bradycardia and 1 with renal failure to contrast product and femoral
© Elsevier Masson SAS. All rights reserved.
Purpose The Berlin Heart (BH) Excor is the only assist device used in adults, children and neonates. We report our 11 years’ experience, focusing on patient characteristics and outcomes.
Results Among the 18 patients who received BH implantation (Table 1), 10 were subsequently transplanted, 1 with acute myocarditis was successfully weaned, 6 died under BH support and 1 is currently waiting for transplantation. Hospital survival rate was 53%. Two patients died after transplantation. Cause of death under support was bleeding, infection and stroke. One patient died 10 months after transplantation from stroke and one patient died suddenly 4 months after weaning. Survival rate to final follow up at 2 to 5 years was 41%. Postoperative characteristics are summarized in Table 1. One patient with a failing Fontan was transplanted successfully following BH support, 4 required dialysis and 3 membran oxygenation. The 2 major complications on BH support were infections (15 patients) and thromboembolic or bleeding events (16 patients). Conclusion The Berlin Heart is efficient as bridge to transplantation, allowing the patient to be in favorable conditions for transplantation. Main complications are infections and thromboembolic or bleeding events. The Edmonton anticoagulation protocol may not be appropriate for all patients. Customized anticoagulation management may be required. Disclosure of interest: The authors have no competing of interest to disclose.