EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION LAB Rachel Arnold PA-C Physician Assistant Interventional Cardiology
DEPARTMENT NAME GOALS
Overview of interventional cases performed at Texas Children’s Hospital Exciting cases
DEPARTMENT NAME Cath Lab Case Distribution 2014- Jan 2019
3% 23% Diagnostic 49% Biopsy 25% Interventional Therapeutic
DEPARTMENT NAME CATH LAB INTERVENTIONS • Open things • Close things • Balloon angioplasty and stenting • Device closure of VSD, ASD or of vessels PDA • Valvuloplasty • Coil occlusion of collaterals • Device closure Fontan fenestration
DEPARTMENT NAME Percutaneous Valves
DEPARTMENT NAME Indication for Percutaneous Pulmonary Valve
• Class IIa: It is reasonable to consider percutaneous pulmonary valve replacement in a patient with an RV-PA conduit with associated moderate-severe pulmonary regurgitation or stenosis provided the patient meets the inclusion/exclusion criteria for the available valve
DEPARTMENT NAME CONGENITAL HEART LESIONS REPAIRED WITH RV-PA CONDUITS
• Tetraology of Fallot • Truncus Arterious • Pulmonary Atresia • Others
https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital- heart-defects/tetralogy-of-fallot
DEPARTMENT NAME Truncus with RV-PA conduit
DEPARTMENT NAME Patient case
• 17 year old male with history of TOF with absent pulmonary valve s/p repair with valved 21mm RV-PA conduit • Referred to cath lab with severe RV-PA conduit obstruction with mean gradient of 63mmHg and moderately dilated RV with moderate dysfunction
DEPARTMENT NAME PATIENT CASE
DEPARTMENT NAME MELODY VALVE • Cow jugular vein hand sewn onto platinum stent • Placed with a 22 Fr system to femoral vein • 18mm, 20mm or 22mm valve
http://www.medtronic.com/melody/patient/therapy.html
DEPARTMENT NAME PATIENT CASE
DEPARTMENT NAME Patient case results
• Underwent implantation of 22mm Melody Valve • Post procedure echo: mean gradient of 18mmHg, now with mildly decreased RV function (previously moderate) • Discharged the day after the procedure
DEPARTMENT NAME Percutaneous Pulmonary valve replacement
• Melody Valve and Edwards Valve • Historically placed in RV-PA conduits for patients with conduit stenosis or severe regurgitation with dilated RV • Now have placed several in native RVOT. For example TOF with patch repair instead of a conduit
DEPARTMENT NAME Patient case jm
• 14 year old male with TOF s/p repair with a 16mm RV-PA conduit • He had echo moderate to severe pulmonary regurgitation and moderate stenosis of the RV-PA conduit • Initial cath: “Due to the left anterior descending coronary artery coursing between the native RVOT and the RV to PA conduit, the landing zone for a transcatheter pulmonary valve if placed in the native RVOT is very short. Decision was made that he needs a shorter valve, probably a 23 mm Edwards Sapien valve and that a melody valve would not be appropriate at this time due to its longer length.”
DEPARTMENT NAME Patient Case #2
DEPARTMENT NAME Edwards
http://www.edwards.com/eu/Products/TranscatheterVal ves/Pages/sapien3.aspx?WT.ac=S3campaignprod
DEPARTMENT NAME Patient Case #2
DEPARTMENT NAME Case Results
• Placement of 23mm Edwards Sapien valve • Post procedure echo revealed mild conduit stenosis and trivial regurgitation • Patient did well and went home the day after the procedure
DEPARTMENT NAME Summary
• Many new valves being developed right now. In all different shapes and sizes. • Several are in clinical trials right now.
http://newsroom.medtronic.com/phoenix.zht ml?c=251324&p=irol-newsArticle&ID=2345036
DEPARTMENT NAME • Feltes, F.F., Bacha, E., Beekman, R.H., Cheatham, J.P., Feinstein, J.A., Gomes, A.S., et al. (2011). Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease. Circulation. 123, 2607-2652. doi: 10.1161/CIR.0b013e3821b1f10 • W. L. Gore & Associates; Product Overview. Retrieved from https://www.goremedical.com/products/cardioformeu?locale=mpd_euro • St. Jude Medical; Products Overview. Retrieved from https://health.sjm.com/amplatzer-septal- occluder • St. Jude Medical; Product Catalogy. Retrieved from https://health.sjm.com/amplatzer-septal- occluder • Medtronic; Melody Transcatheter Pulmonary Valve (TPV) Therapy. Retrived from http://www.medtronic.com/melody/patient/therapy.html • Edwards; Products. Retrived from http://www.edwards.com/eu/Products/TranscatheterValves/Pages/sapien3.aspx?WT.ac=S3campaig nprod • Medtronic; News room. Retrived from http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2345036 • American Heart Association; About congenital heart defects. Retrived from https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart- defects/tetralogy-of-fallot
DEPARTMENT NAME COMMENTS/QUESTIONS?
DEPARTMENT NAME