aamisha gupta md, zahid amin md, damien kenny md, massimo caputo … · 2015-10-02 · background...
TRANSCRIPT
![Page 1: Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo … · 2015-10-02 · Background 1.AminZ,BerryJM,Foker JE,1 Rocchini1AP,BassJL.IntraoperativeClosureofMuscularVentricularSeptalDefectinaCanineModeland](https://reader034.vdocuments.net/reader034/viewer/2022042402/5f10de697e708231d44b3490/html5/thumbnails/1.jpg)
Aamisha Gupta MD, Zahid Amin MD, Damien Kenny MD, Massimo Caputo MD
medtronic.com/melody/melody-‐system.html
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Disclosures
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Background
1. Amin Z, Berry JM, Foker JE, Rocchini AP, Bass JL. Intraoperative Closure of Muscular Ventricular Septal Defect in a Canine Model and Application of the Technique in a Baby. J Thorac Cardiovas Surg. 1998;115:1374-‐6
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Why Perventricular Access?
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Objectives
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Methods electively
*
Absent Pulmonary Valve. Note : These two patients had previously stented RVOT * Trans-‐annular Patch
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Methods
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Sub-Costal Incision No Sternotomy
Access Sheath Conclusion
Holoshitz N, Ilbawi M, Amin Z. Perventricular Melody Valve Implantation in a 12 kg Child. Catheterization and Cardiovascular Interventions 2013; 82:824-‐827
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Procedural Steps: Glidewire Placement
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Procedural Steps: Coronary Injection
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Cook Medical Extra Large Check-Flow Introducer
https://www.cookmedical.com/products/ndo_xvcfw_webds/ XVCFW-22.0-35-25
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Cook Medical Extra Large Check-Flow Introducer
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Procedural Steps: Pre Stent of RVOT
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Procedural Steps: Pre Stent of RVOT
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Procedural Steps: Melody Valve Placement
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Procedural Steps: Melody Valve Balloon Dilation
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Procedural Steps: Post Melody Valve Placement
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Procedural Steps: Sheath Removal
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Results
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Complications
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Complications
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Complications
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Conclusions ü Our initial experience demonstrates that perventricular Melody Valve placement is
feasible in small sized patients ü Intraoperative TEE guidance may be utilized to prevent tricuspid valve injury ü RVOT pre-stenting is preferable at the time of valve placement, not preoperatively
Ø Care needs to be utilized while advancing the sheath across the stented RVOT
ü Procedure requires collaborative approach between CT surgery, interventional cardiology, and anesthesia
ü Associated with an ongoing learning curve ü Our preliminary data suggests that this approach is a relatively safe alternative to
alleviate multiple reentry surgical sternotomies
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Thank You