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Heart, Lung and Circulation S192009;18S:S1–S286 Abstracts

37ASSESSMENT OF VENTRICULAR ASSIST DEVICE(VAD) FUNCTION AND DETECTION OF COMPLI-CATIONS USING TRANSOESOPHAGEAL ECHOCAR-DIOGRAPHY (TOE)

D. Platts, C. Hamilton Craig, B. Bell, T. Boga, J. Bancroft,D. Burstow

The Prince of Charles Hospital, Rode Rd, Brisbane, Queensland,Australia

Background: Ventricular assist devices are utilised inselected cases to treat severe heart failure. However, theiruse can be limited by complications such as thrombosis,infection and device failure. Cardiac and VAD structure,function and resultant haemodynamics can be difficult toassess in these patients, particularly using transthoracicechocardiography (TTE). TOE is uniquely positioned toassess these parameters and detect such complications.

Method: We retrospectively evaluated all patients at ourinstitution who had a VAD inserted in the last 3 years. TOEindications and significant findings were compiled. Keypoints noted were the detection of complications and howTOE findings influenced diagnosis and management.

Results: 101 TOE and 105 TTE studies were performedin 15 patients (M = 9, F = 6, mean age 45.2 years) who hada VAD inserted between 2006 and 2009 (BiVAD = 10, LVADonly = 5). Thoratec = 9, Abiomed = 4, VentrAssist = 2. Rea-son for VAD insertion: CAD = 5, cardiomyopathy = 4, acutemyocarditis = 4, other = 2. Indications for TOE includehaemodynamic instability (40), wind-down protocol (10),cannula flow/position issues (10), possible infection(9), embolic phenomena (5). Number of TOE showingVAD cannula/cardiac thrombosis = 8, VAD infection = 4,VAD cannula obstruction or malposition = 17, pericar-dial haematoma = 15, detection of intra-cardiac shunt = 3,guide to VAD insertion = 14, guide during VAD wind-down = 10, used to optimise VAD settings/flows = 2.

Conclusion: TTE can be of limited use in VAD assess-ment due to reduced acoustic windows in these patientsand lower spatial resolution. TOE is uniquely placed todetect complications which arise and provide data on car-diac and VAD structure, function and haemodynamics,which is of importance in management of these complexpatients.

doi:10.1016/j.hlc.2009.05.039

38ASSESSMENT OF PARAVALVULAR PROSTHETICMITRAL REGURGITATION WITH MULTI-MODALITYIMAGING: PROCEDURAL AND FOLLOW-UPRESULTS

Akshay Mishra, Richard Slaughter, Christian Hamilton-Craig, Tau Boga, Greg Scalia, Darryl Burstow, DarrenWalters

The Prince Charles Hospital, Queensland, Australia

Background: Paravalvular mitral regurgitation is acomplication of mitral valve replacement surgery withincreased morbidity and mortality. Treatment of theseis usually with a repeat surgical procedure however inpatients with a high surgical risk or those with a personalpreference for percutaneous intervention, device closuremay be offered.

Methods: We retrospectively reviewed our institutionaldata on percutaneous mitral paravalvular leak closuresover the last 2 years. Procedural, in hospital and follow-upresults were analysed.

Results: A total of six percutaneous paravalvular leakclosures were performed over 2 years.

Percutaneous intervention was the chosen modality inpreference to surgery due to high surgical risk in threepatients, complications during previous surgery in twoand patient preference in one.

The patients were evaluated with TTE and transesophageal echocardiography (TEE) in all cases. Livethree-dimensional TEE was an additional modality usedin five cases. Patients had preprocedure cardiac magneticresonance imaging (CMRI) in four cases. There were nodeaths or MACE during the procedure. Implantation ofthe device was technically successful in four out of sixpatients. All patients remained well without MACE at amean follow-up of 7 months, range 1–16 months.

Conclusions: Transcatheter percutaneous paravalvularleak closure is a technically demanding but feasible proce-dure. Cardiac imaging using TEE, 3DTEE and CMRI allowfor accurate evaluation of paravalvular geometry, and aidintra-procedural guidance to achieve the best possibleresults.

doi:10.1016/j.hlc.2009.05.040

39ASSESSMENT OF THE VARIABILITY OF THE CORO-NARY SINUS BY CARDIAC COMPUTED TOMOGRA-PHY

R. Poulter, M. Dooris, J.F. Younger

Royal Brisbane & Women’s Hospital, Brisbane, Australia

Introduction: Reconstruction of computed tomography(CT) images in the manner for optimal coronary arteryimaging may not be ideal for venous imaging due tochanges in venous luminal diameter during the cardiaccycle. The nature and magnitude of these changes and thefactors influencing them have not been established.