1
|
Szeliga J, Moszura T, Góreczny S. Percutaneous pulmonary valve implantation in a patient with a single pulmonary artery and distal narrowing. Cardiol Young 2024; 34:687-689. [PMID: 38185980 DOI: 10.1017/s104795112300416x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Percutaneous pulmonary valve implantation is established as a safe and effective method of treating patients with disfunction of right ventricular outflow tract. Modifications of this method allow for an increasingly wider use of this less invasive treatment. We present a staged percutaneous pulmonary valve implantation into a single-branch pulmonary artery in a paediatric patient with tetralogy of Fallot after patch repair.
Collapse
Affiliation(s)
- Judyta Szeliga
- Department of Paediatric Cardiology, University Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Moszura
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland
| | - Sebastian Góreczny
- Department of Paediatric Cardiology, University Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland
| |
Collapse
|
2
|
Jin Q, Long Y, Zhang G, Pan X, Chen M, Feng Y, Liu J, Yu S, Pan W, Zhou D, Ge J. Five-year follow-up after percutaneous pulmonary valve implantation using the Venus P-valve system for patients with pulmonary regurgitation and an enlarged native right ventricular outflow tract. Catheter Cardiovasc Interv 2024; 103:359-366. [PMID: 38054354 DOI: 10.1002/ccd.30916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Percutaneous pulmonary valve implantation (PPVI) with the self-expandable Venus P-valve system is a promising treatment for patients with pulmonary regurgitation (PR) and a native right ventricular outflow tract (RVOT). However, limited data is available regarding its midterm outcomes. This study assessed the midterm clinical and echocardiographic outcomes following Venus P-valve implantation. METHODS From 2013 to 2018, 55 patients with moderate or severe PR after surgical RVOT repair with a transannular or RVOT patch were consecutively enrolled from six hospitals in China. Five-year clinical and echocardiographic outcomes were collected and evaluated. The primary endpoint was a freedom from all-cause mortality and reintervention. RESULTS At 5 years, the primary endpoint was met for 96% of patients, corresponding to a freedom from all-cause mortality of 96% (95% confidence interval [CI]: 86%-99%) and freedom from reintervention of 98% (95% CI: 87%-100%). Endocarditis was reported in five patients (four patients within 1 year and one patient at 5 years) following PPVI. Transpulmonary gradient and stent orifice diameter remained stable compared to at discharge (p>0.05). No paravalvular leak was reported while only 1 patient gradually increased to moderate PR during follow-up. Significant improvement of RV diameter and LVEF (p<0.001) sustained over the 5-year follow-up, in consistent with remarked improved New York Heart Association(NYHA) functional class (p<0.001). CONCLUSION The 5-year results of the China VenusP Study demonstrated the midterm benefits of Venus P-valve implantation in the management of patients with severe PR with an enlarged native RVOT by providing sustained symptomatic and hemodynamic improvement.
Collapse
Affiliation(s)
- Qinchun Jin
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Yuliang Long
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Gejun Zhang
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xin Pan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mao Chen
- Department of Cardiology, West China Hospital of Sichuan University, Sichuan, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital of Sichuan University, Sichuan, China
| | - Jinfen Liu
- Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shiqiang Yu
- Department of Cardiology, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Wenzhi Pan
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| |
Collapse
|
3
|
Gröning M, Smerup MH, Munk K, Andersen H, Nielsen DG, Nissen H, Mortensen UM, Jensen AS, Bække PS, Bjerre J, Engholm M, Vejlstrup N, Juul K, Søndergaard EV, Thyregod HGH, Andersen HØ, Helvind M, De Backer O, Jøns C, Schmidt MR, Jørgensen TH, Sondergaard L. Pulmonary Valve Replacement in Tetralogy of Fallot: Procedural Volume and Durability of Bioprosthetic Pulmonary Valves. JACC Cardiovasc Interv 2024; 17:217-227. [PMID: 38127022 DOI: 10.1016/j.jcin.2023.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Robust data on changes in pulmonary valve replacement (PVR) procedural volume and predictors of bioprosthetic pulmonary valve (BPV) durability in patients with tetralogy of Fallot (TOF) are scarce. OBJECTIVES This study sought to assess temporal trends in PVR procedural volume and BPV durability in a nationwide, retrospective TOF cohort. METHODS Data were obtained from patient records. Robust linear regression was used to assess temporal trends in PVR procedural volume. Piecewise exponential additive mixed models were used to estimate BPV durability, defined as the time from implantation to redo PVR with death as a competing risk, and to assess risk factors for reduced durability. RESULTS In total, 546 PVR were performed in 384 patients from 1976 to 2021. The annual number of PVR increased from 0.4 to 6.0 per million population (P < 0.001). In the last decade, the transcatheter PVR volume increased by 20% annually (P < 0.001), whereas the surgical PVR volume did not change significantly. The median BPV durability was 17 years (Q1: 10-Q3: 10 years-not applicable). There was no significant difference in the durability of different BPV after adjustment for confounders. Age at PVR (HR: 0.78 per 10 years from <1 year; 95% CI: 0.63-0.96; P = 0.02) and true inner valve diameter (9-17 mm vs 18-22 mm HR: 0.40; 95% CI: 0.22-0.73; P = 0.003 and 18-22 mm vs 23-30 mm HR: 0.59; 95% CI: 0.25-1.39; P = 0.23) were associated with reduced BPV durability in multivariate models. CONCLUSIONS The PVR procedural volume has increased over time, with a greater increment in transcatheter than surgical PVR during the last decade. Younger patient age at PVR and a smaller true inner valve diameter predicted reduced BPV durability.
Collapse
Affiliation(s)
- Mathis Gröning
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
| | - Morten Holdgaard Smerup
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Munk
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Helle Andersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Pernille Steen Bække
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Bjerre
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Engholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Juul
- Department of Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Henrik Ørbæk Andersen
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Helvind
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Rahbek Schmidt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
4
|
Houeijeh A, Sudre A, Juthier F, Godart F. Pulmonary valve replacement in a large and tortuous right ventricle outflow tract with a 32 mm Myval valve under local anaesthesia: challenges and technical considerations: a case report. Eur Heart J Case Rep 2023; 7:ytad322. [PMID: 37547365 PMCID: PMC10404027 DOI: 10.1093/ehjcr/ytad322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/01/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
Background Pulmonary valve replacement in patients with congenital heart diseases and heart failure is challenging. Case summary Here, we describe a case of a patient who had surgical fallot repair with chronic heart failure. Investigations found severe biventricular dysfunction and enlargement due to chronic pulmonary regurgitation. The right ventricle outflow tract was tortuous and large with a diameter of 35 mm. Percutaneous pulmonary valve implantation (PPVI) was done after a challenging pre-stenting. A 32 mm Myval valve over-sized to 35 mm was used for PPVI, which yielded a good result. Discussion A 32 mm Myval valve is effective at extending the possibilities of PPVI in a large and tortuous right ventricle outflow tract not accessible for the other valves.
Collapse
Affiliation(s)
| | - Arnaud Sudre
- Cardiac Functional Explorations and Catheterization Unit, ICP, Lille University Hospital, rue Pr. Leclerc, Lille University, UFR3S, 59000 Lille, France
| | - Francis Juthier
- Cardiac Surgery Unit, Lille University Hospital, ICP, rue de Pr.Leclerc Lille University, UFR3S, 59000 Lille, France
| | | |
Collapse
|
5
|
Constantine A, Dimopoulos K, Heng EL, Kempny A. Transcatheter pulmonary valve implantation: An option for the few becoming an option for the many. Int J Cardiol 2023; 373:44-46. [PMID: 36529307 DOI: 10.1016/j.ijcard.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Andrew Constantine
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, United Kingdom.
| | - Ee Ling Heng
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Aleksander Kempny
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, United Kingdom
| |
Collapse
|
6
|
Shao Z, Song S, Han Y, Liang W, Fan T. First hybrid implantations of novel Salus-Valves in patients with severe pulmonary regurgitation: A case series. Front Cardiovasc Med 2022; 9:1059664. [PMID: 36505356 PMCID: PMC9729770 DOI: 10.3389/fcvm.2022.1059664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
With the increasing age of patients after right ventricular outflow tract (RVOT) reconstruction, progressive pulmonary valve (PV) dysfunction can result in different degrees of right heart insufficiency, and PV replacement is frequently needed during follow-up. The traditional redo thoracotomy is difficult and associated with higher risks when compared to transcatheter implantations. Herein, we report the advantages and describe the outcomes of the first hybrid implantations of the novel Salus-Valves (Balance Medical, Beijing, China) from the sub-xiphoid approach in five patients (mean age of 22.6 years) with severe pulmonary regurgitation (PR) after RVOT reconstruction.
Collapse
Affiliation(s)
- Zehua Shao
- Children’s Heart Center, Zhengzhou University People’s Hospital, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Shubo Song
- Children’s Heart Center, Zhengzhou University People’s Hospital, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Yu Han
- Department of Structural Cardiology, Zhengzhou University People’s Hospital, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital, Zhengzhou, China,*Correspondence: Yu Han,
| | - Weijie Liang
- Children’s Heart Center, Zhengzhou University People’s Hospital, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Taibing Fan
- Children’s Heart Center, Zhengzhou University People’s Hospital, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital, Zhengzhou, China,Taibing Fan,
| |
Collapse
|
7
|
Sheth K, Azad S, Dalvi B, Parekh M, Sagar P, Anantharaman R, Radhakrishnan S, Sivakumar K. Early multicenter experience of Melody valve implantation in India. Ann Pediatr Cardiol 2021; 14:302-309. [PMID: 34667400 PMCID: PMC8457271 DOI: 10.4103/apc.apc_73_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/04/2022] Open
Abstract
Background Transcatheter valves provide a safe and effective alternative to surgery for treating dysfunctional right ventricular outflow tracts (RVOTs). We present our early multicenter experience of percutaneous pulmonary valve implantation (PPVI) using Melody valve (Medtronic Inc., Minneapolis, MN). Methods Patients with stenosed conduits or degenerated bioprosthetic valves in RVOT with combined stenosis and regurgitation were evaluated for suitability of Melody valve implantation. After undergoing an initial structured training, PPVI using Melody transcatheter pulmonary valve (TPV) was guided by an approved proctor. Conduits were serially dilated and prestented with careful coronary interrogation, and bioprosthetic valves were dilated with high-pressure balloons. Clinical and echocardiographic follow-up was performed at 6 monthly intervals. Results Fifteen patients (three females) aged 23.1 ± 9.5 years in NYHA Class II-III underwent Melody TPV implantation in four Indian centers. The underlying anatomy comprised surgically implanted bioprosthetic valves for pulmonary regurgitation (n= 5), conduit repair for pulmonary atresia (n = 4), Rastelli repair (n = 3), truncus (n = 1), and Ross procedure (n = 2). Twelve patients had more than one previous surgery. Doppler gradient decreased from 74.2 ± 21.5 mmHg to 10.2 ± 4.5 mmHg after the PPVI. At a median follow-up of 14 months (1-39 months), all the patients were in NYHA Class I with echocardiographic gradients of 8 ± 5.7 mmHg with no evidence of pulmonary regurgitation. There were no major procedural adverse events or deaths. Conclusions Our early experience shows encouraging results of the PPVI program in India with proctored case selection and meticulous planning. It also confirms the safety and efficacy of Melody TPV for treating dysfunctional RVOT in postoperative patients.
Collapse
Affiliation(s)
- Kshitij Sheth
- Department of Pediatric Cardiology, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Sushil Azad
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Bharat Dalvi
- Department of Pediatric Cardiology, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Maulik Parekh
- Department of Pediatric Cardiology, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Pramod Sagar
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Rajaram Anantharaman
- Department of Pediatric Cardiology, Frontier Lifeline Hospital, Chennai, Tamil Nadu, India
| | | | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| |
Collapse
|
8
|
Sivakumar K, Sagar P, Qureshi S, Promphan W, Sasidharan B, Awasthy N, Kappanayil M, Suresh PV, Koneti NR. Outcomes of Venus P-valve for dysfunctional right ventricular outflow tracts from Indian Venus P-valve database. Ann Pediatr Cardiol 2021; 14:281-292. [PMID: 34667398 PMCID: PMC8457277 DOI: 10.4103/apc.apc_175_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 12/05/2022] Open
Abstract
Background : Balloon-expandable pulmonary valves are usually not suitable for dilated native outflow tracts. Methods : Indian Venus P-valve registry was retrospectively analyzed for efficacy, complications, and midterm outcomes. Straight valve was used in prestented conduits in patients with right ventricular pressure above two-thirds systemic pressure and/or right ventricular dysfunction. Flared valve 1–4 mm larger than balloon waist was used in native outflow in symptomatic patients, large ventricular volumes, and ventricular dysfunction. Objectives : A self-expanding porcine pericardial Venus P-valve is available in straight and flared designs.. Results : Twenty-nine patients were included. Straight valve was successful in all seven conduits, reducing gradients significantly, including one patient with left pulmonary artery (LPA) stent. Flared valve was successfully implanted in 20 out of 22 native outflow tracts. Sharp edges of the older design contributed to two failures. Complications included two migrations with one needing surgery, endocarditis in one, insignificant wire-frame fractures in three, and groin vascular complication in one patient. There were no deaths or valve-related reinterventions at a mean follow-up of 47.8 ± 24.5 months (1–85 months). Modifications of technique succeeded in three patients with narrow LPA. There was significant improvement in symptoms, right ventricular volume, and pulmonary regurgitant fraction. Conclusion : Straight and flared Venus P-valves are safe and effective in appropriate outflow tracts. Straight valve is an alternative to balloon-expandable valves in stenosed conduits. Flared valve is suitable for large outflows up to 34 mm, including patients with LPA stenosis. Recent design modifications may correct previous technical failures. Studies should focus on durability and late complications.
Collapse
Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Shakeel Qureshi
- Department of Pediatric Cardiology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS, London, UK
| | - Worakan Promphan
- Department of Pediatric Cardiology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Bijulal Sasidharan
- Department of Pediatric Cardiology, Sree Chitra Tirunal Institute, Thiruvananthapuram, Kerala, India
| | - Neeraj Awasthy
- Department of Pediatric Cardiology, Max Super Specialty Hospital, Delhi, India
| | - Mahesh Kappanayil
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | | | | |
Collapse
|
9
|
Sivaprakasam MC, Reddy JRV, Gunasekaran S, Sivakumar K, Pavithran S, Rohitraj GR, Jayranganath M, Francis E. Early multicenter experience of a new balloon expandable MyVal transcatheter heart valve in dysfunctional stenosed right ventricular outflow tract conduits. Ann Pediatr Cardiol 2021; 14:293-301. [PMID: 34667399 PMCID: PMC8457297 DOI: 10.4103/apc.apc_242_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background : Transcatheter pulmonary valve implantation (TPVI) is a surgical alternative for correcting dysfunctional right ventricular outflow tract conduits in previously operated patients. MyVal transcatheter heart valve (THV) (Meril Life Sciences, India), a new transcatheter valve designed for aortic position has not been used for TPVI. Methods : Patients with stenosed dysfunctional conduits from the right ventricle to pulmonary artery (RV-PA) were prestented after initial computed tomography and balloon interrogation before the implantation of MyVal. Size of MyVal was chosen based on the final diameter of the prestent. Procedural details and post-TPVI follow-up were analyzed. Results : Seven patients aged 17–60 years (median 26 years) had stenosed RV-PA conduits implanted 5–17 years (median 9 years) ago for tetralogy of Fallot in three, following Ross procedure in two, repair of pulmonary stenosis, and following PA debanding in one patient each. Prestenting improved the conduit diameter from 9.3 ± 2.8 mm to 20.8 ± 1.1 mm and relieved the gradient from 87.3 ± 31.7 mmHg (50–137 mmHg) to 12.7 ± 6.4 mmHg (5–20 mmHg). A 23 mm MyVal was implanted in all the seven patients successfully; one patient needed an additional 24.5 mm MyVal valve in valve implantation for residual regurgitation. The mean fluoroscopic time and dose area product were 38.7 ± 25.3 min and 66.917 ± 39.211Gray. cm2, respectively. At a median follow-up duration of 16 months (10–22 months), all patients were asymptomatic receiving dual antiplatelet therapy with no PR and the gradient was 12.5 ± 5.8 mmHg on echocardiography. Although one patient needed an additional valve-in-valve implantation, there were no valve-related adverse events. Conclusions : Early experience of TPVI with MyVal THV in prestented conduits is encouraging with procedural success in all patients and acceptable mid-term outcomes.
Collapse
Affiliation(s)
| | - J Raja Vijendra Reddy
- Department of Pediatric Cardiology, Apollo Children's Hospital, Chennai, Tamil Nadu, India
| | | | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Sreeja Pavithran
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | | | - M Jayranganath
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research Institute, Bengaluru, Karnataka, India
| | - Edwin Francis
- Department of Pediatric Cardiology, Lisie Hospital, Kochi, Kerala, India
| |
Collapse
|