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Van Dijck I, Budts W, Cools B, Eyskens B, Boshoff DE, Heying R, Frerich S, Vanagt WY, Troost E, Gewillig M. Infective endocarditis of a transcatheter pulmonary valve in comparison with surgical implants. Heart 2014; 101:788-93. [PMID: 25539944 DOI: 10.1136/heartjnl-2014-306761] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/04/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Melody valved stents (Medtronic Inc, Minneapolis, Minnesota, USA) have become a very competitive therapeutic option for pulmonary valve replacement in patients with congenital heart disease. After adequate prestenting of the right ventricular outflow tract (RVOT) Melody valved stents have a good medium term functional result but are exposed to infective endocarditis (IE). PATIENTS AND METHODS Retrospective study of tertiary centre Congenital Heart Disease database; to compare incidence of IE in three different types of valved conduits in RVOT: Melody valved stent, cryopreserved homograft (European Homograft Bank) and Contegra graft (Medtronic Inc). RESULTS Between 1989 and 2013, 738 conduits were implanted in 677 patients. 107 Melody valved stents were implanted in 107 patients; IE occurred in 8 (7.5%) patients during a follow-up of 2.0 years (IQR 2.4 years, range 0.3-7.8 years). 577 Homografts were implanted in 517 patients; IE occurred in 14 patients (2.4%) during a median follow-up of 6.5 years (IQR 9.2 years; range 0.1-23.7 years). Finally, 54 Contegra grafts were implanted in 53 patients; 11 patients (20.4%) had IE during a follow-up of 8.8 years (IQR 7.7 years; range 0.2-3.5 years). Survival free of IE by Kaplan-Meier for homografts was 98.7% at 5 years and 97.3% at 10 years; for Contegra 87.8% at 5 years and 77.3% at 10 years and for Melody 84.9% at 5 years (log-rank test; p<0.001). CONCLUSIONS The Contegra conduit and Melody valved stents have a significantly higher incidence of IE than homografts. IE is a significant threat for long-term conduit function.
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Affiliation(s)
- Ine Van Dijck
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Werner Budts
- Department of Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Bjorn Cools
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Benedicte Eyskens
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Derize E Boshoff
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ruth Heying
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Frerich
- Department of Pediatric Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ward Y Vanagt
- Department of Pediatric Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Els Troost
- Department of Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
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Jalal Z, Malekzadeh-Milani S, Hofbeck M, Al Najashi K, Thambo JB, Boudjemline Y. A new percutaneous pulmonary valve implantation technique for complex right ventricular outflow tracts: the "folded melody valve". Catheter Cardiovasc Interv 2014; 85:604-10. [PMID: 25413082 DOI: 10.1002/ccd.25747] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 11/15/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This article sought to describe a new modification of the Melody valve that allows percutaneous pulmonary valve implantation (PPVI) in complex outflow tracts. BACKGROUND PPVI has been validated as a valuable therapeutic option for the management of patients with dysfunctional right ventricular outflow tracts (RVOT). However, complex and unfavourable RVOT anatomy continue to limit the indications for PPVI. METHODS Between April 2012 and November 2013, PPVI was performed in 10 patients (mean age = 16, 3 ± 5 years old) using a new modification of the Melody® valve consisting in a manual shortening of the Melody by folding the two extremities of the stent. We reviewed the results of this technique. RESULTS Indications were short RVOT in three patients, prevention of retrosternal compression in two patients, bioprosthetic valves in four and coronary arteries proximity in one. No complication occurred during procedures. All patients had excellent hemodynamic results [mean post PPVI RV-PA gradient was 14 ± 6 mm Hg, three patients had trivial pulmonary regurgitation (PR) and the remaining had no PR]. After a mean follow-up of 11 months (range 5-21 months), no patient had reintervention. No valve dysfunction or stent fractures were observed. CONCLUSION The "Folded valve technique" is a safe modification of the Melody valve. By shortening the valve, this technique allowed PPVI in short and complex RVOTs with vulnerable neighborhood.
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Affiliation(s)
- Zakaria Jalal
- Department of Congenital and Pediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Pediatric Cardiology, Paris, France; Department of Congenital Adult Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, George Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Unit for Adults with Congenital Heart Defects, Paris, France; Department of Pediatric and Adult Congenital Heart defects, University Hospital of Bordeaux, Pessac, France
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Leventhal A, Shah A, Osten M, Benson L, Horlick E. Transcatheter valve-in-valve therapy: What does the pediatric cardiologist need to know? PROGRESS IN PEDIATRIC CARDIOLOGY 2014. [DOI: 10.1016/j.ppedcard.2014.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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105
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Transcatheter pulmonary valve insertion, expanded use (beyond large conduits from the right ventricle to pulmonary artery), and future directions. Cardiol Young 2014; 24:1095-100. [PMID: 25647384 DOI: 10.1017/s1047951114002005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transcatheter pulmonary valve insertion is the most important advance in congenital interventional cardiology since atrial septal defect devices became commonly available 15 years ago. It has changed the way we look at a number of diverse diagnoses and changes how we plan, diagnose, operate, and follow-up patients. It has changed how we counsel families expecting a child that may benefit from it. Expanded use of the Melody® valve, outside its United States Food and Drug Administration approved indications, has helped numerous additional patients. The use of transcatheter pulmonary valve insertion in selected patients following surgical Gore-tex® bileaflet in valve right ventricular outflow tract reconstruction and those with a history of prior small homograft conduits will be discussed.
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106
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Percutaneous pulmonary valve endocarditis: Incidence, prevention and management. Arch Cardiovasc Dis 2014; 107:615-24. [DOI: 10.1016/j.acvd.2014.07.052] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/15/2014] [Accepted: 07/23/2014] [Indexed: 02/07/2023]
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107
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Incidence and outcomes of right-sided endocarditis in patients with congenital heart disease after surgical or transcatheter pulmonary valve implantation. J Thorac Cardiovasc Surg 2014; 148:2253-9. [DOI: 10.1016/j.jtcvs.2014.07.097] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 12/11/2022]
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108
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Affiliation(s)
- Catherine R. Weinberg
- From the Departments of Medicine (C.R.W., D.B.M.), Pediatrics (D.B.M.), and Cardiothoracic Surgery (D.B.M.), New York University Langone Medical Center, New York
| | - Doff B. McElhinney
- From the Departments of Medicine (C.R.W., D.B.M.), Pediatrics (D.B.M.), and Cardiothoracic Surgery (D.B.M.), New York University Langone Medical Center, New York
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Abstract
PURPOSE OF REVIEW Catheter-based valve technologies have evolved rapidly over the last decade. Transcatheter aortic valve replacement (TAVR) has become a routine procedure in high-risk adult patients with calcific aortic stenosis. In patients with congenital heart disease (CHD), transcatheter pulmonary valve replacement represents a transformative technology for right ventricular outflow tract dysfunction with the potential to expand to other indications. This review aims to summarize the current state-of-the-art for transcatheter valve replacement (TVR) in CHD; the expanding indications for TVR; and the technological obstacles to optimizing TVR. RECENT FINDINGS Multiple case series have demonstrated that TVR with the Melody transcatheter pulmonary valve in properly selected patients is safe, effective, and durable in short-term follow-up. The Sapien transcatheter heart valve represents an alternative device with similar safety and efficacy in limited studies. Innovative use of current valves has demonstrated the flexibility of TVR, while highlighting the need for devices to address the broad range of postoperative anatomies either with a single device or with strategies to prepare the outflow tract for subsequent device deployment. SUMMARY The potential of TVR has not been fully realized, but holds promise in treatment of CHD.
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Meadows JJ, Moore PM, Berman DP, Cheatham JP, Cheatham SL, Porras D, Gillespie MJ, Rome JJ, Zahn EM, McElhinney DB. Use and Performance of the Melody Transcatheter Pulmonary Valve in Native and Postsurgical, Nonconduit Right Ventricular Outflow Tracts. Circ Cardiovasc Interv 2014; 7:374-80. [DOI: 10.1161/circinterventions.114.001225] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Jeffery J. Meadows
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Phillip M. Moore
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Darren P. Berman
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - John P. Cheatham
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Sharon L. Cheatham
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Diego Porras
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Matthew J. Gillespie
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Jonathan J. Rome
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Evan M. Zahn
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Doff B. McElhinney
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
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Travelli FC, Herrington CS, Ing FF. A novel hybrid technique for transcatheter pulmonary valve implantation within a dilated native right ventricular outflow tract. J Thorac Cardiovasc Surg 2014; 148:e145-6. [PMID: 24929802 DOI: 10.1016/j.jtcvs.2014.04.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/17/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Frances C Travelli
- Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif
| | - Cynthia S Herrington
- Division of Cardiology, Department of Cardiothoracic Surgery, Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif
| | - Frank F Ing
- Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif.
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112
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Hasan BS, Lunze FI, Chen MH, Brown DW, Boudreau MJ, Rhodes J, McElhinney DB. Effects of Transcatheter Pulmonary Valve Replacement on the Hemodynamic and Ventricular Response to Exercise in Patients With Obstructed Right Ventricle-to-Pulmonary Artery Conduits. JACC Cardiovasc Interv 2014; 7:530-42. [DOI: 10.1016/j.jcin.2014.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/20/2014] [Accepted: 02/13/2014] [Indexed: 01/28/2023]
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113
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Abstract
In 1967, Donald Ross transferred the patient's own pulmonary valve into the aortic root. Although results of this technique were encouraging, the Ross procedure did not gain widespread popularity until the late 1980s when surgeons started to implant the pulmonary autograft as a freestanding full root replacement with reimplantation of the coronary arteries. However, frequent dilatation of the pulmonary autograft was observed using the freestanding full root replacement technique. In contrast, the original subcoronary implantation technique and aortic root inclusion technique prevented dilatation in the long-term. Through advancing know-how in aortic root surgery and confidence, the Ross procedure has also been used in combined procedures and complex clinical presentations with good long-term results, which encourage continual use. However, the Ross procedure is a complex operation; careful patient selection and experience of the surgeon are mandatory requirements to achieve satisfactory results.
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Affiliation(s)
- Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, INF 110, 69120 Heidelberg, Germany
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114
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Kim GB, Lim HG, Kim YJ, Choi EY, Kwon BS, Jeong S. Novel self-expandable, stent-based transcatheter pulmonic valve: A preclinical animal study. Int J Cardiol 2014; 173:74-9. [DOI: 10.1016/j.ijcard.2014.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 01/04/2014] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
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115
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Abstract
Adolescents with congenital heart disease (CHD) are a rapidly growing population with complex medical needs and psychosocial challenges. Identity formation is an important developmental task accomplished during the teenage years. This article reviews different aspects of ongoing care that pertain to teenagers with CHD, with a particular focus on primary care issues and a summary of recommendations from various scientific societies. A successful smooth transition to the adult health care setting should achieve 2 important goals: to prevent loss of follow-up and to foster and encourage self-care behaviors.
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Affiliation(s)
- Pooja Gupta
- Division of Cardiology, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI 48201-2119, USA.
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Villafañe J, Baker GH, Austin EH, Miller S, Peng L, Beekman R. Melody®pulmonary valve bacterial endocarditis: Experience in four pediatric patients and a review of the literature. Catheter Cardiovasc Interv 2014; 84:212-8. [DOI: 10.1002/ccd.25375] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/10/2013] [Accepted: 12/21/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Juan Villafañe
- Department of Pediatrics (Cardiology); University of Kentucky; Lexington Kentucky
| | - George Hamilton Baker
- Department of Pediatrics; Medical University of South Carolina Children's Hospital; Charleston South Carolina
| | - Erle H. Austin
- Department of Surgery; University of Louisville; Louisville Kentucky
| | - Stephen Miller
- Department of Pediatrics (Cardiology); Duke University; Durham North Carolina
| | - Lynn Peng
- Department of Pediatrics (Cardiology); Stanford University Medical Center; Palo Alto California
| | - Robert Beekman
- Department of Pediatrics; University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
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117
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Abstract
Transcatheter pulmonary valve replacement with the Melody® valve is an accepted alternative to surgical replacement of the pulmonary valve for some patients and therefore a complementary strategy in the long-term management of several groups of patients with congenital heart disease. It allows at least extending the time between sternotomies and possibly improving late outcomes. With a combined surgical and percutaneous approach, late morbidity for some of these patients will likely be diminished. This manuscript will review the current expanded applications for this technology, demonstrate several examples of its use and discuss future directions for this evolving equipment.
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118
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Mylotte D, Martucci G, Piazza N, McElhinney D. Percutaneous options for heart failure in adults with congenital heart disease. Heart Fail Clin 2013; 10:179-96. [PMID: 24275303 DOI: 10.1016/j.hfc.2013.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the context of congenital heart disease (CHD), the complex biochemical and physiologic response to the pressure- or volume-loaded ventricle can be induced by stenotic and shunt/regurgitant lesions, respectively. A range of transcatheter therapies have recently emerged to expand the therapeutic potential of the more traditional surgical and medical interventions for heart failure in patients with CHD. Together, these complementary interventions aim to treat the growing patient population with adult CHD (ACHD). In this article, the most commonly used transcatheter interventions for heart failure in patients with ACHD are reviewed.
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Affiliation(s)
- Darren Mylotte
- Department of Interventional Cardiology, McGill University Health Centre, Royal Victoria Hospital, 687, Pine Avenue West, Montréal H3A-1A1, Québec, Canada
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Cheung G, Vejlstrup N, Ihlemann N, Arnous S, Franzen O, Bundgaard H, Søndergaard L. Infective endocarditis following percutaneous pulmonary valve replacement: diagnostic challenges and application of intra-cardiac echocardiography. Int J Cardiol 2013; 169:425-9. [PMID: 24182680 DOI: 10.1016/j.ijcard.2013.10.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/17/2013] [Accepted: 10/05/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult. METHOD AND RESULT This study is a retrospective review of all patients with Melody valve implantation in a tertiary centre. Between November 2006 and November 2012, 43 procedures were performed in 42 patients (mean age 25 years, 6-67 years). At a median follow-up of 27 months (2-66 months), six patients were suspected for IE. However, repeated transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) showed no evidence of IE and the patients were diagnosed as possible cases according to the modified Duke's criteria. Two patients did not respond to antibiotic treatment and underwent intra-cardiac echocardiography (ICE), which clearly demonstrated vegetations. These two cases required surgical explantation, while the other four patients were treated medically without complications. CONCLUSION IE after Melody valve implantation is uncommon, but difficult to verify since TTE and TEE often cannot demonstrate vegetations inside the stent. ICE should be considered in suspected cases of IE following PPVR with negative TTE and TEE examinations in order to early tailor the best treatment for the individual patient suspected for IE.
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Affiliation(s)
- Gary Cheung
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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120
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Holoshitz N, Hijazi ZM. Transcatheter pulmonary valve replacement: valves, techniques of implantation and outcomes. Interv Cardiol 2013. [DOI: 10.2217/ica.13.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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121
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Abstract
Transcatheter valve implantation or repair has been a very promising approach for the treatment of valvular heart diseases since transcatheter aortic valve implantation (TAVI) was successfully performed in 2002. Great achievements have been made in this field (especially TAVI and transcatheter mitral valve repair--MitraClip system) in recent years. Evidence from clinical trials or registry studies has proved that transcatheter valve treatment for valvular heart diseases is safe and effective in surgical high-risk or inoperable patients. As the evidence accumulates, transcatheter valve treatment might be an alterative surgery for younger patients with surgically low or intermediate risk valvular heart diseases in the near future. In this paper, the updates on transcatheter valve treatment are reviewed.
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Affiliation(s)
- Xian-bao Liu
- Cardiovascular Key Lab of Zhejiang Province, Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
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122
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McElhinney DB, Hennesen JT. The Melody® valve and Ensemble® delivery system for transcatheter pulmonary valve replacement. Ann N Y Acad Sci 2013; 1291:77-85. [PMID: 23834411 PMCID: PMC3910161 DOI: 10.1111/nyas.12194] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Melody® transcatheter pulmonary valve (TPV) is a percutaneous valve system designed for the treatment of obstruction and/or regurgitation of prosthetic conduits placed between the right ventricle and pulmonary arteries in patients with congenital heart disease. In 2000, Melody TPV became the first transcatheter valve implanted in a human; in 2006 it became the first transcatheter valve commercially available anywhere in the world; and in 2010 it was launched as the first commercially available transcatheter valve in the United States. In this review, we present the clinical background against which the Melody valve was developed and implemented, introduce the rationale for and challenges of transcatheter valve technology for this population, outline the history and technical details of its development and use, and summarize currently available data concerning the performance of the device.
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Affiliation(s)
- Doff B McElhinney
- Department of Pediatrics, NYU Langone Medical Center, New York, New York, USA
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123
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Cilingiroglu M, Marmagkiolis K. Use of the Melody™ transcatheter pulmonary valve as a "covered stent": pushing the envelope. Catheter Cardiovasc Interv 2013; 81:985-6. [PMID: 23606493 DOI: 10.1002/ccd.24924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 03/24/2013] [Indexed: 11/10/2022]
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125
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Circulation: Cardiovascular Interventions
Editors’ Picks. Circ Cardiovasc Interv 2013. [DOI: 10.1161/circinterventions.112.000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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