151
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Torres AJ. Pre-Stenting and Melody Valve Stent Fracture. JACC Cardiovasc Interv 2017; 10:1760-1762. [DOI: 10.1016/j.jcin.2017.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 06/06/2017] [Indexed: 11/24/2022]
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152
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Steiner JM, Cooper S, Kirkpatrick JN. Palliative care in end-stage valvular heart disease. Heart 2017; 103:1233-1237. [PMID: 28747535 DOI: 10.1136/heartjnl-2016-310538] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 02/07/2023] Open
Abstract
Valvular heart disease (VHD), particularly aortic valve disease, is prevalent with increasing incidence. When surgery is not possible, or when risks outweigh benefits, percutaneous treatment options may offer effective alternatives. However, procedures may not always go as planned, and frail patients or those whose symptoms are caused by other comorbidities may not benefit from valve intervention at all. Significant effort should be made to assess frailty, comorbidities and patient goals prior to intervention. Palliative care (PC) should play a critical role in the care of patients with severe valve disease. PC is specialised medical care that aims to optimise health-related quality of life by managing symptoms and clarifying patient values and goals of care. It should be implemented at the time of diagnosis and continue throughout the disease course. Because of the paucity of studies dedicated to the provision of PC to patients with advanced VHD, further research is needed.
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Affiliation(s)
- Jill M Steiner
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Stephanie Cooper
- Division of Cardiology, University of Washington, Seattle, Washington, USA.,Division of Cardiology, Harborview Medical Center, Seattle, Washington, USA
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153
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Hill KD, Goldstein BH, Angtuaco MJ, Chu PY, Fleming GA. Post-market surveillance to detect adverse events associated with Melody® valve implantation. Cardiol Young 2017; 27:1090-1097. [PMID: 27829472 PMCID: PMC5425318 DOI: 10.1017/s1047951116002092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to describe previously unrecognised or under-recognised adverse events associated with Melody® valve implantation. BACKGROUND In rare diseases and conditions, it is typically not feasible to conduct large-scale safety trials before drug or device approval. Therefore, post-market surveillance mechanisms are necessary to detect rare but potentially serious adverse events. METHODS We reviewed the United States Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database and conducted a structured literature review to evaluate adverse events associated with on- and off-label Melody® valve implantation. Adverse events were compared with those described in the prospective Investigational Device Exemption and Post-Market Approval Melody® transcatheter pulmonary valve trials. RESULTS We identified 631 adverse events associated with "on-label" Melody® valve implants and 84 adverse events associated with "off-label" implants. The most frequent "on-label" adverse events were similar to those described in the prospective trials including stent fracture (n=210) and endocarditis (n=104). Previously unrecognised or under-recognised adverse events included stent fragment embolisation (n=5), device erosion (n=4), immediate post-implant severe valvar insufficiency (n=2), and late coronary compression (n=2 cases at 5 days and 3 months after implantation). Under-recognised adverse events associated with off-label implantation included early valve failure due to insufficiency when implanted in the tricuspid position (n=7) and embolisation with percutaneous implantation in the mitral position (n=5). CONCLUSION Post-market passive surveillance does not demonstrate a high frequency of previously unrecognised serious adverse events with "on-label" Melody® valve implantation. Further study is needed to evaluate safety of "off-label" uses.
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Affiliation(s)
| | - Bryan H. Goldstein
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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154
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Kim SH. Recent advances in pediatric interventional cardiology. KOREAN JOURNAL OF PEDIATRICS 2017; 60:237-244. [PMID: 29042864 PMCID: PMC5638720 DOI: 10.3345/kjp.2017.60.8.237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/01/2017] [Accepted: 07/09/2017] [Indexed: 01/27/2023]
Abstract
During the last 10 years, there have been major technological achievements in pediatric interventional cardiology. In addition, there have been several advances in cardiac imaging, especially in 3-dimensional imaging of echocardiography, computed tomography, magnetic resonance imaging, and cineangiography. Therefore, more types of congenital heart diseases can be treated in the cardiac catheter laboratory today than ever before. Furthermore, lesions previously considered resistant to interventional therapies can now be managed with high success rates. The hybrid approach has enabled the overcoming of limitations inherent to percutaneous access, expanding the application of endovascular therapies as adjunct to surgical interventions to improve patient outcomes and minimize invasiveness. Percutaneous pulmonary valve implantation has become a successful alternative therapy. However, most of the current recommendations about pediatric cardiac interventions (including class I recommendations) refer to off-label use of devices, because it is difficult to study the safety and efficacy of catheterization and transcatheter therapy in pediatric cardiac patients. This difficulty arises from the challenge of identifying a control population and the relatively small number of pediatric patients with congenital heart disease. Nevertheless, the pediatric interventional cardiology community has continued to develop less invasive solutions for congenital heart defects to minimize the need for open heart surgery and optimize overall outcomes. In this review, various interventional procedures in patients with congenital heart disease are explored.
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Affiliation(s)
- Seong-Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
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155
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Sharma A, Cote AT, Hosking MCK, Harris KC. A Systematic Review of Infective Endocarditis in Patients With Bovine Jugular Vein Valves Compared With Other Valve Types. JACC Cardiovasc Interv 2017; 10:1449-1458. [PMID: 28728659 DOI: 10.1016/j.jcin.2017.04.025] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to systematically evaluate the incidence of infective endocarditis (IE) in right ventricle-to-pulmonary artery conduits and valves, comparing bovine jugular vein (BJV) valves with all others. BACKGROUND Recent evidence suggests that the incidence of IE is higher in patients with congenital heart disease who have undergone implantation of BJV valves in the pulmonary position compared with other valves. METHODS Systematic searches of published research were conducted using electronic databases (MEDLINE, Embase, and CINAHL) and citations cross-referenced current to April 2016. Included studies met the following criteria: patients had undergone right ventricle-to-pulmonary artery conduit or percutaneous pulmonary valve implantation, and investigators reported on the type of conduit or valve implanted, method of intervention (surgery or catheter based), IE incidence, and follow-up time. RESULTS Fifty studies (Levels of Evidence: 2 to 4) were identified involving 7,063 patients. The median cumulative incidence of IE was higher for BJV compared with other valves (5.4% vs. 1.2%; p < 0.0001) during a median follow-up period of 24.0 and 35.5 months, respectively (p = 0.03). For patients with BJV valves, the incidence of IE was not different between surgical and catheter-based valve implantation (p = 0.83). CONCLUSIONS There was a higher incidence of endocarditis with BJV valves than other types of right ventricle-to-pulmonary artery conduits. There was no difference in the incidence of endocarditis between catheter-based bovine valves and surgically implanted bovine valves, suggesting that the substrate for future infection is related to the tissue rather than the method of implantation.
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Affiliation(s)
- Ashutosh Sharma
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Anita T Cote
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada; Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Martin C K Hosking
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kevin C Harris
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
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156
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Abstract
PURPOSE OF REVIEW Procedural technique and short-term outcomes of transcatheter pulmonary valve implantation (TPVI) have been widely described. The purpose of this article is to provide an update on current valve technology, and to focus on recent data surrounding TPVI in the dilated right ventricular outflow tract (RVOT), hybrid interventions, significant outcomes, and procedural costs. RECENT FINDINGS Transcatheter valve technology has expanded with current trials evaluating self-expandable valves that can be implanted in dilated RVOTs. Until those valves are widely available, hybrid techniques have been shown to offer a potential alternative in these patients, as well as in patients of small size. Although medium-term results of TPVI have shown 5-year freedom from reintervention or replacement of 76%, new data have underlined some concerns relating to bacterial endocarditis after the procedure. Procedural costs remain a concern, but vary greatly between institutions and healthcare systems. SUMMARY TPVI has emerged as one of the most innovative procedures in the treatment of patients with dysfunctional RVOT and pulmonary valves. Further device development is likely to expand the procedure to patients of smaller size and with complex, dilated RVOTs.
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157
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Bhagra CJ, Hickey EJ, Van De Bruaene A, Roche SL, Horlick EM, Wald RM. Pulmonary Valve Procedures Late After Repair of Tetralogy of Fallot: Current Perspectives and Contemporary Approaches to Management. Can J Cardiol 2017; 33:1138-1149. [PMID: 28843325 DOI: 10.1016/j.cjca.2017.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/18/2022] Open
Abstract
Few topics in adult congenital heart disease have approached the level of scrutiny bestowed on pulmonary valve replacement (PVR) strategies late after tetralogy of Fallot (TOF) repair. Despite the successes of primary surgery for TOF, there is a growing group of adults with residual right ventricular outflow tract and pulmonary valve dysfunction. Patients with residual chronic pulmonic regurgitation as a consequence of earlier surgery can later develop symptoms of exercise intolerance and complications including heart failure, tachyarrhythmias, and sudden cardiac death. Optimal timing of PVR has sparked debate, which has catalyzed increasing research efforts over the past decade. Although performance of PVR in the absence of symptoms is currently on the basis of the rationale that achievement of complete reverse remodelling is highly desirable, whether this approach results in improvement in patient outcomes in the long-term has yet to be shown. Surgical PVR and percutaneous pulmonary valve intervention are different techniques with specific advantages and disadvantages that require careful consideration for each individual patient, alongside the need for requisite reinterventions over the course of a patient's lifetime. Criteria pertaining to referral strategies are ever being refined as newer technologies for percutaneous therapies continue to evolve. In this article we review the literature surrounding the indications for, the optimal timing of, and the approaches to pulmonary valve procedures in adults with previously repaired TOF.
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Affiliation(s)
- Catriona J Bhagra
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada; Cambridge University and Papworth NHS Foundation Trusts, Cambridge, United Kingdom
| | - Edward J Hickey
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alexander Van De Bruaene
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - S Lucy Roche
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Eric M Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Rachel M Wald
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
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158
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Omelchenko AY, Soynov IA, Gorbatykh YN, Kulyabin YY, Gorbatykh AV, Nichay NR, Voitov AV, Bogochev-Prokophiev AV. [Right ventricular dysfunction after tetralogy of Fallot repair: are all questions resolved?]. Khirurgiia (Mosk) 2017. [PMID: 28638021 DOI: 10.17116/hirurgia2017684-90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A Yu Omelchenko
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - I A Soynov
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Yu N Gorbatykh
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Yu Yu Kulyabin
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - A V Gorbatykh
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - N R Nichay
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - A V Voitov
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
| | - A V Bogochev-Prokophiev
- Siberian Biomedical Research Center Ministry of Health Russian Federation, Novosibirsk, Russia
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159
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Affiliation(s)
- Erle H Austin
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Norton Children's Hospital, Louisville, Ky.
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160
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Petrini L, Dordoni E, Allegretti D, Pott D, Kütting M, Migliavacca F, Pennati G. Simplified Multistage Computational Approach to Assess the Fatigue Behavior of a Niti Transcatheter Aortic Valve During In Vitro Tests: A Proof-of-Concept Study. J Med Device 2017. [DOI: 10.1115/1.4035791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Nowadays, transcatheter aortic valve (TAV) replacement is an alternative to surgical therapy in selected high risk patients for the treatment of aortic stenosis. However, left ventricular contraction determines a severe cyclic loading for the implanted stent-frame, undermining its long-term durability. Technical standards indicate in vitro tests as a suitable approach for the assessment of TAV fatigue behavior: generally, they do not specify test methods but require to test TAV in the worst loading conditions. The most critical conditions could be different according to the specific valve design, hence the compartment where deploying the valve has to be properly identified. A fast and reliable computational methodology could significantly help to face this issue. In this paper, a numerical approach to analyze Nickel-Titanium TAV stent-frame behavior during in vitro durability tests is proposed. A simplified multistage strategy was adopted where, in each stage, only two of the three involved components are considered. As a proof-of-concept, the method was applied to a TAV prototype. Despite its simplifications, the developed computational framework gave useful insights into the stent-frame failures behavior during a fatigue test. Numerical results agree with experimental findings. In particular, the most dangerous condition was identified among a number of experimental tests, where different compartments and pressure gradients were investigated. The specific failure location was also correctly recognized. In conclusion, the presented methodology provides a tool to support the choice of proper testing conditions for the in vitro assessment of TAV fatigue behavior.
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Affiliation(s)
- Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Milano 20133, Italy
| | - Elena Dordoni
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Milano 20133, Italy
| | - Dario Allegretti
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Milano 20133, Italy
| | - Desiree Pott
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen 52062, Germany
| | - Maximilian Kütting
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen 52062, Germany
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Milano 20133, Italy
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy e-mail:
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161
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Morray BH, McElhinney DB, Boudjemline Y, Gewillig M, Kim DW, Grant EK, Bocks ML, Martin MH, Armstrong AK, Berman D, Danon S, Hoyer M, Delaney JW, Justino H, Qureshi AM, Meadows JJ, Jones TK. Multicenter Experience Evaluating Transcatheter Pulmonary Valve Replacement in Bovine Jugular Vein (Contegra) Right Ventricle to Pulmonary Artery Conduits. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004914. [DOI: 10.1161/circinterventions.116.004914] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/17/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Brian H. Morray
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Doff B. McElhinney
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Younes Boudjemline
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Marc Gewillig
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Dennis W. Kim
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Elena K. Grant
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Martin L. Bocks
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Mary H. Martin
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Aimee K. Armstrong
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Darren Berman
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Saar Danon
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Mark Hoyer
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Jeffrey W. Delaney
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Henri Justino
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Athar M. Qureshi
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Jeffery J. Meadows
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Thomas K. Jones
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
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162
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Malekzadeh-Milani S, Boudjemline Y. [The successful saga of percutaneous pulmonary valvulation in congenital heart diseases]. Presse Med 2017; 46:580-585. [PMID: 28549630 DOI: 10.1016/j.lpm.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 04/13/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022] Open
Abstract
With new surgical techniques, more and more complex congenital heart defects are treated requiring sometimes right ventricle to pulmonary artery conduit implantation. In order to extend RV to PA conduit lifespan, 15 years ago a valved stent was developed. The implantation technique was progressively standardized to decrease risks of procedural complications. Medium and long-term hemodynamic results of the stent were so good that indications were broadened to native or complex right ventricular outflow tracts. Currently, 2 types of stents are implanted routinely: the Melody valve® (Medtronic, Minneapolis, USA) and the Sapien® valve (Edwards, Lifesciences, Irvine, USA). Other devices are evaluated in trials: thanks to their diabolo shape, implantation is feasible in large outflows tracts. The main source of worries is infective endocarditis. Numerous studies are conducted in order to identify risks factors, prevention and optimal treatment of this complication. In the near future, new devices and new implantation strategies will make this technology available for a larger number of patients.
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Affiliation(s)
- Sophie Malekzadeh-Milani
- Assistance publique des Hôpitaux de Paris, centre de référence malformations cardiaques congénitales complexes-M3C, hôpital Necker-Enfants-Malades, hôpital européen Georges-Pompidou, 75015 Paris, France
| | - Younes Boudjemline
- Assistance publique des Hôpitaux de Paris, centre de référence malformations cardiaques congénitales complexes-M3C, hôpital Necker-Enfants-Malades, hôpital européen Georges-Pompidou, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France.
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163
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Corno AF, Dawson AG, Bolger AP, Mimic B, Shebani SO, Skinner GJ, Speggiorin S. Trifecta St. Jude medical® aortic valve in pulmonary position. NANO REVIEWS & EXPERIMENTS 2017; 8:1299900. [PMID: 30410702 PMCID: PMC6167870 DOI: 10.1080/20022727.2017.1299900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/01/2017] [Accepted: 02/21/2017] [Indexed: 12/29/2022]
Abstract
Introduction: To evaluate an aortic pericardial valve for pulmonary valve (PV) regurgitation after repair of congenital heart defects. Methods: From July 2012 to June 2016 71 patients, mean age 24 ± 13 years (four to years) underwent PV implantation of aortic pericardial valve, mean interval after previous repair = 21 ± 10 years (two to 47 years). Previous surgery at mean age 3.2 ± 7.2 years (one day to 49 years): tetralogy of Fallot repair in 83% (59/71), pulmonary valvotomy in 11% (8/71), relief of right ventricular outflow tract (RVOT) obstruction in 6% (4/71). Pre-operative echocardiography and MRI showed severe PV regurgitation in 97% (69/71), moderate in 3% (2/71) with associated RVOT obstruction. MRI and knowledge-based reconstruction 3D volumetry (KBR-3D-volumetry) showed mean PV regurgitation = 42 ± 9% (20–58%), mean indexed RV end-diastolic volume = 169 ± 33 (130–265) ml m–2 BSA and mean ejection fraction (EF) = 46 ± 8% (33–61%). Cardio-pulmonary exercise showed mean peak O2/uptake = 24 ± 8 ml kg–1 min–1 (14–45 ml kg–1 min–1), predicted max O2/uptake 66 ± 17% (26–97%). Pre-operative NYHA class was I in 17% (12/71) patients, II in 70% (50/71) and III in 13% (9/71). Results: Mean cardio-pulmonary bypass duration was 95 ± 30ʹ (38–190ʹ), mean aortic cross-clamp in 23% (16/71) 46 ± 31ʹ (8–95ʹ), with 77% (55/71) implantations without aortic cross-clamp. Size of implanted PV: 21 mm in seven patients, 23 mm in 33, 25 mm in 23, and 27 mm in eight. The z-score of the implanted PV was −0.16 ± 0.80 (−1.6 to 2.5), effective orifice area indexed (for BSA) of native PV was 1.5 ± 0.2 (1.2 to –2.1) vs. implanted PV 1.2 ± 0.3 (0.76 to –2.5) (p = ns). In 76% (54/71) patients surgical RV modelling was associated. Mean duration of mechanical ventilation was 6 ± 5 h (0–26 h), mean ICU stay 21 ± 11 h (12–64 h), mean hospital stay 6 ± 3 days (three to 19 days). In mean follow-up = 25 ± 14 months (six to 53 months) there were no early/late deaths, no need for cardiac intervention/re-operation, no valve-related complications, thrombosis or endocarditis. Last echocardiography showed absent PV regurgitation in 87.3% (62/71) patients, trivial/mild degree in 11.3% (8/71), moderate degree in 1.45% (1/71), mean max peak velocity through RVOT 1.6 ± 0.4 (1.0–2.4) m s–1. Mean indexed RV end-diastolic volume at MRI/KBR-3D-volumetry was 96 ± 20 (63–151) ml m–2 BSA, lower than pre-operatively (p < 0.001), and mean EF = 55 ± 4% (49–61%), higher than pre-operatively (p < 0.05). Almost all patients (99% = 70/71) remain in NYHA class I, 1.45% = 1/71 in class II. Conclusion: (a) Aortic pericardial valve is implantable in PV position with an easy and reproducible surgical technique; (b) valve size adequate for patient BSA can be implanted with simultaneous RV remodelling; (c) medium-term outcomes are good with maintained PV function, RV dimensions significantly reduced and EF significantly improved; (d) adequate valve size will allow later percutaneous valve-in-valve implantation.
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Affiliation(s)
- Antonio F Corno
- Service of Paediatric and Congenital Cardiac Surgery, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Alan G Dawson
- Service of Paediatric and Congenital Cardiac Surgery, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Aidan P Bolger
- Service of Adult Congenital Cardiology, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Branco Mimic
- Service of Paediatric and Congenital Cardiac Surgery, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Suhair O Shebani
- Service of Paediatric Cardiology, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Gregory J Skinner
- Service of Paediatric Cardiology, University Hospital Leicester, Glenfield Hospital, Leicester, UK
| | - Simone Speggiorin
- Service of Paediatric and Congenital Cardiac Surgery, University Hospital Leicester, Glenfield Hospital, Leicester, UK
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164
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Andell P, Li X, Martinsson A, Andersson C, Stagmo M, Zöller B, Sundquist K, Smith JG. Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study. Heart 2017; 103:1696-1703. [PMID: 28432156 PMCID: PMC5749343 DOI: 10.1136/heartjnl-2016-310894] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Transitions in the spectrum of valvular heart diseases (VHDs) in developed countries over the 20th century have been reported from clinical case series, but large, contemporary population-based studies are lacking. METHODS We used nationwide registers to identify all patients with a first diagnosis of VHD at Swedish hospitals between 2003 and 2010. Age-stratified and sex-stratified incidence of each VHD and adjusted comorbidity profiles were assessed. RESULTS In the Swedish population (n=10 164 211), the incidence of VHD was 63.9 per 100 000 person-years, with aortic stenosis (AS; 47.2%), mitral regurgitation (MR; 24.2%) and aortic regurgitation (AR; 18.0%) contributing most of the VHD diagnoses. The majority of VHDs were diagnosed in the elderly (68.9% in subjects aged ≥65 years), but pulmonary valve disease incidence peaked in newborns. Incidences of AR, AS and MR were higher in men who were also more frequently diagnosed at an earlier age. Mitral stenosis (MS) incidence was higher in women. Rheumatic fever was rare. Half of AS cases had concomitant atherosclerotic vascular disease (48.4%), whereas concomitant heart failure and atrial fibrillation were common in mitral valve disease and tricuspid regurgitation. Other common comorbidities were thoracic aortic aneurysms in AR (10.3%), autoimmune disorders in MS (24.5%) and abdominal hernias or prolapse in MR (10.7%) and TR (10.3%). CONCLUSIONS Clinically diagnosed VHD was primarily a disease of the elderly. Rheumatic fever was rare in Sweden, but specific VHDs showed a range of different comorbidity profiles . Pronounced sex-specific patterns were observed for AR and MS, for which the mechanisms remain incompletely understood.
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Affiliation(s)
- Pontus Andell
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Andreas Martinsson
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Charlotte Andersson
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Martin Stagmo
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Bengt Zöller
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.,Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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165
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Malone L, Fonseca B, Fagan T, Gralla J, Wilson N, Vargas D, DiMaria M, Truong U, Browne LP. Preprocedural Risk Assessment Prior to PPVI with CMR and Cardiac CT. Pediatr Cardiol 2017; 38:746-753. [PMID: 28210769 DOI: 10.1007/s00246-017-1574-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Abstract
Percutaneous pulmonary valve intervention (PPVI) is a less invasive and less costly approach to pulmonary valve replacement compared with the surgical alternative. Potential complications of PPVI include coronary compression and pulmonary arterial injury/rupture. The purpose of this study was to characterize the morphological risk factors for PPVI complication with cardiac MRI and cardiac CTA. A retrospective review of 88 PPVI procedures was performed. 44 patients had preprocedural cardiac MRIs or CTAs available for review. Multiple morphological variables on cardiac MRI and CTA were compared with known PPVI outcome and used to investigate associations of variables in determining coronary compression or right ventricular-pulmonary arterial conduit injury. The most significant risk factor for coronary artery compression was the proximity of the coronary arteries to the conduit. In all patients with coronary compression during PPVI, the coronary artery touched the conduit on the preprocedural CTA/MRI, whilst in patients without coronary compression the mean distance between the coronary artery and the conduit was 4.9 mm (range of 0.8-20 mm). Multivariable regression analysis demonstrated that exuberant conduit calcification was the most important variable for determining conduit injury. Position of the coronary artery directly contacting the conduit without any intervening fat may predict coronary artery compression during PPVI. Exuberant conduit calcification increases the risk of PPVI-associated conduit injury. Close attention to these factors is recommended prior to intervention in patients with pulmonary valve dysfunction.
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Affiliation(s)
- Ladonna Malone
- Department of Radiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Brian Fonseca
- Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Thomas Fagan
- University of Tennessee Health Sciences Center, Aurora, Colorado, USA
| | - Jane Gralla
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Neil Wilson
- Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Micheal DiMaria
- Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Uyen Truong
- Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lorna P Browne
- Department of Radiology, Children's Hospital Colorado, Aurora, Colorado, USA.
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166
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Tanase D, Ewert P, Georgiev S, Meierhofer C, Pabst von Ohain J, McElhinney DB, Hager A, Kühn A, Eicken A. Tricuspid Regurgitation Does Not Impact Right Ventricular Remodeling After Percutaneous Pulmonary Valve Implantation. JACC Cardiovasc Interv 2017; 10:701-708. [DOI: 10.1016/j.jcin.2017.01.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/19/2017] [Accepted: 01/27/2017] [Indexed: 11/17/2022]
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167
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Frigiola A, Pluchinotta F, Saracino A, Giamberti A, Arcidiacono C, Piazza L, Reali M, Butera G, Varrica A, Carminati M. Surgical mitral valve replacement with the Melody valve in infants and children: the Italian experience. EUROINTERVENTION 2017; 12:2104-2109. [DOI: 10.4244/eij-d-16-00853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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168
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Steinberg ZL, Jones TK, Verrier E, Stout KK, Krieger EV, Karamlou T. Early outcomes in patients undergoing transcatheter versus surgical pulmonary valve replacement. Heart 2017; 103:1455-1460. [DOI: 10.1136/heartjnl-2016-310776] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/07/2017] [Accepted: 03/03/2017] [Indexed: 11/04/2022] Open
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169
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Kenny DP, Hijazi ZM. Current Status and Future Potential of Transcatheter Interventions in Congenital Heart Disease. Circ Res 2017; 120:1015-1026. [DOI: 10.1161/circresaha.116.309185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 02/03/2023]
Abstract
Percutaneous therapies for congenital heart disease have evolved rapidly in the past 3 decades. This has occurred despite limited investment from industry and support from regulatory bodies resulting in a lack of specific device development. Indeed, many devices remain off-label with a best-fit approach often required, spurning an innovative culture within the subspecialty, which had arguably laid the foundation for many of the current and evolving structural heart interventions. Challenges remain, not least encouraging device design focused on smaller infants and the inevitable consequences of somatic growth. Data collection tools are emerging but remain behind adult cardiology and cardiac surgery and leading to partial blindness as to the longer-term consequences of our interventions. Tail coating on the back of developments in other fields of adult intervention will soon fail to meet the expanding needs for more precise interventions and biological materials. Increasing collaboration with surgical colleagues will require development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure that children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia, and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.
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Affiliation(s)
- Damien P. Kenny
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
| | - Ziyad M. Hijazi
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
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170
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Loneker AE, Luketich SK, Bernstein D, Kalra A, Nugent AW, D'Amore A, Faulk DM. Mechanical and microstructural analysis of a radially expandable vascular conduit for neonatal and pediatric cardiovascular surgery. J Biomed Mater Res B Appl Biomater 2017; 106:659-671. [PMID: 28296198 DOI: 10.1002/jbm.b.33874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/20/2017] [Accepted: 02/20/2017] [Indexed: 01/29/2023]
Abstract
In pediatric cardiovascular surgery, there is a significant need for vascular prostheses that have the potential to grow with the patient following implantation. Current clinical options consist of nonexpanding conduits, requiring repeat surgeries as the patient outgrows the device. To address this issue, PECA Labs has developed a novel ePTFE vascular conduit with the capability of being radially expanded via balloon catheterization. In the described study, a systematic characterization and comparison of two proprietary ePTFE expandable conduits was conducted. Conduit sizes of 8 and 16 mm inner diameters for both conduits were evaluated before and after expansion with a 26 mm balloon. Comprehensive mechanical testing was completed, including quantification of circumferential, and longitudinal tensile strength, suture retention strength, burst strength, water entry pressure, dynamic compliance, and kink radius. Scanning electron microscopy was used to investigate the microstructural properties. Automated extraction of the fiber architectural features for each scanning electron micrograph was achieved with an algorithm for each conduit before and after expansion. Results showed that both conduits were able to expand significantly, to as much as 2.5× their original inner diameter. All mechanical properties were within clinically acceptable values following expansion. Analysis of the microstructure properties of the conduits revealed that the circumferential main angle of orientation, orientation index, and spatial periodicity did not significantly change following expansion, whereas the node area fraction decreased post expansion. Successful proof-of-concept of this novel product represents a critical step toward clinical translation and provides hope for newborns and growing children with congenital heart disease. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 659-671, 2018.
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Affiliation(s)
- Abigail E Loneker
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Penninsylvania
| | - Samuel K Luketich
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Penninsylvania.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Penninsylvania
| | | | - Arush Kalra
- PECA Labs, Pittsburgh, Penninsylvania, 15224
| | - Alan W Nugent
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Antonio D'Amore
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Penninsylvania.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Penninsylvania.,Department of Surgery, University of Pittsburgh, Pittsburgh, Penninsylvania.,School of Medicine, University of Pittsburgh, Pittsburgh, Penninsylvania.,RiMED Foundation, Palermo, Italy
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171
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Zablah JE, Misra N, Gruber D, Kholwadwala D, Epstein S. Comparison of Patients Undergoing Surgical Versus Transcatheter Pulmonary Valve Replacement: Criteria for Referral and Mid-Term Outcome. Pediatr Cardiol 2017; 38:603-607. [PMID: 28236163 DOI: 10.1007/s00246-016-1554-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 12/21/2016] [Indexed: 12/01/2022]
Abstract
Pulmonary regurgitation and/or stenosis (PS) is challenging in patients with congenital heart defects. Our aim was to identify if criteria for referral were different between surgical (SPVR) and transcatheter pulmonary valve replacement (TPVR) populations, and to further assess if any baseline differences influence the resultant ventricular remodeling at medium-term follow-up. Retrospective chart review of patients post-SPVR or TPVR at our center from 2013 to 2015 was conducted. Volumetric data from cardiac magnetic resonance (CMR), 1 year before and 1 year after PVR was obtained. PS was defined as peak-peak gradient ≥35 mmHg by catheterization or peak gradient ≥50 mmHg by echocardiography. Thirty patients underwent PVR: 15 SPVR and 15 TPVR (1 hybrid). The indications for SPVR referral were: 2+ CMR parameters in 80% of patients; decreased left ventricular ejection fraction and hemodynamic findings and/or abnormal exercise stress test in 20%. The indications for TPVR referral were predominantly symptoms ± hemodynamic findings in 66% of patients, 2+ CMR findings in 44% of patients. At referral, SPVR group had significantly larger right ventricular (RV) volumes than TPVR group. Biventricular function was not significantly different. Post-PVR, both groups had significantly decreased RV volumes and increased LV diastolic volumes. The SPVR group improved LV cardiac output and biventricular function whereas TPVR group had no significant improvement. The patients in the SPVR group were mostly referred based on CMR volumetric criteria, whereas the patients in the TPVR group were mostly referred due to exercise intolerance with only occasional abnormalities on CMR. 1 year after PVR, both groups had near-normal biventricular volumes and function irrespective of characteristics at referral.
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Affiliation(s)
- Jenny E Zablah
- Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA. .,Children's Hospital of Colorado, 13123 East 16th Avenue, Box 100, Aurora, CO, 80045, USA.
| | - Nilanjana Misra
- Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA
| | - Dorota Gruber
- Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA
| | - Dipak Kholwadwala
- Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA
| | - Shilpi Epstein
- Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA
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172
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McRae ME, Coleman B, Atz TW, Kelechi TJ. Patient outcomes after transcatheter and surgical pulmonary valve replacement for pulmonary regurgitation in patients with repaired tetralogy of Fallot: A quasi-meta-analysis. Eur J Cardiovasc Nurs 2017; 16:539-553. [PMID: 28756698 DOI: 10.1177/1474515117696384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Individuals with repaired tetralogy of Fallot develop pulmonary regurgitation that may cause symptoms (dyspnea, chest pain, palpitations, fatigue, presyncope, and syncope), impair functional capacity, and may affect health-related quality of life. Surgical pulmonary valve replacement is the gold standard of treatment although transcatheter pulmonary valve replacement is becoming more common. Patients want to know whether less invasive options are as good. AIMS This analysis aimed to examine the differences in surgical versus transcatheter pulmonary valve replacement effects in terms of physiological/biological variables, symptoms, functional status and health-related quality of life. METHODS This quasi-meta-analysis included 85 surgical and 47 transcatheter pulmonary valve replacement studies published between 1995-2016. RESULTS In terms of physiological/biological variables, both surgical and transcatheter pulmonary valve replacement improved pulmonary regurgitation and systolic and diastolic right ventricular volume indices but not heart function. In the left heart, only surgical pulmonary valve replacement improved heart function. Only transcatheter pulmonary valve replacement improved left ventricular end-diastolic indices and neither improved endsystolic indices. Only surgery has been demonstrated to decrease QRS duration but there is little evidence of arrhythmia reduction. Symptom change is poorly documented. Functional class improves but exercise capacity generally does not. Some aspects of health-related quality of life improve with surgery and in one small transcatheter pulmonary valve replacement study. CONCLUSION Transcatheter and surgical pulmonary valve replacement compare favorably for heart remodeling. Exercise capacity does not change with either technique. Health-related quality of life improves after surgical pulmonary valve replacement. There are numerous gaps in documentation of changes in arrhythmias and symptoms.
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Affiliation(s)
- Marion E McRae
- 1 Medical University of South Carolina, USA.,2 Guerin Family Congenital Heart Program, Cedars-Sinai Medical Center, USA.,3 David Geffen School of Medicine, University of California at Los Angeles
| | - Bernice Coleman
- 4 Nursing Research Department, Cedars-Sinai Medical Center, USA
| | - Teresa W Atz
- 5 College of Medicine, Medical University of South Carolina, USA
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173
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Rapetto F, Kenny D, Turner M, Parry A, Stoica S, Uzun O, Caputo M. Hybrid Surgery Options for Complex Clinical Scenarios in Adult Patients with Congenital Heart Disease: Three Case Reports. Front Surg 2017; 4:7. [PMID: 28232910 PMCID: PMC5298988 DOI: 10.3389/fsurg.2017.00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/24/2017] [Indexed: 12/03/2022] Open
Abstract
The strategy for the management of adult patients with congenital heart disease (CHD) often represents a challenge for cardiac surgeons and cardiologists due to complex anatomy, wide range of clinical presentations, and a high-risk profile. However, hybrid approach may represent an attractive solution. We report three cases of adult patients previously operated for CHD and recently treated with a hybrid approach in our institution. Case 1: a 76-year-old woman with permanent atrial fibrillation, lung disease, chronic kidney disease, microcytic anemia, and type II diabetes mellitus, previously operated for atrial septal defect closure and pulmonary valvotomy, presented with severe pulmonary regurgitation and advanced right ventricular failure. In order to minimize the surgical risk, a hybrid approach was used: an extensive right ventricular outflow tract (RVOT) plication was followed by implantation of an Edwards Sapien XT prosthesis in the RVOT through the right ventricular apex, without cardiopulmonary bypass. Case 2: a 64-year-old man with previous atrial septum excision and pericardial baffle for partial anomalous pulmonary venous drainage with intact interatrial septum, presented with worsening dyspnea, right ventricular failure, and pulmonary hypertension caused by baffle stenosis. His comorbidities included coronary artery disease, atrial flutter, and previous left pneumonectomy. After performing a redo longitudinal median sternotomy, a 20-mm stent was implanted in the baffle with access through the superior vena cava. Case 3: a 50-year-old man, with previous atrioventricular septal defect repair, followed by mitral valve replacement with a mechanical prosthesis, subsequently developed a paravalvular leak (PVL) with severe mitral regurgitation and severe left ventricular dysfunction. He underwent a transapical PVL device closure with two Amplatzer Vascular Plugs. In our opinion, hybrid surgery is a promising therapeutic modality that increases the available treatment options for this patient population. A multidisciplinary and patient-tailored approach is crucial in these complex clinical scenarios.
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Affiliation(s)
- Filippo Rapetto
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK; Department of Cardiac Surgery, Bristol Royal Hospital for Children, University of Bristol, Bristol, UK
| | - Damien Kenny
- Department of Paediatric Cardiology, Rush University Medical Center , Chicago, IL , USA
| | - Mark Turner
- Department of Cardiology, Bristol Heart Institute, University of Bristol , Bristol , UK
| | - Andrew Parry
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK; Department of Cardiac Surgery, Bristol Royal Hospital for Children, University of Bristol, Bristol, UK
| | - Serban Stoica
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK; Department of Cardiac Surgery, Bristol Royal Hospital for Children, University of Bristol, Bristol, UK
| | - Orhan Uzun
- Department of Paediatric Cardiology, University Hospital of Wales , Cardiff , UK
| | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK; Department of Cardiac Surgery, Bristol Royal Hospital for Children, University of Bristol, Bristol, UK
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174
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Skoglund K, Svensson G, Thilén U, Dellborg M, Eriksson P. RV to PA conduits: impact of transcatheter pulmonary valve replacement in adults – a national register study. SCAND CARDIOVASC J 2017; 51:153-158. [DOI: 10.1080/14017431.2017.1291988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kristofer Skoglund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnar Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulf Thilén
- Department of Cardiology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Eriksson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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175
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Ligon RA, Petit CJ. Not that atretic: Use of an atretic femoral vein for transcatheter pulmonary valve implantation. Catheter Cardiovasc Interv 2017; 89:321-323. [PMID: 27516338 DOI: 10.1002/ccd.26687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/03/2016] [Indexed: 11/08/2022]
Abstract
We report a case of a child with congenital heart disease who presented with critical right ventricular outflow tract obstruction and a history of bilateral femoral vein occlusion. He underwent successful right ventricular outflow tract intervention, culminating in transcatheter pulmonary valve implantation, after recanalization of a completely obstructed femoral vein. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- R Allen Ligon
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher J Petit
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Hager A, Schubert S, Ewert P, Søndergaard L, Witsenburg M, Guccione P, Benson L, Suárez de Lezo J, Lung TH, Hess J, Eicken A, Berger F. Five-year results from a prospective multicentre study of percutaneous pulmonary valve implantation demonstrate sustained removal of significant pulmonary regurgitation, improved right ventricular outflow tract obstruction and improved quality of life. EUROINTERVENTION 2017; 12:1715-1723. [DOI: 10.4244/eij-d-16-00443] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Boudjemline Y, Malekzadeh-Milani S, Patel M, Thambo JB, Bonnet D, Iserin L, Fraisse A. Predictors and outcomes of right ventricular outflow tract conduit rupture during percutaneous pulmonary valve implantation: a multicentre study. EUROINTERVENTION 2017; 11:1053-62. [PMID: 25244126 DOI: 10.4244/eijy14m09_06] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIMS Conduit rupture is a serious complication encountered during percutaneous pulmonary valve implantation (PPVI). We sought to evaluate the incidence and predictors of conduit rupture during right ventricular outflow tract (RVOT) transcatheter treatment. METHODS AND RESULTS All consecutive patients who underwent transcatheter RVOT treatment from May 2008 to December 2011 were prospectively studied. Baseline demographics along with incidence, predictors and outcomes of conduit rupture with various transcatheter therapies were reviewed. Conduit rupture occurred in nine out of 99 patients (9.09%). All conduit ruptures occurred during balloon dilatation. Significant risk factors included heavy calcification (p<0.05, OR=16 [1.87-357]), and conduit type (homograft/others; p<0.05, OR=4.37 [1.1-17.8]). Other factors such as prolonged time interval between prior surgical RVOT repair and interventions, use of high-pressure balloons, balloon diameter, and overexpansion of conduit statistically failed to show any association. All patients were managed in the cardiac catheterisation laboratory. There were no delayed complications during a mean follow-up period of 2.3±0.95 years. CONCLUSIONS Conduit rupture is a serious complication. Heavy calcification and homograft conduit were significant predictors. Immediate diagnosis with the use of targeted interventional therapies should be attempted before proceeding with PPVI.
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Affiliation(s)
- Younes Boudjemline
- Department of Paediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paris, France
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Mohamed KS. Tricuspid Valve Replacement in Infants and Children With Exclusively Autologous Tissue. World J Pediatr Congenit Heart Surg 2016; 8:88-91. [PMID: 28033086 DOI: 10.1177/2150135116663700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tricuspid valve replacement has always been a challenge in the pediatric population, with high rates of mortality and morbidity. This article describes a new technique that we have used to replace the tricuspid valve with exclusively autologous tissues. The pulmonary autograft is used for tricuspid valve replacement. Pulmonary artery wall and autologous pericardium are utilized for right ventricular out flow tract reconstruction with the creation of a monocusp.
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Affiliation(s)
- Khaled Samir Mohamed
- 1 Department of Cardiothoracic Surgery, Ain Shams University Hospitals, Ain Shams University, Cairo, Egypt
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179
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Garay F, Pan X, Zhang YJ, Wang C, Springmuller D. Early experience with the Venus p‑valve for percutaneous pulmonary valve implantation in native outflow tract. Neth Heart J 2016; 25:76-81. [PMID: 27943178 PMCID: PMC5260624 DOI: 10.1007/s12471-016-0932-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction The Venus p‑valve (MedTech, Shanghai, China) is a self-expanding percutaneous heart valve designed to be implanted in a native patched right ventricle outflow tract. The worldwide clinical experience with this valve is just beginning and the results have so far been encouraging. We present our initial early experience implanting the Venus p‑valve in the native right ventricle outflow tract of patients with Tetralogy of Fallot repaired with a transannular patch. Methods In 10 selected patients a procedure for percutaneous pulmonary valve implantation was performed using the Venus p‑valve. The patients mean age was 32 years (13–57), mean weight 59.6 kg (40–80). All patients had Tetralogy of Fallot with moderate to severe pulmonary regurgitation and an indication for pulmonary valve replacement. Results The implantation procedure was successful in all the patients resulting in an immediately functional valve. No procedure-related complications were observed. Follow-up after 12 months (4–21) resulted in an improvement in NYHA class. There was a reduction of the mean right ventricle diastolic volume from 139 ml/m2 (105–179) to 78 ml/m2 (65–100) and improvement in the regurgitation fraction from 42% (29–58) to 1% (0–5), as seen on routine cardiac magnetic resonance 6 months after the implantation. No stent fractures have been observed so far. Conclusion Percutaneous pulmonary valve implantation with the Venus p‑valve resulted in a safe and effective procedure. The valve has predictable and sustained functional competence, resulting in clinical improvement in the patients.
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Affiliation(s)
- F Garay
- Departamento de Cardiología Pediátrica y Enfermedades Respiratorias, Hospital Clínico de la Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago Chile, Chile.
| | - X Pan
- Cardiovascular Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Y J Zhang
- Cardiovascular Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - C Wang
- Cardiovascular Department, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - D Springmuller
- Departamento de Cardiología Pediátrica y Enfermedades Respiratorias, Hospital Clínico de la Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago Chile, Chile
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Pockett CR, Moore JW, El-Said HG. Three dimensional rotational angiography for assessment of coronary arteries during melody valve implantation: introducing a technique that may improve outcomes. Neth Heart J 2016; 25:82-90. [PMID: 27933590 PMCID: PMC5260623 DOI: 10.1007/s12471-016-0931-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Adverse events from Melody valve implantation may be catastrophic. To date a role for three dimensional rotational angiography of the aortic root (3DRAA) during Melody valve implantation has not been established. Objectives To describe the role of 3DRAA in the assessment of Melody valve candidacy and to demonstrate that it may improve outcomes. Methods All patients who underwent cardiac catheterisation for Melody valve implantation and 3DRAA between August 2013 and February 2015 were reviewed. Results 31 patients had 3DRAA with balloon sizing. Ten were deemed not Melody candidates (5 coronary compression, 2 aortic root distortion with cusp flattening, 2 RVOT was too large, and 1 had complex branch stenosis and a short landing zone). Of the 21 patients who were Melody candidates, 12 had conduits, 6 prosthetic valves and 3 native RVOTs. In patients with conduits, the technique of stenting the conduit prior to dilation was used after measuring the distance between the conduit and the coronary arteries on 3DRAA. In the Melody patients, we had 100% procedural success and no serious adverse events (coronary compression, tears, stent fracture or endocarditis). Conclusion As a tool for case selection, 3DRAA may facilitate higher procedural success and decreased risk of serious adverse events. Furthermore, 3D rotational angiography allows stenting of the conduit prior to dilation, which may prevent tears and possibly endocarditis.
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Affiliation(s)
- C R Pockett
- Rady Children's Hospital, San Diego, University of California, San Diego, USA
| | - J W Moore
- Rady Children's Hospital, San Diego, University of California, San Diego, USA
| | - H G El-Said
- Rady Children's Hospital, San Diego, University of California, San Diego, USA.
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181
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Emani SM, Piekarski BL, Zurakowski D, Baird CA, Marshall AC, Lock JE, del Nido PJ. Concept of an expandable cardiac valve for surgical implantation in infants and children. J Thorac Cardiovasc Surg 2016; 152:1514-1523. [DOI: 10.1016/j.jtcvs.2016.08.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/19/2016] [Accepted: 08/19/2016] [Indexed: 12/30/2022]
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182
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Hunter J, Rosenkranz E, Li H, Swaminathan S. Assessment of the longevity of valves placed in the pulmonary position in patients with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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183
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Kuo JA, Feezel AA, Putnam TN, Schutte DA. Melody valve implantation within freestyle stentless porcine aortic heterograft. Catheter Cardiovasc Interv 2016; 89:1224-1230. [DOI: 10.1002/ccd.26862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 10/19/2016] [Accepted: 10/23/2016] [Indexed: 11/10/2022]
Affiliation(s)
- James A. Kuo
- Cook Children's Medical Center; Fort Worth Texas
| | - Ashlea A. Feezel
- University of North Texas Health Sciences Center; Fort Worth Texas
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184
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Chaszczewski K, Kenny D, Hijazi ZM. Pulmonary Artery and Valve Catheter-Based Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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186
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A prospective 5-year study of the frequency of arrhythmias during serial exercise testing and clinical follow-up after Melody valve implant. Heart Rhythm 2016; 13:2135-2141. [DOI: 10.1016/j.hrthm.2016.07.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Indexed: 11/23/2022]
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187
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Moustafa GA, Kolokythas A, Charitakis K, Avgerinos DV. Therapeutic Utilities of Pediatric Cardiac Catheterization. Curr Cardiol Rev 2016; 12:258-269. [PMID: 26926291 PMCID: PMC5304250 DOI: 10.2174/1573403x12666160301121253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/17/2015] [Accepted: 12/27/2015] [Indexed: 11/29/2022] Open
Abstract
In an era when less invasive techniques are favored, therapeutic cardiac catheterization constantly evolves and widens its spectrum of usage in the pediatric population. The advent of sophisticated devices and well-designed equipment has made the management of many congenital cardiac lesions more efficient and safer, while providing more comfort to the patient. Nowadays, a large variety of heart diseases are managed with transcatheter techniques, such as patent foramen ovale, atrial and ventricular septal defects, valve stenosis, patent ductus arteriosus, aortic coarctation, pulmonary artery and vein stenosis and arteriovenous malformations. Moreover, hybrid procedures and catheter ablation have opened new paths in the treatment of complex cardiac lesions and arrhythmias, respectively. In this article, the main therapeutic utilities of cardiac catheterization in children are discussed.
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Affiliation(s)
| | | | | | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Athens Medical Center & Center for Percutaneous Valves and Aortic Diseases, 5-7 Distomou Street, 15125, Marousi, Attica, Greece.
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188
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Defining and refining indications for transcatheter pulmonary valve replacement in patients with repaired tetralogy of Fallot: Contributions from anatomical and functional imaging. Int J Cardiol 2016; 221:916-25. [DOI: 10.1016/j.ijcard.2016.07.120] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/24/2016] [Accepted: 07/08/2016] [Indexed: 12/17/2022]
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189
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Nguyen HH, Shahanavaz S, Van Hare GF, Balzer DT, Nicolas R, Avari Silva JN. Percutaneous Pulmonary Valve Implantation Alters Electrophysiologic Substrate. J Am Heart Assoc 2016; 5:e004325. [PMID: 27694326 PMCID: PMC5121524 DOI: 10.1161/jaha.116.004325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/09/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Percutaneous pulmonary valve implantation (PPVI) is first-line therapy for some congenital heart disease patients with right ventricular outflow tract dysfunction. The hemodynamics improvements after PPVI are well documented, but little is known about its effects on the electrophysiologic substrate. The objective of this study is to assess the short- and medium-term electrophysiologic substrate changes and elucidate postprocedure arrhythmias. METHODS AND RESULTS A retrospective chart review of patients undergoing PPVI from May 2010 to April 2015 was performed. A total of 106 patients underwent PPVI; most commonly these patients had tetralogy of Fallot (n=59, 55%) and pulmonary insufficiency (n=60, 57%). The median follow-up time was 28 months (7-63 months). Pre-PPVI, 25 patients (24%) had documented arrhythmias: nonsustained ventricular tachycardia (NSVT) (n=9, 8%), frequent premature ventricular contractions (PVCs) (n=6, 6%), and atrial fibrillation/flutter (AF/AFL) (n=10, 9%). Post-PPVI, arrhythmias resolved in 4 patients who had NSVT (44%) and 5 patients who had PVCs (83%). New arrhythmias were seen in 16 patients (15%): 7 NSVT, 8 PVCs, and 1 AF/AFL. There was resolution at medium-term follow-up in 6 (86%) patients with new-onset NSVT and 7 (88%) patients with new-onset PVCs. There was no difference in QRS duration pre-PPVI, post-PPVI, and at medium-term follow-up (P=0.6). The median corrected QT lengthened immediately post-PPVI but shortened significantly at midterm follow-up (P<0.01). CONCLUSIONS PPVI reduced the prevalence of NSVT. The majority of postimplant arrhythmias resolve by 6 months of follow-up.
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Affiliation(s)
- Hoang H Nguyen
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Shabana Shahanavaz
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - George F Van Hare
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - David T Balzer
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Ramzi Nicolas
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO Division of Cardiology, Department of Pediatrics, Southern Illinois University, Springfield, IL
| | - Jennifer N Avari Silva
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
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190
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Loar RW, Qureshi AM, Miyake CY, Valdes SO, Kim JJ, De la Uz CM. Percutaneous Pulmonary Valve Implantation-Associated Ventricular Tachycardia in Congenital Heart Disease. J Interv Cardiol 2016; 29:639-645. [DOI: 10.1111/joic.12344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Robert W. Loar
- The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine; Houston Texas
| | - Athar M. Qureshi
- The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine; Houston Texas
| | - Christina Y. Miyake
- The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine; Houston Texas
| | - Santiago O. Valdes
- The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine; Houston Texas
| | - Jeffrey J. Kim
- The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine; Houston Texas
| | - Caridad M. De la Uz
- The Lillie Frank Abercrombie Section of Pediatric Cardiology Texas Children's Hospital/Baylor College of Medicine; Houston Texas
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Abstract
PURPOSE OF REVIEW Transcatheter pulmonary valve replacement has only been both approved and widely available for most congenital heart disease centers for a few years; its use and familiarity for interventionalists have greatly expanded our knowledge of its applicability to a multitude of clinical situations. Expanded worldwide use and longer time from implant have both served to better understand procedural limits and uncommon late adverse events. RECENT FINDINGS Although currently approved for implantation in the USA only in dysfunctional and circumferential right ventricle to pulmonary artery conduits, with expanded experience operators have been able to adapt the delivery of this valve in a large number of additional clinical scenarios. Rare technical limitations of the procedure, most importantly coronary compression, are now being better defined. Although not frequent, a significant number of infective endocarditis episodes have been reported, but more recently several studies have deepened our understanding of this late adverse event for the most commonly implanted transcatheter pulmonary valve prosthesis. SUMMARY Expanded and widened use has extended our understanding of who may benefit from transcatheter pulmonary valve implantation (TPVI), the current limits of TPVI, and uncommon but important late issues following TPVI.
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192
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Buchholz C, Mayr A, Purbojo A, Glöckler M, Toka O, Cesnjevar RA, Rüffer A. Performance of stented biological valves for right ventricular outflow tract reconstruction. Interact Cardiovasc Thorac Surg 2016; 23:933-939. [DOI: 10.1093/icvts/ivw264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/06/2016] [Accepted: 06/22/2016] [Indexed: 11/14/2022] Open
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193
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Sosnowski C, Matella T, Fogg L, Ilbawi M, Nagaraj H, Kavinsky C, Wolf AR, Diab K, Caputo M, Kenny D. Hybrid pulmonary artery plication followed by transcatheter pulmonary valve replacement: Comparison with surgical PVR. Catheter Cardiovasc Interv 2016; 88:804-810. [DOI: 10.1002/ccd.26620] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/04/2016] [Accepted: 05/14/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Cyndi Sosnowski
- Rush Center for Congenital Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Thomas Matella
- Rush Center for Congenital Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Louis Fogg
- Rush Center for Congenital Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Michel Ilbawi
- Rush Center for Congenital Heart Disease; Rush University Medical Center; Chicago Illinois
| | | | - Clifford Kavinsky
- Rush Center for Congenital Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Andrew R Wolf
- Department of Cardiology; Our Lady's Children's Hospital; Dublin Ireland
| | - Karim Diab
- Rush Center for Congenital Heart Disease; Rush University Medical Center; Chicago Illinois
| | - Massimo Caputo
- Bristol Heart Institute; Bristol Royal Infirmary; Bristol UK
| | - Damien Kenny
- Department of Cardiology; Our Lady's Children's Hospital; Dublin Ireland
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194
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Health Care Costs for Adults With Congenital Heart Disease in the United States 2002 to 2012. Am J Cardiol 2016; 118:590-6. [PMID: 27476099 DOI: 10.1016/j.amjcard.2016.05.056] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 11/22/2022]
Abstract
More adults than children with congenital heart disease (CHD) are alive today. Few studies have evaluated adult congenital heart disease (ACHD) health care utilization in the United States. Data from the National Inpatient Sample from 2002 to 2012, using International Classification of Diseases, Ninth Revision, codes for moderate and complex CHD were analyzed. Hospital discharges, total billed and reimbursed amounts, length of stay, and gender/age disparities were evaluated. There was an increase in CHD discharges (moderate CHD: 4,742 vs 6,545; severe CHD: 807 vs 1,115) and total billed and reimbursed dollar amounts across all CHD (billed: $2.7 vs $7.0 billion, 155% increase; reimbursed: $1.3 vs $2.3 billion, 99% increase) and in the ACHD subgroup (billed: $543 million vs $1.5 billion, 178% increase; reimbursed: $221 vs $433 million, 95% increase). Women comprised more discharges in 2002 but not in 2012 (men:women, 2002: 6,503 vs 7,805; 2012: 7,715 vs 7,200, p = 0.39). Gender-based billed amounts followed similar trends (2002: $263 vs $280 million; 2012: $845 vs $662 million, p = 0.006) as did reimbursements (2002: $108 vs $114 million; 2012: $243 vs $190 million, p = 0.008). All age subgroups demonstrated increased health care expenditures, including the >44 versus 18- to 44-year-old age subgroup (billed: $618 vs $347 million, p <0.001; reimbursed: $136 vs $75 million, p <0.001). Our results reveal increased ACHD billed and reimbursed amounts and hospital discharges with a shift in gender-based ACHD hospitalizations: men now account for more hospitalizations in the United States. In conclusion, increased health care expenditure in older patients with ACHD is likely to increase further as health care system use and costs continue to grow.
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195
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Husain J, Praichasilchai P, Gilbert Y, Qureshi SA, Morgan GJ. Early European experience with the Venus P-valve®: filling the gap in percutaneous pulmonary valve implantation. EUROINTERVENTION 2016; 12:e643-51. [DOI: 10.4244/eijv12i5a105] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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196
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Schneider AE, Delaney JW, Cabalka AK. Non-infectious thrombosis of the melody®valve: A tale of two cities. Catheter Cardiovasc Interv 2016; 88:600-604. [DOI: 10.1002/ccd.26339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/08/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew E. Schneider
- Division of Pediatric Cardiology, Department of Pediatrics; Mayo Clinic; Rochester Minnesota
| | - Jeffrey W. Delaney
- Division of Pediatric Cardiology, Department of Pediatrics; University of Nebraska, Children's Hospital and Medical Center; Omaha Nebraska
| | - Allison K. Cabalka
- Division of Pediatric Cardiology, Department of Pediatrics; Mayo Clinic; Rochester Minnesota
- Division of Cardiovascular Diseases, Department of Medicine, Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
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Cohen MS, Eidem BW, Cetta F, Fogel MA, Frommelt PC, Ganame J, Han BK, Kimball TR, Johnson RK, Mertens L, Paridon SM, Powell AJ, Lopez L. Multimodality Imaging Guidelines of Patients with Transposition of the Great Arteries: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2016; 29:571-621. [DOI: 10.1016/j.echo.2016.04.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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198
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Jalal Z, Galmiche L, Beloin C, Boudjemline Y. Impact of percutaneous pulmonary valve implantation procedural steps on leaflets histology and mechanical behaviour: An in vitro study. Arch Cardiovasc Dis 2016; 109:465-75. [PMID: 27346323 DOI: 10.1016/j.acvd.2016.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Percutaneous pulmonary valve implantation (PPVI) using the bovine jugular vein Melody(®) valve (Medtronic Inc., Minneapolis, MN, USA) is safe and effective. However, post-procedural complications have been reported, the reasons for which are unclear. OBJECTIVE To assess the impact of PPVI procedural steps on valvular histology and leaflet mechanical behaviour. METHODS Three different valved stents (the Melody(®) valve and two homemade stents with bovine and porcine pericardium) were tested in vitro under four conditions: (1) control group; (2) crimping; (3) crimping plus inflation of low-pressure balloon; (4) condition III plus post-dilatation (high-pressure balloon). For each condition, valvular leaflets (and a venous wall sample for Melody(®) stents) were taken for histological analysis and mechanical uniaxial testing of the valve leaflets. RESULTS Among the Melody(®) valves, the incidence of transverse fractures was significantly higher in traumatized samples compared with the control group (P<0.05), whereas the incidence and depth of transverse fractures were not statistically different between the four conditions for bovine and porcine pericardial leaflets. No significant modification of the mechanical behaviour of in vitro traumatized Melody(®) valvular leaflets was observed. Bovine and porcine pericardia became more elastic and less resilient after balloon expansion and post-dilatation (conditions III and IV), with a significant decrease in elastic modulus and stress at rupture. CONCLUSION Valved stent implantation procedural steps induced histological lesions on Melody(®) valve leaflets. Conversely, bovine and porcine pericardial valved stents were not histologically altered by in vitro manipulations, although their mechanical properties were significantly modified. These data could explain some of the long-term complications observed with these substitutes.
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Affiliation(s)
- Zakaria Jalal
- Centre de référence malformations cardiaques congénitales complexes, M3C, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, paediatric cardiology, 149, rue de Sèvres, 75015 Paris cedex, France
| | - Louise Galmiche
- Hôpital Necker-Enfants-Malades, laboratoire d'anatomopathologie, 75015 Paris, France
| | - Christophe Beloin
- Unité de génétique des biofilms, département de microbiologie, institut Pasteur, 75015 Paris, France
| | - Younes Boudjemline
- Centre de référence malformations cardiaques congénitales complexes, M3C, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, paediatric cardiology, 149, rue de Sèvres, 75015 Paris cedex, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.
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Kim YY, Ruckdeschel E. Approach to residual pulmonary valve dysfunction in adults with repaired tetralogy of Fallot. Heart 2016; 102:1520-6. [DOI: 10.1136/heartjnl-2015-309067] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/23/2016] [Indexed: 12/28/2022] Open
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Stabilizing an Embolized Pre-stent into the Right Ventricle During MELODY Valve Implantation. Pediatr Cardiol 2016; 37:979-82. [PMID: 27053169 DOI: 10.1007/s00246-016-1384-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
Abstract
Stent embolization is a complication that usually requires surgical extraction. We report a case where the covered stent used in MELODY valve trans-catheter pulmonary valve placement embolized to the right ventricle after being fully dilated on a 24-m-diameter balloon. After several unsuccessful attempts trying to capture it back or push it forward to the intended landing zone, we succeeded in deploying another stent straddling the embolized stent to anchor both of them in the main pulmonary artery. Two months later, we performed the valve implantation supported by both pre-stents.
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