The snared wire technique for Sapien valve implantation in the pulmonary position

Advancing a Bulky Delivery System Using a Novel Technique During Percutaneous Pulmonary Valve Implantation

During percutaneous pulmonary valve implantation, it is challenging to advance the delivery system loaded with a stent-valve through the right ventricular outflow tract. An extra-stiff wire can provide enough supporting and stable positioning to prevent the displacement of the guide wire in stent-valve delivery. In the 2 cases reported here, we used a snare to trap the extra-stiff wire and a large sheath to support the snare; thus, the extra-stiff wire was pulled to the distal end and provided strong support for the advancement of the delivery system. After 8 months of follow-up, the patients were in good condition with excellent valve function. We named this novel, efficient technique the “parallel anchor sheath snare” technique. This report highlights a novel delivery strategy for patients with tortuous right ventricular outflow tracts in percutaneous pulmonary valve implantation.

The rescue snared wire technique for challenging transcatheter pulmonary valve implantation: a case series of two patients

Background

Transcatheter pulmonary valve implantation (TPVI) is an effective treatment for right ventricular outflow tract (RVOT) dysfunction. Patients affected by congenital heart disease requiring TPVI may have difficult anatomies, thus making the intervention technically demanding.

Case summary

We report a case series of two patients affected by RVOT dysfunction. Both the cases were characterized by difficulty to advance the valve over the wire, which was successfully overcome by the application of the snared wire technique (SWT) to TPVI.

Discussion

Various technical pitfalls and tips have been described to facilitate the delivery of the transcatheter Edwards Sapien valve in the pulmonary position. The SWT described by the authors may be a helpful tool to gain supportiveness and stability of the guidewire during the procedure.