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Kapalka M, Galeczka M, Krawiec M, Fiszer R. Percutaneous pulmonary valve implantation in a patient with congenitally corrected transposition of the great arteries: a case report. J Med Case Rep 2024; 18:70. [PMID: 38378619 PMCID: PMC10880314 DOI: 10.1186/s13256-024-04383-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/14/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Percutaneous pulmonary valve implantation has become an attractive method of dysfunctional right ventricle outflow tract treatment. CASE PRESENTATION We describe a unique case of a 20-year-old Caucasian male patient with a complex cyanotic heart defect, namely pulmonary atresia, with congenitally corrected transposition of the great arteries and ventricular septal defect after Rastelli-like surgery at the age of 5 years with homograft use. At the age of 20 years, the patient needed percutaneous pulmonary valve implantation owing to homograft dysfunction. Despite unusual course of the coronary arteries, balloon testing in the landing zone of the right ventricle outflow tract excluded potential coronary artery compression. Then, after presentation, a Melody valve was implanted successfully in the pulmonary valve position. The 8-year follow-up was uneventful. CONCLUSION This is likely the first description of a percutaneous pulmonary valve implantation in such anatomy. Such a procedure is feasible; however, it requires exceptional caution owing to the anomalous coronary arteries course, which can be the reason for their compression.
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Affiliation(s)
- Michal Kapalka
- Student Scientific Association at Department of Paediatric Cardiology and Congenital Heart Defects, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Michal Galeczka
- Department of Paediatric Cardiology and Congenital Heart Defects, Faculty of Medical Sciences in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Curie-Sklodowskiej 9 Street, 41-800, Zabrze, Poland.
| | - Michal Krawiec
- Student Scientific Association at Department of Paediatric Cardiology and Congenital Heart Defects, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Roland Fiszer
- Department of Paediatric Cardiology and Congenital Heart Defects, Faculty of Medical Sciences in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Curie-Sklodowskiej 9 Street, 41-800, Zabrze, Poland
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Pan W, Hou S, Chen S, Zhou D, Ge J. Advancing a Bulky Delivery System Using a Novel Technique During Percutaneous Pulmonary Valve Implantation. Tex Heart Inst J 2022; 49:487443. [DOI: 10.14503/thij-20-7541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Wenzhi Pan
- 1 Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People's Republic of China
| | - Shiqiang Hou
- 1 Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People's Republic of China
| | - Shasha Chen
- 1 Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People's Republic of China
| | - Daxin Zhou
- 1 Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People's Republic of China
| | - Junbo Ge
- 1 Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People's Republic of China
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Bobylev D, Avsar M, Sarikouch S, Cvitkovic T, Boethig D, Westhoff-Bleck M, Bertram H, Beerbaum P, Haverich A, Horke A. Valve-sparing aortic root replacement in adult patients with congenital heart disease. Interact Cardiovasc Thorac Surg 2021; 33:959-965. [PMID: 34279037 DOI: 10.1093/icvts/ivab189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 06/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Aortic root dilatation is frequently observed in patients with congenital heart defects (CHD), but has received little attention in terms of developing a best practice approach for treatment. In this study, we analysed our experience with aortic valve-sparing root replacement in patients following previous operations to repair CHD. METHODS In this study, we included 7 patients with a history of previous surgery for CHD who underwent aortic valve-sparing operations. The underlying initial defects were tetralogy of Fallot (n = 3), transposition of great arteries (n = 2), coarctation of the aorta (n = 1), and pulmonary atresia with ventricle septum defect (n = 1). The patients' age ranged from 20 to 40 years (mean age 31 ± 6 years). RESULTS David reimplantation was performed in 6 patients and a Yacoub remodelling procedure was performed in 1 patient. Four patients underwent simultaneous pulmonary valve replacement. The mean interval between the corrective procedure for CHD and the aortic valve-sparing surgery was 26 ± 3 years. There was no operative or late mortality. The patient with transposition of great arteries following an arterial switch operation was re-operated 25 months after the valve-sparing procedure due to severe aortic regurgitation. In all other patients, the aortic valve regurgitation was mild or negligible at the latest follow-up (mean 8.7 years, range 2.1-15.1 years). CONCLUSIONS Valve-sparing aortic root replacement resulted in good aortic valve function during the first decade of observation in 6 of 7 patients. This approach can offer a viable alternative to root replacement with mechanical or biological prostheses in selected patients following CHD repair.
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Affiliation(s)
- Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tomislav Cvitkovic
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Harald Bertram
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Kothari SS. Percutaneous pulmonary valve implantation in India: Quo Vadis? Ann Pediatr Cardiol 2021; 14:310-314. [PMID: 34667401 PMCID: PMC8457268 DOI: 10.4103/apc.apc_127_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Shyam Sunder Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Tengler A, Ulrich S, Fischer M, Pastor-Villaescusa B, Kanaan M, Pozza RD, Haas NA, Jakob A. Rationale and feasibility of transcatheter pulmonary valve implantation in small conduits with the Edwards Sapien valves. Int J Cardiol 2020; 325:45-50. [PMID: 33049296 DOI: 10.1016/j.ijcard.2020.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/06/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Conduit dilatation above 110% and TPVI in conduits <16 mm is not recommended. However, if we want to reach normal values for RVOT diameters and diminish reintervention rates, pushing these boundaries is essential. METHODS Analysis of subsequent patients who underwent TPVI with Edwards Sapien valves in conduits ≤16 mm between 2010 and 2020. RESULTS In n = 33 cases median age was 13 years (5-20 y) and median weight 47 kg (15-91 kg). Preexisting RVOT grafts were n = 28 Contegra® conduits and n = 5 homografts (12 mm n = 15; 14 mm n = 11; 16 mm n = 7). Implanted were the Sapien (n = 8), Sapien XT (n = 10) and Sapien 3 valve (n = 15) with 20 mm (n = 4), 23 mm (n = 19), 26 mm (n = 9) and 29 mm (n = 1). Mean minimal RVOT diameter after TPVI was 22,7 ± 2,3 mm (18-30 mm) which is 150% of the mean minimal RVOT diameter before TPVI (15,1 ± 4,3 mm). Covered stents were used in n = 10 cases. Contained conduit rupture occurred in n = 7 cases (21%). Residual RVOT gradients of 5,7 ± 4,9 mmHg (0-18 mmHg) showed adequate RV unloading. CONCLUSION TPVI could be performed successfully in all patients. Dilatation above 150% and a valve/conduit diameter ratio up to 2,4 were well tolerated. There was a considerable amount of conduit rupture but all were confined without further need for intervention or surgery.
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Affiliation(s)
- Anja Tengler
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany.
| | - Sarah Ulrich
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany
| | - Marcus Fischer
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany
| | - Belén Pastor-Villaescusa
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, LMU Ludwig Maximilians University Munich, 80337 Munich, Germany
| | - Majed Kanaan
- Center for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany; Department for Congenital Heart Defects, University Hospital Aachen, 52074 Aachen, Germany
| | - Robert Dalla Pozza
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany
| | - Nikolaus A Haas
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany
| | - André Jakob
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany
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Early Outcomes of Percutaneous Pulmonary Valve Implantation with Pulsta and Melody Valves: The First Report from Korea. J Clin Med 2020; 9:jcm9092769. [PMID: 32859019 PMCID: PMC7565703 DOI: 10.3390/jcm9092769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 02/05/2023] Open
Abstract
Percutaneous pulmonary valve implantation (PPVI) is used to treat pulmonary stenosis (PS) or pulmonary regurgitation (PR). We described our experience with PPVI, specifically valve-in-valve transcatheter pulmonary valve replacement using the Melody valve and novel self-expandable systems using the Pulsta valve. We reviewed data from 42 patients undergoing PPVI. Twenty-nine patients had Melody valves in mostly bioprosthetic valves, valved conduits, and homografts in the pulmonary position. Following Melody valve implantation, the peak right ventricle-to-pulmonary artery gradient decreased from 51.3 ± 11.5 to 16.7 ± 3.3 mmHg and right ventricular systolic pressure fell from 70.0 ± 16.8 to 41.3 ± 17.8 mmHg. Thirteen patients with native right ventricular outflow tract (RVOT) lesions and homograft underwent PPVI with the new self-expandable Pulsta valve—a nitinol wire stent mounted with a trileaflet porcine pericardial valve. Following Pulsta valve implantation, cardiac magnetic resonance imaging showed a decreased PR fraction and that the right ventricular end-diastolic volume index decreased from 166.1 ± 11.9 to 123.6 ± 12.4 mL/m2. There were no mortality, severe procedural morbidity, or valve-related complications. At the mean 14.2 month (4–57 months) follow-up, no patients had more than mild PR. PPVI using Melody and Pulsta valves was first shown to provide excellent early outcomes without serious adverse event in most patients with RVOT dysfunction in Korea.
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