The Utility of Intracardiac Echocardiography Following Melody™ Transcatheter Pulmonary Valve Implantation

2015 ◽  
Vol 36 (8) ◽  
pp. 1754-1760 ◽  
Author(s):  
Wendy Whiteside ◽  
Sara K. Pasquali ◽  
Sunkyung Yu ◽  
Martin L. Bocks ◽  
Jeffrey D. Zampi ◽  
...  
Keyword(s):  
Pulmonary Valve ◽  
Intracardiac Echocardiography ◽  
Valve Implantation ◽  
Pulmonary Valve Implantation

Abstract 17451: Use of Intracardiac Echocardiography to Predict Follow-Up Hemodynamic Changes After Transcatheter Pulmonary Valve Implantation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Salvador Alberto J Rodriguez Franco ◽  
Salvador Alberto A Rodriguez Franco ◽  
Ryan A Leahy ◽  
Jess T Randall ◽  
Jenny E Zablah ◽  
...  
Keyword(s):  
Strong Correlation ◽  
Pulmonary Valve ◽  
Retrospective Chart Review ◽  
Intracardiac Echocardiography ◽  
Predictive Equation ◽  
Post Procedure ◽  
Correlation Models ◽  
Valve Function ◽  
Valve Implantation ◽  
Pulmonary Valve Implantation

Objective: Evaluate the correlation between intracardiac echocardiography (ICE) gradients and next-day and one-month transthoracic echocardiography (TTE) gradients, after percutaneous pulmonary valve implantation (PPVI) Background: Post-procedure Doppler-derived gradients have gained popularity as acceptable parameters to evaluate valve function after PPVI, but they have no proven correlation with the invasive gradient measured during the procedure, indeed a large disparity between these two measurements has been described. Interestingly, ICE gradients, which are also an invasive assessment, have been suggested to present a strong correlation with post-procedure echocardiographic evaluations, and their application could allow a more accurate and predictable evaluation of valve function, establishing a typical pattern of short-term hemodynamic progression in these patients. Methods: We performed a retrospective chart review of 84 patients who underwent PPVI between January 2018 and December 2019 and selected 51 patients in whom ICE was performed after valve implantation. We evaluated the correlation between ICE and RV-PA gradients with post-procedural Doppler-derived gradients. Among the parameters assessed, the one which demonstrated the strongest correlation was used to create a predictive model to estimate the expected gradients after PPVI. Results: All the assessed correlation models between Doppler-derived parameters during ICE evaluation and post-procedure TTE evaluations were statistically significant, and presented moderate to strong linear relationships. The strongest correlation was found between ICE Doppler mean gradient and post-procedural Doppler mean gradient. The derived predictive equation was distributed by the size of the device implanted and body mass index. We found this model was capable of predicting post-procedural evaluations (mean Doppler-derived gradients at 1 day and 1 month) within a range of ±5 mmHg from the observed value in more than 80% of cases. Conclusions: There is a strong correlation between ICE and post-procedure TTE. This allowed us to derive a predictive equation, distributed by body size and device size that defines expected echo Doppler-derived hemodynamic pathways after PPVI.

Baseline intracardiac echocardiography predicts haemodynamic changes and Doppler velocity patterns during follow-up after percutaneous pulmonary valve implantation

2021 ◽  
pp. 1-7
Author(s):  
Gareth J. Morgan ◽  
Salvador A. Rodriguez ◽  
Ryan Leahy ◽  
Jess Randall ◽  
Jenny E. Zablah
Keyword(s):  
Pulmonary Valve ◽  
Intracardiac Echocardiography ◽  
Doppler Velocity ◽  
Post Procedure ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Starting Point ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve ◽  
Pulmonary Valve Implantation

Abstract Background: Intracardiac echocardiography Doppler-derived gradients have previously been shown to correlate with post-procedure echocardiographic evaluations when compared with invasive gradients measured during percutaneous pulmonary valve implantation, suggesting that intracardiac echocardiography could offer an accurate and predictable starting point to estimate valve function after percutaneous pulmonary valve implantation. Methods: We performed a retrospective chart review of 51 patients who underwent percutaneous pulmonary valve implantation between September 2018 and December 2019 in whom intracardiac echocardiography was performed immediately after valve implantation. We evaluated the correlation between intracardiac echocardiography gradients and post-procedural Doppler-derived gradients. Among the parameters assessed, those which demonstrated the strongest correlation were used to create a predictive model of expected echo-derived gradients after percutaneous pulmonary valve implantation. The equation was validated on the same sample data along with a subsequent cohort of 25 consecutive patients collected between January 2020 and July 2020. Results: All the assessed correlation models between intracardiac echocardiography evaluation and post-procedure transthoracic echocardiographic assessments were statistically significant, presenting moderate to strong correlations. The strongest relationship was found between intracardiac echocardiography mean gradients and post-procedural transthoracic echocardiographic mean gradients. Therefore, an equation was created based on the intracardiac echocardiography-derived mean gradient, to allow prediction of the post-procedural and follow-up transthoracic echocardiographic-derived mean gradients within a range of ±5 mmHg from the observed value in more than 80% of cases. Conclusions: There is a strong correlation between intracardiac echocardiography and post-procedure transthoracic echocardiographic. This allowed us to derive a predictive equation that defines the expected transthoracic echocardiographic Doppler-derived gradient following the procedure and at out-patient follow-up after percutaneous pulmonary valve implantation.

Coronary event after transcatheter pulmonary valve implantation

2012 ◽  
Vol 60 (S 01) ◽  
Author(s):  
D Biermann ◽  
J Schönebeck ◽  
M Rebel ◽  
J Weil ◽  
H Reichenspurner ◽  
...  
Keyword(s):  
Pulmonary Valve ◽  
Coronary Event ◽  
Valve Implantation ◽  
Pulmonary Valve Implantation

Percutaneous Pulmonary Valve Implantation in a Bangladeshi Center: A Case Series

2020 ◽  
Vol 28 (1) ◽  
pp. 1-6
Author(s):  
Fatema Nurun Nahar ◽  
Jufan Mansur Al ◽  
Shubert Stephan ◽  
Hossain Mir Mahmud
Keyword(s):  
Heart Disease ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Pulmonary Valve ◽  
Case Series ◽  
Military Hospital ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve ◽  
Pulmonary Valve Implantation

INTRODUCTION Incidence of congenital heart disease is 25 per thousand live birth in Bangladesh which is much higher than other countries. Tetralogy of Fallot, the commonest cyanotic heart disease (5%) and some other complex diseases with right ventricular outflow tract abnormality demand surgical correction and revision in many occasions including percutaneous intervention. As a resource constraint country, it was a difficult task to introduce percutaneous pulmonary valve implantation (PPVI) with MelodyTM. However, it was started on 12th December 2012 in Combined Military Hospital Dhaka, Bangladesh and cases performed till October 2019 were included in this series. METHODS Retrospective analysis of six cases who had PPVI with MelodyTM in Combined Military Hospital, Bangladesh. Patient with dysfunctional conduit between right ventricle (RV) and pulmonary artery causing (a) Symptoms of exceptional dyspnoea of various grade (NYHA II,III, IV) (b) RVEVD >150 ml/m2 ±regurgitant fraction >40% (c) RVOT peak instantaneous gradient > 30 mm Hg. (d) RV dysfunction (RVEF<40%) were accepted for the procedure and outcome were analyzed. RESULTS Mean age was 9.56 ± 2.96 years, weight was 28.75 ± 8.61 kg, height was 137.5 ± 17.52 cm. Mean age at surgery was 4.25 ± 2.72 years. Female were 66.66%. Aortic homograft was used in 66.66% cases. Eighteen mm Ensemble was used in four (66.66%) cases and 20 mm and 22 mm in one each. Immediate result was excellent with no residual PS in two cases and negligible residual flow acceleration across pulmonary valve in four cases. No PR seen in all except one. One patient developed Bacterial endocarditis after 3 years and was treated. CONCLUSION Aim of PPVI is to prolong the life expectancy of conduits which were placed surgically from right ventricle to pulmonary artery. In our case series, we found that Melody valve is functioning well without any complications like infective endocarditis or stent fracture. KEYWORDS PPVI, MelodyTM, RVOT, Outcome

scholarly journals Acute and mid-term outcomes of transcatheter pulmonary valve implantation in patients older than 40 years

2021 ◽  
Vol 3 ◽  
pp. 100084
Author(s):  
Osamah Aldoss ◽  
Kaitlin Carr ◽  
Shabana Shahanavaz ◽  
David Balzer ◽  
Daniel S. Levi ◽  
...  
Keyword(s):  
Pulmonary Valve ◽  
Valve Implantation ◽  
Pulmonary Valve Implantation

#81: Care Process Measures and Outcomes of Percutaneous Pulmonary Valve Implantation-associated Infective Endocarditis

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S9-S9
Author(s):  
B Rubbab ◽  
C Talluto ◽  
A Nuibe ◽  
R Levorson
Keyword(s):  
Infective Endocarditis ◽  
Tetralogy Of Fallot ◽  
Median Duration ◽  
Pulmonary Valve ◽  
Coagulase Negative Staphylococcus ◽  
Elapsed Time ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve ◽  
Pulmonary Valve Implantation

Abstract Background Percutaneous pulmonary valve implantation (PPVI) is being increasingly used as a minimally invasive corrective procedure for right ventricular outflow tract (RVOT) dysfunction. Ten-year survival following PPVI is estimated at over 90% due to the durability of the various bioprosthetic valves. However, infective endocarditis (IE) remains a potential complication of such valves with significant morbidity and mortality. We evaluated the presenting symptoms, clinical features, pathogens, and outcomes of patients with IE following PPVI to identify opportunities to improve early diagnosis and management. Methods A convenience sample of patients at a large Pediatric Cardiology practice in Northern Virginia was queried for PPVI and IE from January 1, 2016, to June 30, 2019. Manual chart review was done to extract clinical points of interest and descriptive analyses were performed. Patients were classified as having IE per modified Duke’s criteria. Results We identified 14 patients who underwent PPVI. Five of these patients (36%) developed IE. All IE patients had underlying Tetralogy of Fallot and none had previous episodes of IE. 60% of patients with IE were male with a median age of 26 years old (IQR 20–30). Four IE patients had a Melody valve and 1 had a SAPIEN valve. The median elapsed time between PPVI and IE diagnosis was 128 days (IQR 32–391) with a median duration of illness prior to the diagnosis of IE of 6 days (IQR 5–9). All IE patients had to present fever. 40% of IE patients had to present chest pain and 20% had presenting musculoskeletal pain. All IE patients had an elevated initial C-reactive protein (CRP) with a median value of 13.1 mg/dL (IQR 12.5–15.2). The median initial white blood cell count was 9.3 × 103/μL (IQR 8.1–10.3). The median duration of bacteremia was 1 day (IQR 1–2). A pathogen was recovered in all five IE patients with different organisms amongst the patients: coagulase-negative Staphylococcus species were recovered in patients who developed IE within 60 days from PPVI (Staphylococcus lugdunensis and Staphylococcus epidermidis) whereas coagulase-negative Staphylococcus species and oral commensal organisms were found in IE patients beyond 60 days from PPVI (Staphylococcus sanguinis, Gamella haemolysans, and Neisseria elongata). The initial echocardiogram did not show vegetations in any of the patients and 40% went on to have sternotomy with valve replacement. There were no deaths. Conclusions With an increase in PPVI, clinicians should have a high index of suspicion for IE in patients with underlying Tetralogy of Fallot who present with fever and elevated CRP, regardless of elapsed time from PPVI or valve type. Empiric antimicrobial therapy for suspected IE following PPVI should remain broad with other possible pathogens beyond coagulase-negative Staphylococcus species.

scholarly journals Percutaneous Pulmonary Valve Implantation Alters Electrophysiologic Substrate

2016 ◽  
Vol 5 (10) ◽  
Author(s):  
Hoang H. Nguyen ◽  
Shabana Shahanavaz ◽  
George F. Van Hare ◽  
David T. Balzer ◽  
Ramzi Nicolas ◽  
...  
Keyword(s):  
Pulmonary Valve ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve ◽  
Pulmonary Valve Implantation
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