Early Outcomes of Pulmonary Valve and Right Ventricle to Pulmonary Artery (RV-PA) Conduit Replacement

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

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Evaluation of right ventricle pulmonary artery coupling on right ventricular function in post operative tetralogy of Fallot patients underwent for pulmonary valve replacement

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01281-1 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Bhushan Sandeep ◽

Xin Huang ◽

Yuan Li ◽

Xiaowei Wang ◽

Long Mao ◽

...

Keyword(s):

Magnetic Resonance ◽

Pulmonary Artery ◽

Right Ventricle ◽

Right Ventricular ◽

Ventricular Function ◽

Right Ventricular Function ◽

Pulmonary Valve ◽

Primary Repair ◽

Pulmonary Valve Replacement ◽

Rv Function

Abstract Background To evaluate RV-PA coupling in post operative TOF patients with ventricular dilatation underwent for PVR and investigate the correlation between ventricular functions measuring Ea/Emax ratio using cardio magnetic resonance and the effect of surgical type at primary repair of TOF on coupling. Method RV-PA coupling was measured noninvasively by Ea/Emax ratio from CMRI and ECHO. From CMRI results the patients were divided in two groups, RV-PA coupling and RV-PA uncoupling. Ea/Emax ≤1 was considered for coupling patients and Ea/Emax > 1 for uncoupling patients. Results Ninety patients were uncoupled (Ea/Emax: 1.55 ± 0.46) and 45 were coupled (Ea/Emax: 0.81 ± 0.15). Out of 75 TAP repaired patients 60 were uncoupled RV-PV. In addition, higher pro-BNP is an important factor for uncoupled RV-PV (P = 0.001). CMR evaluation for right ventricular function between uncoupling and coupling were RVEDVi (196.65 ± 63.57 vs. 154.28 ± 50.07, P = 0.001), RVESVi (121.19 ± 51.47 vs. 83.94 ± 20.43, P = 0.001), RVSVi (67.19 ± 19.87 vs. 106.31 ± 33.44, P = 0.001), and RVEF (40.90 ± 8.73 vs. 54.63 ± 4.76, P = 0.001). The increased RVEDVi, RVESVi and RVSVi and decreased RVEF have significant correlation with Ea/Emax. Ea/Emax was also found positively correlated with RVEDVi (P = < 0.05, r = 0.35), RVESVi (P = < 0.001, r = 0.41) and negatively correlated with RVSVi (P = < 0.05, r = 0.22) and RVEF (P = < 0.05, r = 0.78). Conclusions Unfavorable RV-PA coupling is present in post operative TOF patients and it is affected by several factors. Our results explain a new concept of RV-PA interactions as a contributing mechanism for the observed decline in RV function.

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97 An unusual combination of rare congenital heart defects in a 70 years old lady complaining worsening dyspnea

European Heart Journal Supplements ◽

10.1093/eurheartj/suab133.005 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Matteo Bellettini ◽

Antonio Montefusco ◽

Andrea Angelini ◽

Fulvio Orzan ◽

Fabrizio D’Ascenzo ◽

...

Keyword(s):

Coronary Artery ◽

Left Ventricle ◽

Pulmonary Artery ◽

Right Ventricle ◽

Tricuspid Regurgitation ◽

Congenital Heart ◽

Pulmonary Valve ◽

Pulmonary Regurgitation ◽

Subaortic Membrane ◽

The Right

Abstract Methods and results A 70-year-old woman presented to our outpatient clinic complaining of worsening dyspnoea in the last 3 months. She had a medical history of hypertension, diabetes, dyslipidemia, and paroxysmal atrial fibrillation. We performed a comprehensive evaluation starting with a transthoracic echocardiogram that showed a dilatation of right ventricle with normal function, severe pulmonary regurgitation, and moderate tricuspid regurgitation with estimated pulmonary artery systolic pressure of 55 mmHg; the left ventricle had normal dimension and function, with mild aortic and mitral regurgitation, and a subaortic membrane which caused a mild obstruction (maximum gradient 17 mmHg). The cardiac magnetic resonance (CMR) confirmed the enlargement of the right ventricle and of the pulmonary artery trunk (51 mm) and the severity of pulmonary regurgitation (regurgitant fraction of 41%). CMR also clearly showed the VSD just below the subaortic membrane and the left to right shunt with a jet that appeared to proceed straight from the left ventricle through the pulmonary valve (Figure 1A). The estimated Qp/Qs was 1.6 and no intramyocardial late enhancement was present. Pulmonary pressures and pulmonary vascular resistance were normal at the right heart catheterization and the Qp/Qs ratio calculated invasively was 1.45. Considering patient high-risk profile for coronary artery disease, a coronary angiography was also performed showing an abnormal origin of the right coronary artery (RCA) from the mid-portion of the left anterior descending coronary artery (LAD) with two significant stenosis: one involving the bifurcation of RCA and the other the mid-portion of the LAD (Figure 1B). The coronary computed tomography angiography (CCTA) showed a benign course of the RCA anterior to the pulmonary artery towards the auriculoventricular groove (Figure 1C, D). Taking into account all these findings, multidisciplinary heart team decided to perform a cardiac surgery intervention of pulmonary valve and trunk replacement, closure of ventricular septal defect and two coronary bypass grafts on LAD and RCA. Conclusions This case represents a combination of some rare congenital heart abnormalities where multimodality cardiovascular imaging techniques were essential to establish a proper diagnosis and to plan an adequate surgical repair. We hypothesize that the peculiar orientation of the VSD jet may have caused the pulmonary trunk dilatation considering that neither the shunt, nor the pulmonary pressure appear to have been of sufficient magnitude to cause it. Pulmonary ectasia and the damage inflicted by the jet to the cusps of the valve have led to the severe valvular insufficiency. While aortic and tricuspid regurgitation are known to be associated with VSD, to the best of our knowledge this is the first report of pulmonary regurgitation secondary to VSD.

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Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction

The Lancet ◽

10.1016/s0140-6736(00)02844-0 ◽

2000 ◽

Vol 356 (9239) ◽

pp. 1403-1405 ◽

Cited By ~ 655

Author(s):

Philipp Bonhoeffer ◽

Younes Boudjemline ◽

Zakhia Saliba ◽

Jacques Merckx ◽

Yacine Aggoun ◽

...

Keyword(s):

Pulmonary Artery ◽

Right Ventricle ◽

Pulmonary Valve ◽

Valve Dysfunction

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Evaluation of right ventricle pulmonary artery coupling on right ventricular function in post operative Tetralogy of Fallot patients underwent for pulmonary valve replacement

10.21203/rs.3.rs-22394/v2 ◽

2020 ◽

Author(s):

Sandeep Bhushan ◽

Huang Xin ◽

Li Yuan ◽

Wang Xiaowei ◽

Mao Long ◽

...

Keyword(s):

Magnetic Resonance ◽

Pulmonary Artery ◽

Right Ventricle ◽

Right Ventricular ◽

Ventricular Function ◽

Right Ventricular Function ◽

Pulmonary Valve ◽

Primary Repair ◽

Pulmonary Valve Replacement ◽

Rv Function

Abstract Background: To evaluate RV-PA coupling in post operative TOF patients with ventricular dilatation underwent for PVR and investigate the correlation between ventricular functions measuring Ea/Emax ratio using cardio magnetic resonance and the effect of surgical type at primary repair of TOF on coupling.Method: RV-PA coupling was measured noninvasively by Ea/Emax ratio from CMRI and ECHO. From CMRI results the patients were divided in two groups, RV-PA coupling and RV-PA uncoupling. Ea/Emax ≤1 was considered for coupling patients and Ea/Emax >1 for uncoupling patients.Results : 90 patients were uncoupled (Ea/Emax: 1.55±0.46) and 45 were coupled (Ea/Emax: 0.81±0.15). Out of 75 TAP repaired patients 60 were uncoupled RV-PV. In addition, higher pro-BNP is an important factor for uncoupled RV-PV ( P =0.001). CMR evaluation for right ventricular function between uncoupling and coupling were RVEDVi (196.65±63.57 vs. 154.28±50.07, P =0.001), RVESVi (121.19±51.47 vs. 83.94±20.43, P =0.001), RVSVi (67.19±19.87 vs. 106.31±33.44, P =0.001), and RVEF (40.90±8.73 vs. 54.63±4.76, P =0.001). The increased RVEDVi, RVESVi and RVSVi and decreased RVEF have significant correlation with Ea/Emax. Ea/Emax was also found positively correlated with RVEDVi ( P=< 0.05, r =0.35), RVESVi ( P=< 0.001, r =0.41) and negatively correlated with RVSVi ( P=< 0.05, r =0.22) and RVEF ( P=< 0.05, r =0.78).Conclusions: Unfavorable RV-PA coupling is present in post operative TOF patients and it is affected by several factors. Our results explain a new concept of RV-PA interactions as a contributing mechanism for the observed decline in RV function.

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Primary infective endocarditis with isolated involvement of the pulmonary valve not associated with drug addiction

The Clinician ◽

10.17650/1818-8338-2019-13-1-2-65-71 ◽

2019 ◽

Vol 13 (1-2) ◽

pp. 65-71

Author(s):

N. S. Chipigina ◽

N. Yu. Karpova ◽

M. M. Tulinov ◽

E. V. Golovko ◽

L. M. Goloukhova ◽

...

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

Pulmonary Artery ◽

Right Ventricle ◽

Female Patient ◽

Drug Addiction ◽

Clinical Picture ◽

Rare Case ◽

Pulmonary Valve ◽

The Right

Objective: to describe a rare case of infective endocarditis (IE) with isolated localization in the pulmonary valve (PV).Materials and methods. We observed primary IE with isolated localization in the PV in a 27-year-old female patient without risk factors of right-side IE.Results. The disease was caused by Streptococcus gordonii and proceeded acutely with typical signs of right-side IE: fever above 38 °С, chills, clinical picture of bilateral septic embolic abscess pneumonia, as well as secondary anemia, secondary thrombocytopenia, and glomerulonephritis. Echocardiography showed large vegetations in the PV prolapsing in the right ventricle and pulmonary artery.Conclusion. IE with localization in the PV should be suspected in patients with fever and clinical picture of septic embolic pneumonia in absence of other embolic situations.

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Does Larger Fetal Ascending Aorta Than the Pulmonary Artery Indicate Major Cardiac Anomaly?

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2020.1060 ◽

2020 ◽

pp. 1

Author(s):

Safak Yilmaz Baran ◽

Alev Arslan ◽

Gulsen Dogan Durdag ◽

Hakan Kalayci ◽

Seda Yuksel Simsek ◽

...

Keyword(s):

Pulmonary Artery ◽

Right Ventricle ◽

Pulmonary Valve ◽

Main Pulmonary Artery ◽

Double Outlet Right Ventricle ◽

Ascending Aorta ◽

Pulmonary Valve Stenosis ◽

Chamber View ◽

Aorta Diameter ◽

Pulmonary Artery Diameter

OBJECTIVE: This study investigated the cases in which the fetal ascending aorta is larger than the main pulmonary artery on the three-vessel view and aimed to determine the relationship between the larger ascending aorta and major cardiac anomalies.STUDY DESIGN: Pregnancies between 18-24 gestational weeks who underwent detailed second-trimester screening during 2015-2019 were evaluated. Cases whose fetal ascending aorta diameter was larger than fetal main pulmonary artery diameter on the three-vessel view despite normal four-chamber view were analyzed. Prenatal and postnatal echocardiography studies were performed for each case.RESULTS: Fetal ascending aorta diameter larger than fetal main pulmonary artery diameter on the three-vessel view despite normal four-chamber view was detected in 21 fetuses in a total of 3810 pregnancies (0.55%), and 10 (47.6%) of them had major congenital heart disease. The diagnosis of Tetralogy of Fallot, double outlet right ventricle, ventricular septal defect, pulmonary valve stenosis, and moderate to severe tricuspid regurgitation were confirmed with prenatal/postnatal echocardiography studies. The highest ratio of ascending aorta/main pulmonary artery was 1.4 in a fetus with a double outlet right ventricle and pulmonary valve stenosis.CONCLUSION: The fetal ratio of ascending aorta/main pulmonary artery larger than 1 on the three-vessel view may be a sign of certain cardiac anomalies. Nevertheless, this rate is not an indicator of a serious cardiac defect in all cases. Fetal advanced echocardiography and early postnatal cardiac evaluation should be done to confirm the diagnosis.

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