Endocarditis risk following percutaneous pulmonary valve implantation is higher with Melody valve compared to Sapien valve.

AbstractCoronary artery compression is a rare and potentially fatal complication after percutaneous pulmonary valve implantation. We report on a case of an acute antero-septal non-ST myocardial infarction secondary to the partial laceration of the conduit and the creation of a thrombus giving an extrinsic compression of left anterior descendent coronary artery after Melody valve implantation.

Download Full-text

Early Outcomes of Percutaneous Pulmonary Valve Implantation with Pulsta and Melody Valves: The First Report from Korea

Journal of Clinical Medicine ◽

10.3390/jcm9092769 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2769

Author(s):

Ah Young Kim ◽

Jo Won Jung ◽

Se Yong Jung ◽

Jae Il Shin ◽

Lucy Youngmin Eun ◽

...

Keyword(s):

Right Ventricular ◽

Pulmonary Valve ◽

Pulmonary Regurgitation ◽

Systolic Pressure ◽

Volume Index ◽

Melody Valve ◽

Percutaneous Pulmonary Valve Implantation ◽

Valve Implantation ◽

Percutaneous Pulmonary Valve ◽

Pulmonary Valve Implantation

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.

Download Full-text

Mid-Term Outcomes Following Percutaneous Pulmonary Valve Implantation Using the “Folded Melody Valve” Technique

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009707 ◽

2021 ◽

Vol 14 (4) ◽

Author(s):

Zakaria Jalal ◽

Estíbaliz Valdeolmillos ◽

Sophie Malekzadeh-Milani ◽

Andreas Eicken ◽

Stanimir Georgiev ◽

...

Keyword(s):

Right Ventricular ◽

Pulmonary Valve ◽

Therapeutic Option ◽

Pulmonary Regurgitation ◽

Right Ventricular Outflow Tract ◽

Melody Valve ◽

Percutaneous Pulmonary Valve Implantation ◽

Valve Implantation ◽

Percutaneous Pulmonary Valve ◽

Pulmonary Valve Implantation

Background: The folded valve is a manual shortening of the Melody device, which has been validated as a valuable therapeutic option for the management of dysfunctional right ventricular outflow tracts needing a short valved stent. In this article, we aimed to evaluate, in a multicenter cohort, the mid-term outcomes of patients in whom a percutaneous pulmonary valve implantation was performed using the folded valve technique. Methods: A 2012 to 2018 retrospective multicenter study was performed in 7 European institutions. All patients who benefit from percutaneous pulmonary valve implantation with a folded Melody valve were included. Results: A total of 49 patients (median age, 19 years [range 4–56], 63% male) were included. The primary percutaneous pulmonary valve implantation indication was right ventricular outflow tract stenosis (n=19; 39%), patched native right ventricular outflow tracts were the most common substrate (n=15; 31%). The folded technique was mostly used in short right ventricular outflow tracts (n=28; 57%). Procedural success was 100%. After a median follow-up of 28 months (range, 4–80), folded Melody valve function was comparable to the immediate postimplantation period (mean transvalvular peak velocity=2.6±0.6 versus 2.4±0.6 m/s, P >0.1; only 2 patients had mild pulmonary regurgitation). Incidence rate of valve-related reinterventions was 2.1% per person per year (95% CI, 0.1%–3.9%). The probability of survival without valve-related reinterventions at 36 months was 90% (95% CI, 76%–100%). Conclusions: The folded Melody valve is a safe technique with favorable mid-term outcomes up to 6.5 years after implantation, comparable with the usual Melody valve implantation procedure. Complications and reinterventions rates were low, making this technique relevant in selected patients.

Download Full-text

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

ASEAN Heart Journal ◽

10.31762/ahj2028.0101 ◽

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

Download Full-text

Faculty Opinions recommendation of Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1107046.571360 ◽

2008 ◽

Author(s):

Larry Latson ◽

Athar Qureshi

Keyword(s):

Clinical Outcome ◽

Learning Curve ◽

Pulmonary Valve ◽

Technology And Learning ◽

Percutaneous Pulmonary Valve Implantation ◽

Valve Implantation ◽

Percutaneous Pulmonary Valve ◽

Pulmonary Valve Implantation

Download Full-text

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

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.025 ◽

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.

Download Full-text