Management of balloon rupture during a percutaneous pulmonary valve implantation procedure

2018 ◽  
Vol 28 (10) ◽  
pp. 1168-1170 ◽  
Author(s):  
Alessia Faccini ◽  
Massimo Chessa ◽  
Mansour Aljoufan
Keyword(s):  
Right Ventricle ◽  
Pulmonary Valve ◽  
Outflow Tract ◽  
Alternative Procedure ◽  
Landing Zone ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve ◽  
Implantation Procedure ◽  
Pulmonary Valve Implantation

AbstractPercutaneous pulmonary valve implantation is increasingly adopted as an alternative procedure to surgery in dysfunctional homograft, and in patients with “native” or wide right ventricle outflow tract dysfunction. Pre-stenting is mandatory in this category of patients for many reasons, one of which is to create an adequate landing zone for the bioprosthesis. Here we report on a tricky situation that occurred during pre-stenting, and we describe how we successfully overcame it.

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

Abstract 3176: Percutaneous Pulmonary Valve Implantation Is A Successful Treatment Option For RVOT Conduit Failure After Ross Procedure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Johannes Nordmeyer ◽  
Philipp Lurz ◽  
Louise Coats ◽  
Fiona Walker ◽  
Andrew M Taylor ◽  
...  
Keyword(s):  
Treatment Option ◽  
Pulmonary Valve ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Ross Procedure ◽  
Ross Operation ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve ◽  
Pulmonary Valve Implantation

Background- The Ross operation offers good autograft function and low re-operation rates for the left ventricular outflow tract, however, the rate of conduit dysfunction in the right ventricular outflow tract (RVOT) remains a significant concern. Percutaneous pulmonary valve implantation (PPVI) is a novel trans-catheter treatment option for RVOT conduit dysfunction. Methods and Results- Of the 156 patients who underwent PPVI at our institutions with the current device, we retrospectively analyzed the outcomes of 11 patients (mean age: 26±5 years) who had RVOT conduit failure, 11.3±3.2 years following the Ross operation. PPVI could be performed in all patients (procedure time: 100±15 min; fluoroscopy time: 20±6 min). The RVOT gradient during catheterization and pulmonary regurgitant fraction (PRF) measured on magnetic resonance imaging (MRI) fell after PPVI (RVOT gradient: 35±6.5 mmHg to 14±2.8 mmHg, P<0.01; PRF: 18±6% to 3±2%, P<0.05). During mean follow-up of 17.4±5.2 months, there was 1 explantation (re-stenosis). The probability for freedom from RVOT re-operation was 100% at 1 year and 85.7% at 3 years. Conclusions- Failure of the conduit in the RVOT following Ross procedure can be successfully treated with PPVI to decrease the cumulative surgical burden in the lifetime management of congenital or acquired lesions of ventricular outflow tracts.

Percutaneous pulmonary valve implantation in patients after Ross procedure: role of intravascular ultrasound

2018 ◽  
Vol 29 (2) ◽  
pp. 256-258 ◽  
Author(s):  
Karol Zbroński ◽  
Lidia Tomkiewicz-Pająk ◽  
Janusz Kochman ◽  
Zenon Huczek
Keyword(s):  
Right Ventricle ◽  
Intravascular Ultrasound ◽  
Pulmonary Valve ◽  
Covered Stent ◽  
Outflow Tract ◽  
Balloon Inflation ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Coronary Compression ◽  
Pulmonary Valve Implantation

AbstractCoronary compression exclusion during right ventricle outflow tract stenting is recommended and potential oversight may be fatal. Balloon inflation in right ventricle outflow tract with simultaneous aortography can be inconclusive or falsely negative. We present a case of 27-year-old male post Ross operation qualified for percutaneous pulmonary valve implantation. Neither of the conventional views obtained provided a definite exclusion of coronary compression, therefore an intravascular ultrasound of the left coronary artery before and during balloon inflation in right ventricle outflow tract was performed. Acquired images allowed excluding potential constriction, thus a covered stent and pulmonary valve were implanted and the procedure was concluded. Two hours later, the patient complained of chest pain. Transthoracic echocardiography demonstrated a significant pericardial effusion. Retrospective analysis of the final angiogram revealed a possibility of subtle extravasation at the distal part of the homograft. A hybrid procedure consisting of additional covered stent implantation, pericardial drainage, and second pulmonary valve implantation was performed with an acceptable result. To conclude, in case of doubtful or unconvincing images obtained from aortography or selective angiography during balloon inflation in right ventricle outflow tract, intravascular ultrasound might be a feasible and useful technique. Signs of homograft rupture may be subtle, whereas symptoms of cardiac tamponade delayed. In selected patients percutaneous treatment of homograft rupture is achievable and beneficial.

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