Challenges of percutaneous pulmonary valve implantation

2020 ◽  
pp. 127-144
Author(s):  
Robin HS Chen ◽  
Salim Jivanji ◽  
Sachin Khambadkone
Keyword(s):  
Decision Making ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Percutaneous Approach ◽  
Percutaneous Pulmonary Valve Implantation ◽  
The Right ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve ◽  
Artery Conduit

This case study looks at a common pathway in the management of a patient with truncus arteriosus. The chapter follows the various considerations in decision-making and the conundrums in contemplating an intervention in the right ventricular outflow tract. The chapter explores the evidence available in determining an intervention and the suitability in consideration for a percutaneous approach. It further explores the various conduits used in the creation of a ‘right ventricle to pulmonary artery’ conduit and the resulting challenges associated with them, the pre-procedural workup, the benefits and risks in the percutaneous approach, and the various valves (specifically the Melody® valve) currently available.

scholarly journals Favorable Atrial Remodeling After Percutaneous Pulmonary Valve Implantation and Its Association With Changes in Exercise Capacity and Right Ventricular Function

2021 ◽  
Author(s):  
Heiner Latus ◽  
Danik Born ◽  
Nerejda Shehu ◽  
Heiko Stern ◽  
Alfred Hager ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Exercise Capacity ◽  
Left Atrial ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Peak Oxygen Uptake ◽  
Outflow Tract ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve

Background Right atrial (RA) dilatation and impaired right ventricular (RV) filling are common in patients with RV outflow tract dysfunction. We aimed to study potential correlations between atrial function with clinically relevant hemodynamic parameters and to assess the predictive impact of atrial performance on the recovery of exercise capacity and RV pump function after percutaneous pulmonary valve implantation (PPVI). Methods and Results Altogether, 105 patients with right ventricular outflow tract dysfunction (median age at PPVI, 19.2 years; range, 6.2–53.4 years) who underwent cardiac magnetic resonance imaging before and 6 months after PPVI were included. RA and left atrial maximal and minimal volumes as well as atrial passive and active emptying function were assessed from axial cine slices. RA emptying function was inversely related to invasive RV end‐diastolic pressure, and RA passive emptying correlated significantly with peak oxygen uptake. After PPVI, a significant decrease in RA minimum volume was observed, whereas RA passive emptying function improved, and RA active emptying function decreased significantly. Patients with predominant right ventricular outflow tract stenosis showed more favorable changes in RA active and left atrial passive emptying than those with primary volume overload. None of the RA and left atrial emptying parameters was predictive for recovery of peak oxygen uptake or RV ejection fraction. Conclusions In patients with right ventricular outflow tract dysfunction, impaired RA emptying assessed by cardiac magnetic resonance imaging was associated with increased RV filling pressures and lower exercise capacity. PPVI leads to a reduction in RA size and improved passive RA emptying function. However, RA function was not associated with improved exercise performance and RV pump function.

First experiences with Myval Transcatheter Heart Valve System in the treatment of severe pulmonary regurgitation in native right ventricular outflow tract and conduit dysfunction

2021 ◽  
pp. 1-7
Author(s):  
Ender Odemis ◽  
Irem Yenidogan
Keyword(s):  
Right Ventricular ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Valve System ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve

Abstract The rate of morbidity and mortality related to pulmonary regurgitation and pulmonary stenosis are big concerns after the surgery for CHD. Percutaneous pulmonary valve implantation has been established as a less invasive technique compared to surgery with promising results according to long-term follow-up of the patients. There are only two approved valve options for percutaneous pulmonary valve implantation until now, which are Melody (Medtronic, Minneapolis, Minn, USA) and Sapien (Edwards Lifesciences, Irvine, Ca, USA). Both valves have limitations and do not cover entire patient population. Therefore, the cardiologists need more options to improve outcomes with fewer complications in a such promising area. Herein, we present a case series applying for pulmonary position in conduits and native right ventricular outflow tract of a new transcatheter valve system Myval ® which is designed for transcatheter aortic valve implantation procedures. This is the first patient series in which the use of Myvalv in dysfunctional right ventricular outflow tracts is described, after surgical repair of CHD.

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