A rare cause of Right ventricular outflow tract Pseudoaneurysm in Tetralogy of Fallot

Pseudoaneurysm of the right ventricular outflow tract(RVOT) is an uncommon yet catastrophic complication after intracardiac repair of Tetralogy of Fallot(TOF). We describe a patient diagnosed with RVOT pseudoaneurysm in the immediate postoperative period after complete repair for TOF with single pulmonary artery. The pseudoaneurysm was repaired successfully. This case is reported to emphasise the importance of a high degree of suspicion of this rare entity in these patients for its early diagnosis and management.

Tissue Engineered Transcatheter Pulmonary Valved Stent Implantation: Current State and Future Prospect

Patients with the complex congenital heart disease (CHD) are usually associated with right ventricular outflow tract dysfunction and typically require multiple surgical interventions during their lives to relieve the right ventricular outflow tract abnormality. Transcatheter pulmonary valve replacement was used as a non-surgical, less invasive alternative treatment for right ventricular outflow tract dysfunction and has been rapidly developing over the past years. Despite the current favorable results of transcatheter pulmonary valve replacement, many patients eligible for pulmonary valve replacement are still not candidates for transcatheter pulmonary valve replacement. Therefore, one of the significant future challenges is to expand transcatheter pulmonary valve replacement to a broader patient population. This review describes the limitations and problems of existing techniques and focuses on decellularized tissue engineering for pulmonary valve stenting.

Hybrid Surgery for Severe Mitral Valve Calcification: Limitations and Caveats for an Open Transcatheter Approach

Background and Objectives: Mitral stenosis with extensive mitral annular calcification (MAC) remains surgically challenging in respect to clinical outcome. Prolonged surgery time with imminent ventricular rupture and systolic anterior motion can be considered as a complex of causal factors. The aim of our alternative hybrid approach was to reduce the risk of annual rupture and paravalvular leaks and to avoid obstruction of the outflow tract. A review of the current literature was also carried out. Materials and Methods: Six female patients (mean age 76 ± 9 years) with severe mitral valve stenosis and severely calcified annulus underwent an open implantation of an Edwards Sapien 3 prosthesis on cardiopulmonary bypass. Our hybrid approach involved resection of the anterior mitral leaflet, placement of anchor sutures and the deployment of a balloon expanded prosthesis under visual control. Concomitant procedures were carried out in three patients. Results: The mean duration of cross-clamping was 95 ± 31 min and cardiopulmonary bypass was 137 ± 60 min. The perioperative TEE showed in three patients an inconspicuous, heart valve-typical gradient on all implanted prostheses and a clinically irrelevant paravalvular leakage occurred in the anterior annulus. In the left ventricular outflow tract, mild to moderately elevated gradients were recorded. No adverse cerebrovascular events and pacemaker implantations were observed. All but one patient survived to discharge. Survival at one year was 83.3%. Conclusions: This “off label” implantation of the Edwards Sapien 3 prosthesis may be considered as a suitable bail-out approach for patients at high-risk for mitral valve surgery or deemed inoperable due to extensive MAC.

Effect of 3D-Printed Hearts Used in Left Ventricular Outflow Tract Obstruction: A Multicenter Study

Objective:The purpose of this research was to explore the application value of a three-dimensional (3D)-printed heart in the operation for left ventricular outflow tract (LVOT) obstruction. Methods: From August 2019 to October 2021, 46 patients with LVOT obstruction underwent surgical treatment at Peking University International Hospital, Southwest Medical University Affiliated Hospital of Traditional Chinese Medicine and Guangyuan First People's Hospital. According to the treatment method, 22 cases were allocated to the experimental group and 24 cases to the control group . The operation time, cardiopulmonary bypass time, intraoperative blood loss, hospitalization time, postoperative ejection fraction (EF), left ventricular flow velocity (LVFV), LVOT pressure difference (LVP), postoperative interventricular septal thickness (IST), inner diameter of the left ventricular outflow tract (IDLV), systolic anterior motion (SAM), atrioventricular block rate, aortic regurgitation (AR) rate and surgical complication rate of the two groups were compared. Results: The operation time, cardiopulmonary bypass time, intraoperative blood loss, hospitalization time, LVP, postoperative IST, AR, SAM, and postoperative LVFV of the experimental group were significantly lower than those of the control group (P < 0.05). The IDLV was larger than that of the control group (P < 0.05). There was no significant difference in the postoperative EF, atrioventricular block rate or complication rate between the two groups (P > 0.05). Conclusion: A 3D-printed heart model for in vitro simulation surgery is conducive to formulating a more reasonable surgical plan and reducing surgical trauma and operation time, thereby promoting the recovery and maintenance of the heart.

Is Porcine Small Intestinal Submucosal Extracellular Matrix (ECM) a Suitable Material for Right Ventricular Outflow Tract Reconstruction in Association With Pulmonary Valve Replacement?

Pulmonary valve replacement (PVR) with right ventricular outflow tract (RVOT) reconstruction is a common congenital cardiac operation. Porcine submucosal intestinal-derived extracellular matrix (ECM) patches have been used for RVOT reconstruction. We present 2 adult patients with Tetralogy of Fallot who underwent PVR with RVOT reconstruction utilizing ECM. Both cases required reoperation due to patch dehiscence causing a large paravalvular leak. One patient also had a pseudoaneurysm associated with ECM dehiscence. There may be a propensity for ECM dehiscence in this application and, based on these cases, we recommend avoidance of ECM in RVOT reconstruction with PVR. PVR patients repaired with ECM should be monitored for this complication.

Successful delayed endovascular correction of migration of transcatheter aortic valve prosthesis in left ventricle outflow tract: case report

<p>We report the successful endovascular correction of the migration of a transcatheter aortic valve prosthesis in the left ventricle outflow tract (LVOT). A 72-old man was underwent transcatheter aortic valve implantation (TAVI) at Almazov National Medical Research Centre for severe aortic stenosis. During the procedure, the self-expanding prosthesis dislocated 10–12 mm into the LVOT. The frame was optimised with the use of a balloon catheter, and aortic regurgitation I-II degree was achieved. However, on day 17 of hospitalisation, acute heart failure with episodes of asystole occurred as a result of severe paravalvular regurgitation; cardiopulmonary resuscitation was necessary. The prosthesis malpositioning was corrected by traction with endovascular snare devices. The patient was stable during the postprocedural period and discharged on day 31. Dislocation of self-expanding prostheses into the LVOT is a complication specific to TAVI that may quickly aggravate a patient’s condition; therefore, correction of valve malpositioning should be performed as soon as possible. The case reported here in an illustration of successful endovascular correction of dislocation performed with the snare traction technique. This bail-out approach can be used by interventional cardiologists in similar situations.</p><p>Received 27 May 2021. Revised 29 July 2021. Accepted 30 July 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest: </strong>Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Literature review: A.D. Gorovaya, D.D. Zubarev, A.A. Prokhorikhin<br /> Drafting the article: A.D. Gorovaya, V.S. Krasnov, A.A. Prokhorikhin<br /> Critical revision of the article: A.D. Gorovaya, M.A. Chernyavskiy, A.A. Prokhorikhin<br /> Surgical treatment: D.D. Zubarev, V.S. Krasnov, A.A. Prokhorikhin<br /> Final approval of the version to be published: A.D. Gorovaya, D.D. Zubarev, V.S. Krasnov, M.A. Chernyavskiy, A.A. Prokhorikhin</p>