CLINICAL STUDY: PEDIATRIC CARDIOLOGY
Percutaneous insertion of the pulmonary valve
Philipp Bonhoeffer, MD*,*,
Younes Boudjemline, MD ,
Shakeel A. Qureshi, MD ,
Jerome Le Bidois, MD ,
Laurence Iserin, MD ,
Philippe Acar, MD ,
Jacques Merckx, MD ,
Jean Kachaner, MD and
Daniel Sidi, MD
* Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
Cardiac Unit, Guys Hospital, London, United Kingdom
Manuscript received October 11, 2001;
revised manuscript received February 19, 2002,
accepted February 20, 2002.
* Reprint requests and correspondence: Dr. Philipp Bonhoeffer, Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, United Kingdom. Bonhop{at}gosh.nhs.uk
OBJECTIVES: We report our experience of percutaneous valve insertion in pulmonary position in humans.
BACKGROUND: Over the past 40 years, prosthetic conduits have been developed to surgically establish continuity between the right ventricle and the pulmonary artery. However, stenosis and insufficiency of the conduit due to valvular degeneration or panus ingrowth frequently occur, limiting patients lifespan. Percutaneous stenting of conduits has recently emerged as a technique for delaying surgical replacement, but it creates a pulmonary regurgitation when crossing the valve.
METHODS: Seven children and one adult with stenosis and/or insufficiency of the pulmonary graft underwent percutaneous implantation of a bovine jugular valve in pulmonary position.
RESULTS: Percutaneous pulmonary valve (PV) replacement was successful in all patients. No complications occurred in early follow-up. Angiography, hemodynamic studies and echocardiography after the procedure showed no significant regurgitation of the implanted valve. Implantation was effective in relieving the obstruction in five patients. All patients showed improvement in their clinical status at the latest follow-up (mean 10.1 months).
CONCLUSIONS: Non-surgical insertion of the PV is possible without any major complications. This new technique may have an important role in the management of conduit obstructions and pulmonary regurgitation.
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Abbreviations and Acronyms
| | NYHA | | New York Heart Association | | PA | | pulmonary artery | | PV | | pulmonary valve | | RV | | right ventricle, right ventricular | | VSD | | ventricular septal defect |
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