CLINICAL RESEARCH: PERCUTANEOUS VALVE REPLACEMENT
Percutaneous pulmonary valve replacement in a large right ventricular outflow tract
An experimental study
Younes Boudjemline, MD* ,*,
Gabriella Agnoletti, MD*,
Damien Bonnet, MD*,
Daniel Sidi, MD* and
Philipp Bonhoeffer, MD
* Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
INSERM EMIU 0016, Faculté de Necker Enfants Malades, Paris, France
Cardiothoracic Unit, Great Ormond Street Hospital, London, United Kingdom
Manuscript received May 20, 2003;
revised manuscript received September 20, 2003,
accepted October 27, 2003.
* Reprint requests and correspondence: Dr. Younes Boudjemline, Service de Cardiologie Pédiatrique, Hôpital Necker-Enfants-Malades, 149 rue de Sèvres, 75015 Paris cedex, France.
younes.boudjemline{at}nck.ap-hop-paris.fr
OBJECTIVES: We report our initial experience with percutaneous pulmonary valve replacement in animals with large pulmonary trunks, using a modified percutaneous approach.
BACKGROUND: Percutaneous pulmonary valve replacement has recently been introduced, and early clinical experience has been reported. This technique is presently limited to patients with a right ventricular outflow tract no bigger than 22 mm in diameter.
METHODS: In seven animals (groups 1 and 3), we implanted a newly designed nitinol stent in the shape of a conduit with a central restriction of its diameter, containing an 18-mm bovine valve, as a one-step procedure. The animals in groups 1 and 3 were sacrificed after valve implantation and after two-month follow-up, respectively. In the second group (n = 3), we expected to percutaneously reduce the diameter of the pulmonary artery. Eight weeks later, we implanted an 18-mm valve mounted in a balloon-expandable stent. These animals were sacrificed after valve implantation.
RESULTS: Eight of 10 devices were successfully delivered and were functioning perfectly at the initial evaluation and after two months. We failed to cross the tricuspid valve in two cases. The downsize mechanism allowed the pulmonary diameter to be reduced from 30 to 18 mm, without an impact on right ventricular function in any of the animals.
CONCLUSIONS: Non-surgical implantation of a pulmonary valve is possible in ewes with all types of pulmonary trunk, regardless of its size. A "downsize" stent is needed to allow valve implantation in a large trunk. Further refinements will make this technique feasible in humans.
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Abbreviations and Acronyms
| | PA | = pulmonary artery | | PTFE | = polytetrafluoroethylene | | RV | = right ventricular | | RVOT | = right ventricular outflow tract | | TOF | = tetralogy of Fallot |
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