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FOCUS ISSUE: VALVULAR HEART DISEASE: CLINICAL RESEARCH

Extended Application of Percutaneous Pulmonary Valve Implantation

Tarek S. Momenah, MD^_*,_*, Reida El Oakley, MD^_*, Khalid Al Najashi, MD^_*, Saad Khoshhal, MD^_*, Howaida Al Qethamy, MD^_* and Philipp Bonhoeffer, MD

^_* Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
Cardiac Unit, Great Ormond Street Hospital for Children, London, United Kingdom

Manuscript received June 18, 2008; accepted August 13, 2008.

^_* Reprint requests and correspondence: Dr. Tarek S. Momenah, Prince Sultan Cardiac Center, P.O. Box 7897, Riyadh 11159, Saudi Arabia (Email: kidecho{at}yahoo.com).

Objectives: This study was designed to report a novel indication for percutaneous pulmonary valve implantation in patients with previous right ventricular outflow tract (RVOT) patch.

Background: Current indications for percutaneous pulmonary valve implantation are limited to patients who had pulmonary valve stenosis and/or regurgitation in a right ventricle-to-pulmonary artery conduit. Percutaneous pulmonary valve implantation has not been previously reported in patients with severe pulmonary valve regurgitation following repair of tetralogy of Fallot (TOF) using RVOT patch.

Methods: After assessment of the RVOT patch in multiple projections, a catheter was placed in a distal pulmonary artery branch. In patients with an RVOT patch, sizing of the narrowest diameter of the RVOT patch by manual inflation of a sizing balloon was performed; a stent was placed into the RVOT patch at the level of the narrowest area to anchor the stent and to create an artificial conduit to place the Melody valve. The percutaneous valve was then implanted.

Results: Seven females and 6 males with a mean age of 14.3 years and mean body weight 45 kg had successful percutaneous implantation of the Melody valve. Four patients had previous repair of TOF using RVOT patch. All patients were discharged within 2 days after the procedure without complications. After a mean of 4 months follow-up all patients were alive and well. Transthoracic echocardiography showed competent pulmonary valve. Chest X-ray showed no stent migration or fracture.

Conclusions: Percutaneous pulmonary valve implantation can be performed in patients with pulmonary valve regurgitation, including those with previous RVOT patch using pre-stenting techniques, with satisfactory results.

Key Words: percutaneous valve • pulmonary valve • tetralogy of Fallot • RVOT patch

Abbreviations and Acronyms   PA = pulmonary artery   PPVI = percutaneous pulmonary valve implantation   PVR = pulmonary valve regurgitation   RV = right ventricular   RVOT = right ventricular outflow tract   TOF = tetralogy of Fallot

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J. Am. Coll. Cardiol. 2009 53: A28. [Full Text] [PDF]