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Steps Toward the Percutaneous Replacement of Atrioventricular Valves

An Experimental Study

Younes Boudjemline, MD^_*,,_*, Gabriella Agnoletti, MD^_*, Damien Bonnet, MD^_*,, Luc Behr, DVM, Nicolas Borenstein, DVM, Daniel Sidi, MD^_*, and Philipp Bonhoeffer, MD

^_* Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades
EMIU 0016, Pr Lafon, Faculte de Necker
IMM Recherche, Institut Mutualiste Montsouris, Paris, France
Cardiothoracic Unit, Great Ormond Street Hospital, London, England

View larger version (90K): [in a new window]   Figure 1 (A, B, C) En face and lateral views of the newly designed stent before its covering (A and B), after its covering by a polytetrafluoroethylene membrane and the suture of the valve in the central tubular part (C). The stent is shown from the ventricular side with a valve in closed position.

View larger version (122K): [in a new window]   Figure 2 Angiograms showing the various steps of device deployment. (A) Lateral view before valve replacement. (B) The delivery system is advanced over a wire placed in the distal pulmonary artery. (C) The ventricular disk is progressively opened in the right ventricle. (D) The ventricular disk is fully opened and applied to the tricuspid annulus. (E) The device is completely deployed. (F) Angiogram showing the good function of the implanted valve.

View larger version (79K): [in a new window]   Figure 3 Echographic and schematic views showing the profile of the device on the long and short axis. RA = right atrium; RV = right ventricle; TV = tricuspid valve.

View larger version (92K): [in a new window]   Figure 4 Macroscopic views showing the newly designed valved nitinol stent explanted one month after implantation from ventricular (A) and atrial (B) sides. Note the partial fibrous covering of the nitinol wires and the thin valve inside the stent.