Article

Percutaneous pulmonary valve implantation in the young 2-year follow-up.

Department of Pediatrics, The Hospital for Sick Children, The Labatt Family Heart Centre, University of Toronto School of Medicine, Toronto, Canada.
JACC. Cardiovascular Interventions (Impact Factor: 1.07). 04/2010; 3(4):439-48. DOI: 10.1016/j.jcin.2010.02.003
Source: PubMed

ABSTRACT The aim of this study was to investigate physiological and clinical consequences of percutaneous pulmonary valve implantation (PPVI) in patients with chronic right ventricular outflow tract (RVOT) obstruction and volume overload.
The PPVI is a nonsurgical technique to address RVOT conduit dysfunction.
Twenty-eight adolescents (median age 14.9 years; age range 10.9 to 19 years) underwent PPVI due to RVOT stenosis and/or pulmonary regurgitation (PR). Before and after PPVI echocardiographic and magnetic resonance imaging, cardiopulmonary exercise tests were obtained.
The RVOT gradient (p < 0.001) and right ventricular (RV) systolic pressure decreased (p < 0.001), acutely. Magnetic resonance imaging (median 6 months) documented reduction in RV end-diastolic (149 +/- 49 ml/m(2) vs. 114 +/- 35 ml/m(2), p < 0.005) volume, increases in left ventricular (LV) end-diastolic (p < 0.007) volume and cardiac output (RV: p < 0.04 and LV: p < 0.02), and reduced PR fraction (24 +/- 10% to 7 +/- 7%, p < 0.0001). Symptoms, aerobic exercise performance (maximal oxygen consumption: p < 0.0001) and ventilatory response to carbon dioxide production (p < 0.003) improved. After 24 months, echocardiography demonstrated the RV/systemic-pressure ratio, and RVOT peak pressure gradient reductions persisted, and PR was absent in 93% (n = 12 of 13) of the cohort. Freedom from surgery was 91%, 83%, and 83%, and freedom from transcatheter reintervention was 91%, 80%, and 80%, at 12, 24, and 36 months, respectively. There were no acute device-related complications, with stent fractures noted in 10.8%.
Percutaneous pulmonary valve implantation is feasible and safe in the young with dysfunctional RVOT conduits. An improvement in symptoms, hemodynamic status, and objective findings of exercise performance occurs. Early follow-up demonstrates persistent improvement in ventricular parameters, PR, and objective exercise capacity.

0 Bookmarks
 · 
56 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The Melody® transcatheter pulmonary valve (TPV) is a percutaneous valve system designed for the treatment of obstruction and/or regurgitation of prosthetic conduits placed between the right ventricle and pulmonary arteries in patients with congenital heart disease. In 2000, Melody TPV became the first transcatheter valve implanted in a human; in 2006 it became the first transcatheter valve commercially available anywhere in the world; and in 2010 it was launched as the first commercially available transcatheter valve in the United States. In this review, we present the clinical background against which the Melody valve was developed and implemented, introduce the rationale for and challenges of transcatheter valve technology for this population, outline the history and technical details of its development and use, and summarize currently available data concerning the performance of the device.
    Annals of the New York Academy of Sciences 07/2013; · 4.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Catheter-based valve technologies have evolved rapidly over the last decade. Transcatheter aortic valve replacement (TAVR) has become a routine procedure in high-risk adult patients with calcific aortic stenosis. In patients with congenital heart disease (CHD), transcatheter pulmonary valve replacement represents a transformative technology for right ventricular outflow tract dysfunction with the potential to expand to other indications. This review aims to summarize the current state-of-the-art for transcatheter valve replacement (TVR) in CHD; the expanding indications for TVR; and the technological obstacles to optimizing TVR. Multiple case series have demonstrated that TVR with the Melody transcatheter pulmonary valve in properly selected patients is safe, effective, and durable in short-term follow-up. The Sapien transcatheter heart valve represents an alternative device with similar safety and efficacy in limited studies. Innovative use of current valves has demonstrated the flexibility of TVR, while highlighting the need for devices to address the broad range of postoperative anatomies either with a single device or with strategies to prepare the outflow tract for subsequent device deployment. The potential of TVR has not been fully realized, but holds promise in treatment of CHD.
    Current opinion in cardiology 11/2013; · 2.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Interventional cardiac catheterization has become an integral component of the management of adults with congenital heart disease. The origins of this approach come from the paediatric interventional experience, although techniques and indications for interventional cardiac catheterization in adults are now being developed for use in the burgeoning field of adult congenital heart disease. Progress in the application and acceptance of interventional cardiac catheterization in this setting has been swift, and the pace is quickening. This Review provides a broad overview of some of the most common procedures used in the treatment of adults with congenital heart lesions, with an emphasis on new tools that have revolutionized the field. Specifically, we discuss interventions that can be broadly classified into the following groups: techniques for closing shunt lesions, valvular interventions, methods for achieving patency of vascular obstructions, and selected additional interventions applicable to some complex lesions. We emphasize the need for a thorough understanding of the anatomy of the lesion, its natural or unnatural history, and indications for intervention before the procedure takes place. Such procedures must be performed in centres where the operators are knowledgeable of the lesions being addressed, with full surgical, anaesthetic, nursing and imaging support.
    Nature Reviews Cardiology 08/2013; · 10.40 Impact Factor

Full-text

View
0 Downloads
Available from