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Annals of Biomedical Engineering Nov 2023A common feature of congenital heart disease is the presence of right ventricular outflow tract (RVOT) obstruction that can range from mild to severe and can lead to... (Review)
Review
A common feature of congenital heart disease is the presence of right ventricular outflow tract (RVOT) obstruction that can range from mild to severe and can lead to atresia of the pulmonary valve, in extreme conditions. RVOT abnormalities can frequently be corrected surgically or via interventional means. However, most of these patients will ultimately develop pulmonary valve insufficiency and eventual right ventricular dilation, which will require a pulmonary valve replacement at some point in their life to mitigate the detrimental effects of pulmonary valve regurgitation (PVR) on the right ventricle (RV). The evolution from the studies done by Philip Bonhoeffer to implant a pulmonary valve via transcatheter means, have provided a bedrock for transcatheter pulmonary valve replacement (TPVR). Yet, several areas of unmet need for a demographic of patients still exist. Here, we discuss the clinical unmet needs in children under 20 Kg and expand the use of hybrid and other TPVR approaches along with the current indications and contraindications for pulmonary valve replacement. The constraints and limitations from commercially available pulmonary valves will be discussed from a clinical standpoint. Finally, we explore the use of hybrid and periventricular delivery of transcatheter pulmonary valves in younger patients.
Topics: Child; Humans; Pulmonary Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Prosthesis Design; Cardiac Catheterization; Treatment Outcome; Pulmonary Valve Insufficiency; Heart Defects, Congenital; Ventricular Outflow Obstruction, Right; Retrospective Studies
PubMed: 37543538
DOI: 10.1007/s10439-023-03328-5 -
Multimedia Manual of Cardiothoracic... Nov 2022Absent pulmonary valve syndrome is a relatively rare condition, representing a subset of about 3% of cases of tetralogy of Fallot in both autopsy and clinical reviews...
Absent pulmonary valve syndrome is a relatively rare condition, representing a subset of about 3% of cases of tetralogy of Fallot in both autopsy and clinical reviews (1). The syndrome is characterized by a ringlike and usually stenotic malformation rather than by the absence of the pulmonary valve, with failure of development of the valve cusps. Another important feature of absent pulmonary valve syndrome is the marked aneurysmal dilatation of the proximal pulmonary arteries, which causes extrinsic compression of the tracheobronchial tree, leading to respiratory symptoms of variable severity (2). The surgical goals are to correct any intracardiac anomaly, prevent right-sided heart failure, and alleviate or prevent bronchial compression and peripheral lung damage. In this video tutorial, we present the straightforward correction of tetralogy of Fallot with absent pulmonary valve with a transannular patch combined with size reduction arterioplasty of bilateral aneurysmal pulmonary arteries. This patient also had a subaortic membrane that was completely removed concomitantly. Our technique shows right ventricular outflow tract reconstruction without using a valved conduit or creating a monocusp patch in order to reduce the incidence of a right ventricular outflow track reoperation. Nonapplication of the right ventricle-pulmonary artery conduit did not affect the early postoperative course or the immediate postoperative outcome.
Topics: Humans; Pulmonary Valve; Tetralogy of Fallot; Cardiac Surgical Procedures; Pulmonary Artery; Reoperation
PubMed: 36345972
DOI: 10.1510/mmcts.2022.071 -
JACC. Clinical Electrophysiology Oct 2021
Topics: Cardiac Surgical Procedures; Defibrillators, Implantable; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Tetralogy of Fallot
PubMed: 34674838
DOI: 10.1016/j.jacep.2021.03.014 -
Indian Heart Journal 2024There is conclusive evidence for relief of pulmonary valve obstruction immediately after balloon pulmonary valvuloplasty (BPV) and at follow-up. Development of... (Review)
Review
There is conclusive evidence for relief of pulmonary valve obstruction immediately after balloon pulmonary valvuloplasty (BPV) and at follow-up. Development of infundibular obstruction is seen in more severe PS cases and in older subjects. Reappearance of PS was observed in approximately 10 % of patients following BPV. The reasons for recurrence were found to be balloon/annulus ratio less than 1.2 and immediate post-BPV pulmonary valve peak gradients greater than 30 mmHg. Recurrent stenosis is successfully addressed by repeating BPV with lager balloons than used initially. Long-term results revealed continue relief of obstruction, but with development of pulmonary insufficiency, some patients requiring replacement of the pulmonary valve. It was concluded that BPV is the treatment of choice in the management valvar PS and that balloon/annuls ratio used for BPV should be lowered to 1.2 to 1.25. It was also suggested that strategies should be developed to prevent/reduce pulmonary insufficiency at long-term follow-up.
Topics: Humans; Balloon Valvuloplasty; Pulmonary Valve Stenosis; Pulmonary Valve; Treatment Outcome
PubMed: 38147974
DOI: 10.1016/j.ihj.2023.12.007 -
The Journal of Thoracic and... Aug 2020
Topics: Animals; Aortic Valve; Heart Valve Prosthesis; Pericardium; Pulmonary Valve; Swine
PubMed: 32089346
DOI: 10.1016/j.jtcvs.2020.01.038 -
The Journal of Thoracic and... Aug 2020
Topics: Animals; Heart Valve Prosthesis; Pericardium; Pulmonary Valve; Swine
PubMed: 32532504
DOI: 10.1016/j.jtcvs.2020.04.135 -
Current Cardiology Reviews 2019Patients with congenital heart disease (CHD) with right ventricle outflow tract (RVOT) dysfunction need sequential pulmonary valve replacements throughout their life in... (Review)
Review
Patients with congenital heart disease (CHD) with right ventricle outflow tract (RVOT) dysfunction need sequential pulmonary valve replacements throughout their life in the majority of cases. Since their introduction in 2000, the number of percutaneous pulmonary valve implantations (PPVI) has grown and reached over 10,000 procedures worldwide. Overall, PPVI has been proven safe and effective, but some anatomical variations can limit procedural success. This review discusses the current status and future perspectives of the procedure.
Topics: Female; Heart Valve Prosthesis Implantation; Humans; Male; Pulmonary Valve; Treatment Outcome
PubMed: 30582483
DOI: 10.2174/1573403X15666181224113855 -
Hellenic Journal of Cardiology : HJC =... 2022The majority of patients with congenital heart disease (CHD) who have undergone open heart surgery during childhood are possible candidates for additional transcatheter... (Review)
Review
The majority of patients with congenital heart disease (CHD) who have undergone open heart surgery during childhood are possible candidates for additional transcatheter or surgical interventions. One fifth of these conditions usually involve the right ventricular outflow tract (RVOT). Percutaneous pulmonary valve replacement (PPVR) has been widely established as an alternative, less invasive option to surgical pulmonary valve replacement (SPVR). The variability of RVOT anatomy and size, the relative course of the coronary arteries, and the anatomy of the pulmonary artery branches are factors that determine the success of the intervention and the complication rates. Careful and reliable pre-interventional imaging warrants the selection of suitable candidates and minimizes the risk of complications. 2D and 3D fluoroscopy have been extensively used during pre- and peri-interventional assessment. Established imaging techniques such as cardiovascular magnetic resonance (CMR) and computed tomography (CT) and newer techniques such as fusion imaging have proved to be efficient and reliable tools during pre-procedural planning in patients assessed for PPVR.
Topics: Cardiac Catheterization; Cardiac Surgical Procedures; Heart Defects, Congenital; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Retrospective Studies; Treatment Outcome
PubMed: 35863726
DOI: 10.1016/j.hjc.2022.06.004 -
European Journal of Cardio-thoracic... May 2023After a Ross procedure, autograft failure can occur. At reoperation, repair of the autograft preserves the advantages of the Ross procedure. The aim of this...
OBJECTIVES
After a Ross procedure, autograft failure can occur. At reoperation, repair of the autograft preserves the advantages of the Ross procedure. The aim of this retrospective study was to assess mid-term results after reoperation of a failed autograft.
METHODS
Between 1997 and 2022, 30 consecutive patients (83% male; age 41 ± 11 years) underwent autograft reintervention between 60 days and 24 years (median 10 years) after a Ross procedure. The initial technique varied, full-root replacement (n = 25) being the most frequent. The indication for reoperation was isolated autograft regurgitation (n = 7), root dilatation (>43 mm) with (n = 17) or without (n = 2) autograft regurgitation, mixed dysfunction (n = 2) and endocarditis (n = 2). In 4 instances, the valve was replaced by valve (n = 1) or combined valve and root replacement (n = 3). Valve-sparing procedures consisted of isolated valve repair (n = 7) or root replacement (n = 19), and tubular aortic replacement. Cusp repair was performed in all but 2. Mean follow-up was 5.4 ± 6 years (35 days to 24 years).
RESULTS
Mean cross-clamp and perfusion times were 74 ± 26 and 132 ± 64 min. There were 2 perioperative deaths (7%; both valve replacement) and 2 patients died late (32 days to 1.2 years postoperatively). Freedom from cardiac death at 10 years was 96% after valve repair and 50% after replacement. Two patients required reoperation (1.68 and 16 years) following repair. One underwent valve replacement for cusp perforation, the other, root remodelling for dilatation. Freedom from autograft reintervention at 15 years was 95%.
CONCLUSIONS
Autograft reoperations after the Ross procedure can be performed as valve-sparing operations in the majority of cases. With valve-sparing, long-term survival and freedom from reoperation are excellent.
Topics: Humans; Male; Infant; Female; Reoperation; Autografts; Treatment Outcome; Retrospective Studies; Transplantation, Autologous; Dilatation, Pathologic; Aortic Valve; Aortic Valve Insufficiency; Pulmonary Valve; Follow-Up Studies
PubMed: 36971602
DOI: 10.1093/ejcts/ezad117 -
Journal of the American College of... Jan 2022Transcatheter pulmonary valve (TPV) replacement (TPVR) has become the standard therapy for postoperative pulmonary outflow tract dysfunction in patients with a...
BACKGROUND
Transcatheter pulmonary valve (TPV) replacement (TPVR) has become the standard therapy for postoperative pulmonary outflow tract dysfunction in patients with a prosthetic conduit/valve, but there is limited information about risk factors for death or reintervention after this procedure.
OBJECTIVES
This study sought to evaluate mid- and long-term outcomes after TPVR in a large multicenter cohort.
METHODS
International registry focused on time-related outcomes after TPVR.
RESULTS
Investigators submitted data for 2,476 patients who underwent TPVR and were followed up for 8,475 patient-years. A total of 95 patients died after TPVR, most commonly from heart failure (n = 24). The cumulative incidence of death was 8.9% (95% CI: 6.9%-11.5%) 8 years after TPVR. On multivariable analysis, age at TPVR (HR: 1.04 per year; 95% CI: 1.03-1.06 per year; P < 0.001), a prosthetic valve in other positions (HR: 2.1; 95% CI: 1.2-3.7; P = 0.014), and an existing transvenous pacemaker/implantable cardioverter-defibrillator (HR: 2.1; 95% CI: 1.3-3.4; P = 0.004) were associated with death. A total of 258 patients underwent TPV reintervention. At 8 years, the cumulative incidence of any TPV reintervention was 25.1% (95% CI: 21.8%-28.5%) and of surgical TPV reintervention was 14.4% (95% CI: 11.9%-17.2%). Risk factors for surgical reintervention included age (0.95 per year [95% CI: 0.93-0.97 per year]; P < 0.001), prior endocarditis (2.5 [95% CI: 1.4-4.3]; P = 0.001), TPVR into a stented bioprosthetic valve (1.7 [95% CI: 1.2-2.5]; P = 0.007), and postimplant gradient (1.4 per 10 mm Hg [95% CI: 1.2-1.7 per 10 mm Hg]: P < 0.001).
CONCLUSIONS
These findings support the conclusion that survival and freedom from reintervention or surgery after TPVR are generally comparable to outcomes of surgical conduit/valve replacement across a wide age range.
Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Defibrillators, Implantable; Endocarditis; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Infant; Infant, Newborn; Male; Middle Aged; Pacemaker, Artificial; Pulmonary Valve; Registries; Reoperation; Young Adult
PubMed: 34991785
DOI: 10.1016/j.jacc.2021.10.031