-
Methodist DeBakey Cardiovascular Journal 2019Right ventricular outflow tract (RVOT) dysfunction is common following surgical repair of tetralogy of Fallot and other forms of complex congenital heart disease. This... (Review)
Review
Right ventricular outflow tract (RVOT) dysfunction is common following surgical repair of tetralogy of Fallot and other forms of complex congenital heart disease. This results in pulmonary stenosis or regurgitation and may ultimately lead to RV failure and dysrhythmias. Transcatheter valve technologies are now available to treat certain patients with RVOT dysfunction. Current devices include the Medtronic Melody valve and the Edwards Lifesciences SAPIEN XT. Although these valves are approved for use in dysfunctional circumferential RVOT conduits, they are increasingly being used off label for nonconduit outflow tracts. Procedural complications include but are not limited to conduit rupture and coronary compression. Longer-term complications include stent fracture and endocarditis. Outcomes with these valves have demonstrated durable relief of stenosis and regurgitation. The Medtronic Harmony valve and the Alterra Prestent from Edwards Lifesciences are investigational devices that are intended to treat the patulous RVOT that is too large to accommodate currently available valves. This review will focus on current indications to treat RVOT dysfunction, existing transcatheter valve technologies, and investigational devices undergoing clinical trials. Hopefully, within the not-too-distant future, transcatheter pulmonary valve implantation will be feasible in the vast majority of patients with RVOT dysfunction following surgical repair of congenital heart disease.
Topics: Cardiac Surgical Procedures; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Postoperative Complications; Prosthesis Design; Pulmonary Valve; Pulmonary Valve Insufficiency; Pulmonary Valve Stenosis; Risk Factors; Tetralogy of Fallot; Treatment Outcome; Ventricular Outflow Obstruction
PubMed: 31384375
DOI: 10.14797/mdcj-15-2-122 -
Journal of the American College of... Nov 2015Due to recurrent right ventricular outflow tract (RVOT) dysfunction, patients with complex congenital heart disease of the RVOT traditionally require multiple surgical... (Review)
Review
Due to recurrent right ventricular outflow tract (RVOT) dysfunction, patients with complex congenital heart disease of the RVOT traditionally require multiple surgical interventions during their lifetimes. Percutaneous pulmonary valve implantation (PPVI) has been developed as a nonsurgical alternative for the treatment of right ventricular to pulmonary artery stenosis or pulmonary regurgitation. PPVI has been shown to be a safe and effective procedure in patients with dysfunctional surgical RVOT conduits. In this population, PPVI has the potential to improve symptoms, functional capacity, and biventricular hemodynamics. However, limitations to the anatomical substrate and size of the RVOT currently restrict PPVI eligibility to less than one-quarter of patients with RVOT dysfunction. The current review discusses contemporary practices in PPVI, evidence supporting the procedure, and future technologies and developments in the field.
Topics: Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Treatment Outcome; Ventricular Outflow Obstruction
PubMed: 26564602
DOI: 10.1016/j.jacc.2015.09.055 -
Archives of Gynecology and Obstetrics Nov 2022The purpose of this study was to explore the outcome in fetuses with prenatal diagnosis of absent pulmonary valve syndrome (APVS) on ultrasound imaging.
OBJECTIVE
The purpose of this study was to explore the outcome in fetuses with prenatal diagnosis of absent pulmonary valve syndrome (APVS) on ultrasound imaging.
METHODS
A manual web scraping technique was utilized, where MEDLINE and EMBASE were searched along the combination with other relevant medical subject headings such as "absent pulmonary valve syndrome", "prenatal APVS" and "APVS/outcome". The observed outcomes encompassed the rate of chromosomal abnormalities, associations and malformations linked to APVS and fetuses with APVS. A quality assessment of the included studies was also performed. We used meta-analyses of proportions to combine data and fixed or random-effects models according to the heterogeneity of the results.
RESULTS
Seven studies including 199 fetuses with APVS were included in the analysis. The median gestational age at referral to the tertiary center was 24.8 weeks. An association to tetralogy of Fallot (TOF) could be seen in 84.4% of all cases. In total 140 out of 199 cases underwent invasive testing, with a total number of 55 abnormal karyotypes [39.3% (95% CI 31.1-47.9%)]. 35.2% of the patients opted for termination of pregnancy (95% CI 28.5-42.3%).
CONCLUSION
The analysis underlines the distribution of fetuses with APVS, with 84.4% of cases presenting with TOF/APVS and only 12.6% having APVS/intact ventricular septum (IVS). Larger and more prospective study analyses is now needed, especially focusing on long-term follow-up periods of fetuses and children with APVS. Particularly as the postnatal course shows great variety depending on prenatal diagnosis.
Topics: Child; Female; Humans; Infant; Pregnancy; Prospective Studies; Pulmonary Atresia; Pulmonary Valve; Retrospective Studies; Tetralogy of Fallot; Ultrasonography, Prenatal
PubMed: 35043273
DOI: 10.1007/s00404-022-06397-4 -
International Journal of Molecular... Jan 2022Patients with the complex congenital heart disease (CHD) are usually associated with right ventricular outflow tract dysfunction and typically require multiple surgical... (Review)
Review
Patients with the complex congenital heart disease (CHD) are usually associated with right ventricular outflow tract dysfunction and typically require multiple surgical interventions during their lives to relieve the right ventricular outflow tract abnormality. Transcatheter pulmonary valve replacement was used as a non-surgical, less invasive alternative treatment for right ventricular outflow tract dysfunction and has been rapidly developing over the past years. Despite the current favorable results of transcatheter pulmonary valve replacement, many patients eligible for pulmonary valve replacement are still not candidates for transcatheter pulmonary valve replacement. Therefore, one of the significant future challenges is to expand transcatheter pulmonary valve replacement to a broader patient population. This review describes the limitations and problems of existing techniques and focuses on decellularized tissue engineering for pulmonary valve stenting.
Topics: Animals; Heart Valve Prosthesis Implantation; Heart Ventricles; Humans; Prognosis; Pulmonary Valve; Stents; Tissue Engineering; Treatment Outcome; Ventricular Function
PubMed: 35054905
DOI: 10.3390/ijms23020723 -
The Journal of Thoracic and... Nov 2014
Topics: Cardiac Catheterization; Endocarditis; Female; Heart Defects, Congenital; Heart Valve Prosthesis Implantation; Humans; Male; Pulmonary Valve
PubMed: 25266880
DOI: 10.1016/j.jtcvs.2014.08.053 -
Current Problems in Cardiology Aug 2023Prevalence of congenital heart diseases worldwide is around 9 per 1000 newborns, 20% of which affect the pulmonary valve or right ventricular outflow tract. As survival... (Review)
Review
Prevalence of congenital heart diseases worldwide is around 9 per 1000 newborns, 20% of which affect the pulmonary valve or right ventricular outflow tract. As survival after surgical repair of these defects has improved over time, there is the need to address the long-term issues of older children and young adults with "repaired" congenital heart diseases. In recent decades, the most used types of valves are the mechanical and bioprosthetic valves. Despite improving patients' quality of life, these effects are suboptimal due to their limitations, such as the inability to grow and adapt to hemodynamic changes. These issues have led to the search for living valve solutions through tissue engineering to respond to these challenges. This article aims to review the performance of traditional pulmonary valves and understand how tissue engineering-based valves can improve the management of these patients.
Topics: Infant, Newborn; Child; Young Adult; Humans; Adolescent; Pulmonary Valve; Tissue Engineering; Heart Valve Prosthesis Implantation; Quality of Life; Treatment Outcome; Heart Defects, Congenital; Heart Valve Prosthesis; Bioprosthesis
PubMed: 35460681
DOI: 10.1016/j.cpcardiol.2022.101212 -
The Journal of Thoracic and... Feb 2021
Topics: Animals; Heart Valve Prosthesis; Humans; Pericardium; Pulmonary Valve; Swine
PubMed: 32921441
DOI: 10.1016/j.jtcvs.2020.08.036 -
Journal of the American College of... Jan 2021Transcatheter balloon valvuloplasty for the treatment of aortic and pulmonary valve stenosis was first described nearly 40 years ago. Since that time, the technique has... (Review)
Review
Transcatheter balloon valvuloplasty for the treatment of aortic and pulmonary valve stenosis was first described nearly 40 years ago. Since that time, the technique has been refined in an effort to optimize acute outcomes while reducing the long-term need for reintervention and valve replacement. Balloon pulmonary valvuloplasty is considered first-line therapy for pulmonary valve stenosis and generally results in successful relief of valvar obstruction. Larger balloon to annulus (BAR) diameter ratios can increase the risk for significant valvar regurgitation. However, the development of regurgitation resulting in right ventricular dilation and dysfunction necessitating pulmonary valve replacement is uncommon in long-term follow-up. Balloon aortic valvuloplasty has generally been the first-line therapy for aortic valve stenosis, although some contemporary studies have documented improved outcomes following surgical valvuloplasty in a subset of patients who achieve tri-leaflet valve morphology following surgical repair. Over time, progressive aortic regurgitation is common and frequently results in the need for aortic valve replacement. Neonates with critical aortic valve stenosis remain a particularly high-risk group. More contemporary data suggest that acutely achieving an aortic valve gradient <35 mm Hg with mild aortic regurgitation may improve long-term valve performance and reduce the need for valve replacement. Continued study will help to further improve outcomes and reduce the need for future reinterventions.
Topics: Aortic Valve Insufficiency; Aortic Valve Stenosis; Balloon Valvuloplasty; Heart Defects, Congenital; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Pulmonary Valve Stenosis
PubMed: 33413944
DOI: 10.1016/j.jacc.2020.10.052 -
The Journal of Thoracic and... Dec 2022The Ross procedure is an excellent option for children or young adults who need aortic valve replacement because it can restore survival to that of the normal...
OBJECTIVE
The Ross procedure is an excellent option for children or young adults who need aortic valve replacement because it can restore survival to that of the normal aged-matched population. However, autograft remodeling can lead to aneurysmal formation and reoperation, and the biomechanics of this process is unknown. This study investigated postoperative autograft remodeling after the Ross procedure by examining patient-specific autograft wall stresses.
METHODS
Patients who have undergone the Ross procedure who had intraoperative pulmonary root and aortic specimens collected were recruited. Patient-specific models (n = 16) were developed using patient-specific material property and their corresponding geometry from cine magnetic resonance imaging at 1-year follow-up. Autograft ± Dacron for aneurysm repair and ascending aortic geometries were reconstructed to develop patient-specific finite element models, which incorporated material properties and wall thickness experimentally measured from biaxial stretching. A multiplicative approach was used to account for prestress geometry from in vivo magnetic resonance imaging. Pressure loading to systemic pressure (120/80) was performed using LS-DYNA software (LSTC Inc, Livermore, Calif).
RESULTS
At systole, first principal stresses were 809 kPa (25%-75% interquartile range, 691-1219 kPa), 567 kPa (485-675 kPa), 637 kPa (555-755 kPa), and 382 kPa (334-413 kPa) at the autograft sinotubular junction, sinuses, annulus, and ascending aorta, respectively. Second principal stresses were 360 kPa (310-426 kPa), 355 kPa (320-394 kPa), 272 kPa (252-319 kPa), and 184 kPa (147-222 kPa) at the autograft sinotubular junction, sinuses, annulus, and ascending aorta, respectively. Mean autograft diameters were 29.9 ± 2.7 mm, 38.3 ± 5.3 mm, and 26.6 ± 4.0 mm at the sinotubular junction, sinuses, and annulus, respectively.
CONCLUSIONS
Peak first principal stresses were mainly located at the sinotubular junction, particularly when Dacron reinforcement was used. Patient-specific simulations lay the foundation for predicting autograft dilatation in the future after understanding biomechanical behavior during long-term follow-up.
Topics: Humans; Child; Young Adult; Aged; Autografts; Transplantation, Autologous; Polyethylene Terephthalates; Aortic Valve; Aortic Valve Insufficiency; Pulmonary Valve
PubMed: 34538420
DOI: 10.1016/j.jtcvs.2021.08.058 -
Anatolian Journal of Cardiology Mar 2017
Topics: Heart Neoplasms; Humans; Myxoma; Pulmonary Artery; Pulmonary Valve
PubMed: 28321103
DOI: 10.14744/AnatolJCardiol.2017.7534