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Interactive Cardiovascular and Thoracic... Sep 2022Residual regurgitation is common after congenital surgery for right ventricular outflow tract malformation. It is accepted as there is no competent valve solution in a...
OBJECTIVES
Residual regurgitation is common after congenital surgery for right ventricular outflow tract malformation. It is accepted as there is no competent valve solution in a growing child. We investigated a new surgical technique of trileaflet semilunar valve reconstruction possessing the potential of remaining sufficient and allowing for some growth with the child. In this proof-of-concept study, our aim was to evaluate if it is achievable as a functional pulmonary valve reconstruction in vitro.
METHODS
Explanted pulmonary trunks from porcine hearts were evaluated in a pulsatile flow-loop model. First, the native pulmonary trunk was investigated, after which the native leaflets were explanted. Then, trileaflet semilunar valve reconstruction was performed and investigated. All valves were initially investigated at a flow output of 4 l/min and subsequently at 7 l/min. The characterization was based on hydrodynamic pressure and echocardiographic measurements.
RESULTS
Eight pulmonary trunks were evaluated. All valves are competent on colour Doppler. There is no difference in mean pulmonary systolic artery pressure gradient at 4 l/min (P = 0.32) and at 7 l/min (P = 0.20). Coaptation length is increased in the neo-valve at 4 l/min (P < 0.001, P < 0.001, P = 0.008) and at 7 l/min (P < 0.001, P = 0.006, P = 0.006). A windmill shape is observed in all neo-valves.
CONCLUSIONS
Trileaflet semilunar valve reconstruction is sufficient and non-stenotic. It resulted in an increased coaptation length and a windmill shape, which is speculated to decrease with the growth of the patient, yet remains sufficient as a transitional procedure until a long-term solution is feasible. Further in vivo investigations are warranted.
Topics: Animals; Aortic Valve; Echocardiography; Heart Valve Prosthesis; Heart Ventricles; Humans; Pulmonary Valve; Swine
PubMed: 36066430
DOI: 10.1093/icvts/ivac227 -
International Journal of Cardiology Feb 2023
Topics: Humans; Pulmonary Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Treatment Outcome; Cardiac Catheterization; Prosthesis Design; Pulmonary Valve Insufficiency
PubMed: 36529307
DOI: 10.1016/j.ijcard.2022.12.024 -
Journal of the American College of... May 2023
Topics: Humans; Pulmonary Valve; Tetralogy of Fallot; Cardiac Surgical Procedures
PubMed: 37225361
DOI: 10.1016/j.jacc.2023.04.005 -
Current Cardiology Reviews 2023Quadricuspid pulmonary valve (QPV) is a rare congenital anomaly. Simple QPV had been mainly diagnosed at the time of autopsy before 2000, and the frequency rates of QPV...
BACKGROUND
Quadricuspid pulmonary valve (QPV) is a rare congenital anomaly. Simple QPV had been mainly diagnosed at the time of autopsy before 2000, and the frequency rates of QPV are approximately 0.02%-0.41%. QPV was initially diagnosed using transthoracic echocardiography (TTE) after 2000 and with contrast computed tomography (CT) or cardiac magnetic resonance imaging (CMR) after 2009. Obtaining the cross-sectional view of the pulmonary valve using TTE is difficult. We aimed to review the papers regarding the incidence, embryology, diagnosis, associated congenital heart anomalies, and prognosis in patients with QPV, and furthermore to compare with those in patients with quadricuspid aortic valve (QAV).
CASE PRESENTATION
We diagnosed QPV with mild stenosis in a 12-month-old infant. With a slight angulation of the transducer superiorly from the left high parasternal short-axis view, a short-axis view of QPV was obtained.
RESULTS
In QPV cases diagnosed at autopsy, Hurwitz's type-b with three equal cusps and one smaller cusp is dominant, whereas Hurwitz's type-a with four equal cusps is dominant in clinically diagnosed cases. Congenital heart anomaly and valvular stenosis are more frequent in patients with QPV than in patients with QAV. Coronary artery anomalies and infectious endocarditis are more frequent in patients with QAV than in patients with QPV. The incidence of PR is more common in type-a QPV than in type-b QPV. There is no difference between type-a QAV and type-b QAV with respect to the incidence of aortic regurgitation (AR). It is assumed that QPV is a risk factor for a Ross operation. However, QPVs have been used as autografts in certain patients.
CONCLUSION
Between QPV and QAV, various differences were found in frequency rates, diagnostic methods, valve morphology, valve function, associated congenital heart diseases, and frequencies of infectious endocarditis.
Topics: Infant; Humans; Aortic Valve; Quadricuspid Aortic Valve; Pulmonary Valve; Constriction, Pathologic; Cross-Sectional Studies; Heart Defects, Congenital; Endocarditis
PubMed: 35319379
DOI: 10.2174/1573403X18666220322092706 -
Interactive Cardiovascular and Thoracic... Apr 2021Many surgeons develop unique techniques for unmet needs for right ventricular outflow reconstruction to resolve pulmonary regurgitation after corrective surgery for... (Review)
Review
OBJECTIVES
Many surgeons develop unique techniques for unmet needs for right ventricular outflow reconstruction to resolve pulmonary regurgitation after corrective surgery for congenital heart diseases. Expanded polytetrafluoroethylene (ePTFE) stands out as a reliable synthetic material, and clinical results with handmade ePTFE valves have been promising. This review focuses on the historical evolution of the use of ePTFE in pulmonary valve replacement and in the techniques for pioneering the translation of the handmade ePTFE trileaflet design for the transcatheter approach.
METHODS
We searched for and reviewed publications from 1990 to 2020 in the Pubmed database. Nineteen clinical studies from 2005 to 2019 that focused on ePTFE-based valves were summarized. The evolution of the ePTFE-based valve over 3 decades and recent relevant in vitro studies were investigated.
RESULTS
The average freedom from reintervention or surgery in the recorded ePTFE-based valve population was 90.2% at 5 years, and the survival rate was 96.7% at 3 years.
CONCLUSIONS
Non-inferior clinical results of this ePTFE handmade valve were revealed compared to allograft or xenograft options for pulmonary valve replacement. Future investigations on transferring ePTFE trileaflet design to transcatheter devices should be considered.
Topics: Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Polytetrafluoroethylene; Prosthesis Design; Pulmonary Valve; Treatment Outcome
PubMed: 33377488
DOI: 10.1093/icvts/ivaa302 -
JACC. Cardiovascular Interventions Jan 2024
Topics: Humans; Pulmonary Valve; Treatment Outcome
PubMed: 38267138
DOI: 10.1016/j.jcin.2023.12.002 -
Pediatric Cardiology Aug 2023Management of pulmonary atresia, ventricular septal defect with major aorto-pulmonary collateral arteries, and hypoplastic native pulmonary arteries focuses on growth of...
Management of pulmonary atresia, ventricular septal defect with major aorto-pulmonary collateral arteries, and hypoplastic native pulmonary arteries focuses on growth of the native pulmonary arteries. One strategy to grow the native pulmonary arteries is through pulmonary valve perforation followed by right ventricular outflow tract stenting, if suitable. We present a unique case of retrograde pulmonary valve perforation and stenting of the right ventricular outflow tract through a major aorto-pulmonary collateral artery.
Topics: Humans; Infant; Pulmonary Valve; Heart Defects, Congenital; Pulmonary Atresia; Heart Septal Defects, Ventricular; Pulmonary Artery; Collateral Circulation
PubMed: 37227453
DOI: 10.1007/s00246-023-03185-y -
The American Journal of Cardiology Nov 2023
Topics: Humans; Pulmonary Valve; Magnetic Resonance Angiography; Cardiovascular System; Cardiac Surgical Procedures; Transcatheter Aortic Valve Replacement; Aortic Valve; Aortic Valve Stenosis; Treatment Outcome; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation
PubMed: 37802700
DOI: 10.1016/j.amjcard.2023.09.028 -
Catheterization and Cardiovascular... Mar 2024Transcatheter pulmonary valve replacement (TPVR), also known as percutaneous pulmonary valve implantation, refers to a minimally invasive technique that replaces the...
Transcatheter pulmonary valve replacement (TPVR), also known as percutaneous pulmonary valve implantation, refers to a minimally invasive technique that replaces the pulmonary valve by delivering an artificial pulmonary prosthesis through a catheter into the diseased pulmonary valve under the guidance of X-ray and/or echocardiogram while the heart is still beating not arrested. In recent years, TPVR has achieved remarkable progress in device development, evidence-based medicine proof and clinical experience. To update the knowledge of TPVR in a timely fashion, and according to the latest research and further facilitate the standardized and healthy development of TPVR in Asia, we have updated this consensus statement. After systematical review of the relevant literature with an in-depth analysis of eight main issues, we finally established eight core viewpoints, including indication recommendation, device selection, perioperative evaluation, procedure precautions, and prevention and treatment of complications.
Topics: Humans; Pulmonary Valve; Treatment Outcome; Cardiac Surgical Procedures; Asia; Catheters
PubMed: 38419402
DOI: 10.1002/ccd.30978 -
JACC. Cardiovascular Interventions Jan 2022
Topics: Cardiac Surgical Procedures; Heart Valve Prosthesis Implantation; Humans; Longitudinal Studies; Pulmonary Valve; Treatment Outcome
PubMed: 35057988
DOI: 10.1016/j.jcin.2021.12.001