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Bioengineering & Translational Medicine Jul 2023Congenital heart diseases (CHDs) frequently impact the right ventricular outflow tract, resulting in a significant incidence of pulmonary valve replacement in the... (Review)
Review
Congenital heart diseases (CHDs) frequently impact the right ventricular outflow tract, resulting in a significant incidence of pulmonary valve replacement in the pediatric population. While contemporary pediatric pulmonary valve replacements (PPVRs) allow satisfactory patient survival, their biocompatibility and durability remain suboptimal and repeat operations are commonplace, especially for very young patients. This places enormous physical, financial, and psychological burdens on patients and their parents, highlighting an urgent clinical need for better PPVRs. An important reason for the clinical failure of PPVRs is biofouling, which instigates various adverse biological responses such as thrombosis and infection, promoting research into various antifouling chemistries that may find utility in PPVR materials. Another significant contributor is the inevitability of somatic growth in pediatric patients, causing structural discrepancies between the patient and PPVR, stimulating the development of various growth-accommodating heart valve prototypes. This review offers an interdisciplinary perspective on these challenges by exploring clinical experiences, physiological understandings, and bioengineering technologies that may contribute to device development. It thus aims to provide an insight into the design requirements of next-generation PPVRs to advance clinical outcomes and promote patient quality of life.
PubMed: 37476058
DOI: 10.1002/btm2.10501 -
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 -
JACC. Case Reports Jun 2020
PubMed: 34317365
DOI: 10.1016/j.jaccas.2020.05.002 -
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 -
Cureus Jun 2020Infective endocarditis involving the right side of the heart is typically associated with IV drug abuse and chronic indwelling catheters which commonly involve the...
Infective endocarditis involving the right side of the heart is typically associated with IV drug abuse and chronic indwelling catheters which commonly involve the tricuspid valve. Isolated pulmonary valve endocarditis (PVE) is a rare clinical entity. We report a rare case of a young woman with a history of end-stage renal disease (ESRD) on hemodialysis through tunneled catheter presenting with persistent coagulase-negative staphylococcus (CoNS) epidermidis bacteremia despite being on appropriate treatment with IV vancomycin for two weeks. Because of the persistent bacteremia, a transesophageal echocardiogram was performed and it revealed a thickened pulmonary valve with 1.8 cm vegetation in the left posterior cusp. She was successfully treated with IV daptomycin course for a total of six weeks. The recommended management for PVE is usually medical treatment with IV antibiotics gauged according to sensitivities of the cultures. Our article highlights the fact that the decision to manage it medically versus surgically can propose a challenge as the guidelines are not very robust.
PubMed: 32685317
DOI: 10.7759/cureus.8650