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Expert Review of Medical Devices Jun 2020Right ventricular outflow tract (RVOT) dysfunction is common among individuals with congenital heart disease (CHD). Surgical intervention often carries prohibitive risks... (Review)
Review
INTRODUCTION
Right ventricular outflow tract (RVOT) dysfunction is common among individuals with congenital heart disease (CHD). Surgical intervention often carries prohibitive risks due to the need for sequential pulmonary valve (PV) replacements throughout their life in the majority of cases. Transcatheter pulmonary valve replacement (tPVR) is one of the most exciting recent developments in the treatment of CHD and has evolved to become an attractive alternative to surgery in patients with RVOT dysfunction.
AREAS COVERED
In this review, we examine the pathophysiology of RVOT dysfunction, indications for tPVR, and the procedural aspect. Advancements in clinical application and valve technology will also be covered.
EXPERT OPINION
tPVR is widely accepted as an alternative to surgery to address RVOT dysfunction, but still significant numbers of patients with complex RVOT morphology deemed not suitable for tPVR. As the technology continues to evolve, new percutaneous valves will allow such complex RVOT patient to benefit from tPVR.
Topics: Cardiac Catheterization; Child; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Patient Selection; Pulmonary Valve; Treatment Outcome
PubMed: 32459512
DOI: 10.1080/17434440.2020.1775578 -
Expert Review of Cardiovascular Therapy Nov 2011The last decade has generated enormous advances in the diagnostic and therapeutic possibilities for diseases of the pulmonary valve. There have been advances in all age... (Review)
Review
The last decade has generated enormous advances in the diagnostic and therapeutic possibilities for diseases of the pulmonary valve. There have been advances in all age groups from fetus to adult, with not only the development of novel treatments (fetal interventions, new surgical strategies and percutaneous pulmonary valve implantation), but also an improved understanding of the long-term sequelae of pulmonary valve disease. In this article, we discuss treatments of the native valve in the fetus and neonate and the management of the consequences of early interventions in later life, with the particular focus on the introduction of percutaneous pulmonary valve implantation, its follow-up and the development of new devices to treat pulmonary stenosis and incompetence without the need for open-heart surgery.
Topics: Adult; Age Factors; Animals; Female; Fetal Therapies; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Infant, Newborn; Pregnancy; Pulmonary Valve; Pulmonary Valve Stenosis
PubMed: 22059793
DOI: 10.1586/erc.11.150 -
JACC. Cardiovascular Interventions Dec 2020
Topics: Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Stents; Treatment Outcome
PubMed: 33303114
DOI: 10.1016/j.jcin.2020.09.015 -
The Journal of Thoracic and... Feb 2021
Topics: Bioprosthesis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Longevity; Pulmonary Valve
PubMed: 32859415
DOI: 10.1016/j.jtcvs.2020.08.003 -
The Journal of Thoracic and... Sep 2021
Review
Topics: Cardiac Catheterization; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Pulmonary Valve; Recovery of Function; Treatment Outcome; Ventricular Function, Right
PubMed: 33097216
DOI: 10.1016/j.jtcvs.2020.07.126 -
Seminars in Thoracic and Cardiovascular... 2022
Topics: Humans; Pulmonary Valve; Treatment Outcome; Pulmonary Valve Insufficiency; Cardiac Surgical Procedures; Heart Valve Prosthesis Implantation
PubMed: 35584775
DOI: 10.1053/j.semtcvs.2022.05.006 -
Seminars in Thoracic and Cardiovascular... 2009Percutaneous pulmonary valve implantation is a new treatment option in patients with dysfunctional conduits. The aim of percutaneous pulmonary valve implantation is to... (Review)
Review
Percutaneous pulmonary valve implantation is a new treatment option in patients with dysfunctional conduits. The aim of percutaneous pulmonary valve implantation is to prolong the lifespan of right ventricle to pulmonary artery conduits and thereby postponing open-heart surgery. Early results have shown a significant reduction in right ventricular pressure and right ventricular outflow tract gradient. During a follow-up of a median of 28 months, freedom from re-operation is 93 (2), 86 (3), 84 (4), and 70 (13)% at 10, 30, 50, and 70 months, respectively. The most common complication during follow-up are stent fractures with an incidence around 20%. Although clinically silent in the majority of cases, stent fractures led to re-intervention in the form of implantation of a second device (valve-in-valve). Valvar function during follow-up was well maintained. Significant pulmonary regurgitation was only seen in the context of endocarditis. Pulmonary valve implantation has the potential to become the standard procedure in the treatment of dysfunctional conduits. Bigger challenges will now have to be met in order to extend this technology to patients with native outflow tracts and free pulmonary regurgitation.
Topics: Cardiac Catheterization; Catheterization; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Infant; Infant, Newborn; Minimally Invasive Surgical Procedures; Postoperative Complications; Pulmonary Valve; Pulmonary Valve Insufficiency; Stents; Ventricular Outflow Obstruction
PubMed: 19349024
DOI: 10.1053/j.pcsu.2009.01.011 -
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 -
International Journal of Cardiology Nov 2022
Topics: Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Pulmonary Valve
PubMed: 36064036
DOI: 10.1016/j.ijcard.2022.08.049 -
Journal of Cardiothoracic Surgery Jan 2021Isolated pulmonary valve endocarditis (IPE) is rare, accounting for 1.5-2% of all cases of infective endocarditis. Herein, we describe a case of isolated pulmonary valve... (Review)
Review
BACKGROUND
Isolated pulmonary valve endocarditis (IPE) is rare, accounting for 1.5-2% of all cases of infective endocarditis. Herein, we describe a case of isolated pulmonary valve endocarditis with rapid progression in a 28-year-old male. Unlike most patients reported previously who were cured with only anti-infective therapy, without surgery at an early stage, multiple complications occurred in this patient in less than 2 weeks.
CASE PRESENTATION
The patient was diagnosed with pulmonary valve endocarditis with blood cultures showing Staphylococcus aureus and echocardiography revealing 2 masses (measuring 14*13 mm、11*16 mm in size). Only 12 days later, acute massive pulmonary embolism occurred. Then, repeated echocardiography revealed multiple masses attached to the pulmonary valve with severe pulmonary insufficiency and the possibility of pulmonary valve destruction. Finally, pulmonary valve replacement, vegetation removal, and right pulmonary thromboendarterectomy together with resection of the middle and lower lobes of the right lung were performed.
CONCLUSIONS
The role of surgery at an early stage might need to be reconsidered, and it may be viable to combine medical and surgical approaches.
Topics: Adult; Cardiac Surgical Procedures; Disease Progression; Echocardiography; Endocarditis, Bacterial; Humans; Male; Pulmonary Valve; Staphylococcal Infections; Staphylococcus aureus
PubMed: 33509229
DOI: 10.1186/s13019-020-01375-w