eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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vol. 6

Original paper
Early and one year results of transvascular pulmonary valve implantation in patients after tetralogy of Fallot, Ross and Rastelli operations

Elżbieta K. Biernacka
Marcin Demkow
Mateusz Śpiewak
Lars Sřndergaard
Mirosław Kowalski
Hanna Siudalska
Piotr Wolski
Jolanta Miśko
Piotr Hoffman
Witold Rużyłło

Post Kardiol Interw 2010; 6, 3 (21): 104-111
Online publish date: 2010/10/01
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Background: Transcatheter pulmonary artery valve implantation (TPVI) is a relatively new method of treatment in patients (pts) after repair of congenital heart disease (CHD).
Aim: To assess the early and one year results of TPVI in patients with right ventricular outflow tract conduit dysfunction.
Material and methods: TPVI with routine pre-stenting with BMS was performed in 17 pts (9 men, mean age 24.1 ±5.6 years) for pulmonary conduit dysfunction 11.4 ±6.4 years after total repair of tetralogy of Fallot or pulmonary atresia (11 pts: 8 pts with pulmonary homograft, 3 pts with Contegra xenograft or aortic monocusp homograft), pulmonary stenosis (1 pt), Ross procedure (3 pts) and Rastelli operation (TGA, pulmonary atresia – 2 pts). The schedule of follow-up assessment comprised clinical evaluation, cardiovascular magnetic resonance, transthoracic echocardiography and chest X-ray to screen for device integrity. Seventeen pts completed 1-month, 11 pts 6-month and 10 pts 12-month follow-up.
Results: TPVI was performed with no serious complications in all patients. In 15 patients with significant pulmonary stenosis peak right ventricular outflow tract (RVOT) gradient was reduced from a mean of 73.4 ±30.0 mm Hg to 35,3 ±14,7 mm Hg on the next day after implantation (p < 0.001). At 1-month, 6-month and 12-month follow-up mean RVOT gradient was 30.4 ±11.2 mm Hg, 31.1 ±11.9 and 32.7 ±11.7 mm Hg, respectively (NS). In all patients pulmonary valve competence was restored. Mean pulmonary regurgitation fraction decreased from 20.9 ±7.8% to 2.4 ±2.1% (p = 0.0001) one month after procedure and the effect was stable after one year observation. Significant decrease in right ventricular end-diastolic and end-systolic volumes (131.8 ±47.8 ml/m2 to 115.3 ±40.3 ml/m2; p = 0.002 and 73.1 ±41.1 ml/m2 vs. 57,6 ±39,0 ml/m2; p = 0.004, respectively) as well as a slight improvement in RV ejection fraction (47.9 ±13.0% to 53.2 ±15.2%; p = 0.07) were observed one month after procedure. No stent fractures were seen.
1. TPVI is an effective and safe method of non-surgical treatment for patients with RVOT conduit dysfunction.
2. TPVI wit the use of pre-stenting technique may be performed in selected patients with RVOT patch.
3. Routine pre-stenting with BMS may protect against stent fractures after TPVI.
4. The study showed excellent results in 10 patients after one-year follow-up.

pulmonary valve, homograft, transvascular implantation, congenital heart diseases

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