Percutaneous insertion of the pulmonary valve.
OBJECTIVE
We report our experience of percutaneous valve insertion in pulmonary position in humans.


BACKGROUND
Over the past 40 years, prosthetic conduits have been developed to surgically establish continuity between the right ventricle and the pulmonary artery. However, stenosis and insufficiency of the conduit due to valvular degeneration or panus ingrowth frequently occur, limiting patients' lifespan. Percutaneous stenting of conduits has recently emerged as a technique for delaying surgical replacement, but it creates a pulmonary regurgitation when crossing the valve.


METHODS
Seven children and one adult with stenosis and/or insufficiency of the pulmonary graft underwent percutaneous implantation of a bovine jugular valve in pulmonary position.


RESULTS
Percutaneous pulmonary valve (PV) replacement was successful in all patients. No complications occurred in early follow-up. Angiography, hemodynamic studies and echocardiography after the procedure showed no significant regurgitation of the implanted valve. Implantation was effective in relieving the obstruction in five patients. All patients showed improvement in their clinical status at the latest follow-up (mean 10.1 months).


CONCLUSIONS
Non-surgical insertion of the PV is possible without any major complications. This new technique may have an important role in the management of conduit obstructions and pulmonary regurgitation.
Bonhoeffer
Philipp
P
Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom. Bonhop@gosh.nhs.uk
Boudjemline
Younes
Y
Qureshi
Shakeel A
SA
Le Bidois
Jerome
J
Iserin
Laurence
L
Acar
Philippe
P
Merckx
Jacques
J
Kachaner
Jean
J
Sidi
Daniel
D
D000293:Adolescent; D000328:Adult; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation*; D002648:Child; D015150:Echocardiography, Doppler; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D011474:Prosthesis Design; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000601:surgery