Percutaneous pulmonary valve implantation within bioprosthetic valves.
OBJECTIVE
Replacement of bioprosthetic valves in the right ventricular (RV) outflow tract (RVOT) is inevitable due to acquired valvar dysfunction. Percutaneous pulmonary valve implantation (PPVI) may result in acceptable clinical improvement avoiding surgical reintervention. To report outcomes of PPVI in dysfunctional surgically implanted bioprosthetic valves.


RESULTS
All children undergoing PPVI into a bioprosthetic pulmonary valve between October 2005 and February 2008 were reviewed. Acute haemodynamic changes were compared and an analysis of variance applied to assess changes in ventricular geometry and pressure over time. Fourteen children (seven males), median weight 57.8 kg and 14.7 years of age were identified, with an echocardiographic RVOT gradient of 59.6 +/- 26.8 mmHg and a pulmonary regurgitation (PR) grade of 3.6 +/- 0.8 (out of 4). Implantation was successful in all. Twenty-four hours after implantation, there was a significant improvement in RV pressure (RVP) (from 82.2 +/- 15.6 to 59.4 +/- 9.9 mmHg, P < 0.001) and degree of PR to 0.6 +/- 0.9 (P < 0.001). Mean hospital stay was 2.0 +/- 0.4 days. Freedom from reintervention was 92 and 89% at 1 and 2 years, respectively. Follow-up echocardiography (mean 12.9 +/- 9.8 months) revealed a further reduction in RVP (P < 0.001) and RVOT gradients (P < 0.001) and an increase in left ventricular end-diastolic volume (P= 0.01) and aortic valve annulus diameters (P < 0.001).


CONCLUSIONS
Percutaneous pulmonary valve implantation for RVOT dysfunction in a previously implanted prosthetic valve is feasible and safe. Short-term follow-up data are encouraging, yet longer-term information is required to determine if this form of palliation has a significant impact on management strategies.
Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, 555 University Avenue, Toronto M5M1P9, Canada.
Kentaro
K
Asoh
Mark
M
Walsh
Edward
E
Hickey
Mohamed
M
Nagiub
Rajiv
R
Chaturvedi
Kyong-Jin
KJ
Lee
Lee N
LN
Benson
D000293:Adolescent; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D055815:Young Adult