Percutaneous pulmonary valve implantation preceded by routine prestenting with a bare metal stent.
OBJECTIVE
To evaluate the effectiveness and safety of percutaneous pulmonary valve implantation (PPVI) with routine prestenting with a bare metal stent (BMS).


BACKGROUND
PPVI is a relatively new method of treating patients with repaired congenital heart disease (CHD). Results of PPVI performed with routine prestenting have never been reported.


METHODS
Consecutive patients who underwent PPVI for homograft dysfunction with prestenting with BMS were studied. The schedule of follow-up assessment comprised clinical evaluation, cardiovascular magnetic resonance, transthoracic echocardiography, and chest X-ray to screen for device integrity.


RESULTS
PPVI was performed with no serious complications in all patients (n=10, mean age 26.8±4.0 years, 60% males). In nine patients with significant pulmonary stenosis, peak right ventricular outflow tract (RVOT) gradient was reduced from a mean of 80.6±22.7 to 38.8±10.4 mm Hg on the day following implantation (P=0.001). At 1-month and 6-month follow-ups, mean RVOT gradient was 34.0±9.8 and 32.0±12.2 mm Hg, respectively. In patients with significant pulmonary regurgitation, mean pulmonary regurgitation fraction decreased from 19%±6% to 2%±1% (P=0.0008). Relief of RVOT obstruction and restoration of pulmonary valve competence were associated with significant decrease in right ventricular (RV) end-diastolic and end-systolic volumes (125.5±48.6 to 109.2±42.9 mL/m2 ; P=0.002 and 68.4±41.5 vs. 50.9±40.6 mL/m2; P=0.001) as well as improvement in RV ejection fraction (48.8%±13.1% to 57.6%±14.4%; P=0.003) and New York Heart Association class (P=0.003). All patients completed 6-month follow-up. No stent fractures were observed.


CONCLUSIONS
PPVI with routine prestenting with BMS is a safe and effective method of treatment in patients with repaired CHD.
Demkow
Marcin
M
Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. mdemkow@ikard.pl
Biernacka
Elżbieta Katarzyna
EK
Spiewak
Mateusz
M
Kowalski
Mirosław
M
Siudalska
Hanna
H
Wolski
Piotr
P
Sondergaard
Lars
L
Miśko
Jolanta
J
Hoffman
Piotr
P
Rużyłło
Witold
W
D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008670:Metals; D011044:Poland; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000503:physiopathology*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013902:Radiography, Thoracic; D015607:Stents; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
D008670:Metals