title: Percutaneous pulmonary valve implantation: initial experience.
abstract: BACKGROUND
  Patients with congenital heart disease who undergo surgical implantation of a conduit between the right ventricle and the pulmonary artery (RV-PA conduit) may develop stenosis and/or insufficiency over time. These cases, which are associated with arrhythmias, RV dysfunction and sudden death, remain a challenge for surgical re-intervention, due to its complexity and associated morbidity and mortality. Percutaneous pulmonary valve implantation (PPVI) is therefore a valid alternative.
  
  
  OBJECTIVE
  To report our center's initial experience with PPVI.
  
  
  METHODS
  Prospective assessment of clinical, echocardiographic, magnetic resonance, hemodynamic and angiographic data from our series of PPVI.
  
  
  RESULTS
  Six patients in NYHA functional class +/- II underwent PPVI. All had significant conduit dysfunction and five had stenosis. The procedure consisted of implanting a bare metal stent to reduce the risk of fracture of the Melody valved stents (Medtronic) that were then successfully deployed in all. The immediate hemodynamic results showed a reduction in RV pressure (94 +/-27 to 44 +/- 7 mmHg), RV/LV pressure ratio (94 +/-27 to 44 +/- 7%) and conduit gradient (65 +/- 28 to 11 +/- 4 mmHg), and no insufficiency. The median duration of the procedure was 180 minutes, with no major complications. Patients were discharged a median of two days after the procedure. After a median follow-up of 7.8 months, patients are in functional class I (5) or II (1), with no evidence of conduit dysfunction on non-invasive assessment.
  
  
  CONCLUSIONS
  Our results are similar to the excellent results reported in larger series. PPVI is a valid therapeutic option in patients with conduit dysfunction.
authors.affiliation: Servigos de Cardiologia e Cardiologia Pedidtrica, Hospital de Santa Marta, EPE, Lisboa, Portugal. jdferreiramartins@gmail.com
authors.forename: José Diogo Ferreira
authors.initials: JD
authors.lastname: Martins
authors.forename: Peter
authors.initials: P
authors.lastname: Ewert
authors.forename: Lídia
authors.initials: L
authors.lastname: Sousa
authors.forename: Isabel
authors.initials: I
authors.lastname: Freitas
authors.forename: Conceição
authors.initials: C
authors.lastname: Trigo
authors.forename: Nuno
authors.initials: N
authors.lastname: Jalles
authors.forename: Pedro
authors.initials: P
authors.lastname: Matos
authors.forename: Ana
authors.initials: A
authors.lastname: Agapito
authors.forename: Rui
authors.initials: R
authors.lastname: Ferreira
authors.forename: Fatima Ferreira
authors.initials: FF
authors.lastname: Pinto
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015607:Stents; D055815:Young Adult