title: [Percutaneous catheter-based implantation of artificial pulmonary valves in patients with congenital heart defects].
abstract: BACKGROUND
  Percutaneous catheter-based implantation of artificial heart valves is a new technique that may supplement surgery and which may be used more in the future. We here report our first experience with implantation of artificial pulmonary valves in children with congenital heart defects.
  
  
  METHODS
  Eligible patients were those with symptoms of heart failure combined with stenosis and/or insufficiency in an established artificial right ventricular outflow tract. The valve was inserted through a catheter from a vein in the groin or neck. Symptoms, echocardiography, invasive measurements and angiography were assessed for evaluation of treatment effect. Our treatment results are reported for the period April 2007-September 2009.
  
  
  RESULTS
  Ten patients (seven men and three women, median age 17 years) were assessed. The procedure reduced pressure in the right ventricle (p = 0.008) and resolved the pulmonary insufficiency in all patients. The median time in hospital was two days. No patients had complications that were directly associated with the implantation procedure. One patient developed a pseudoaneurysm in the femoral artery, another had a short-lasting fever two days after the procedure and one patient experienced a stent fracture that required surgery 9 months after the implantation. After 6 months all patients had a reduced pressure gradient in the right ventricular outflow tract (p = 0.008), the pulmonary insufficiency had improved (p = 0.006) and they all reported improval of symptoms. These results persisted for at least 24 months for the four patients who were monitored until then.
  
  
  CONCLUSIONS
  Percutaneous catheter-based implantation of artificial pulmonary valves improves hemodynamics in the right ventricle of selected patients with congenital heart defects. A randomized controlled study should be undertaken to provide a stronger evidence-base for usefulness of this procedure.
authors: Hjerte-, lunge- og allergiseksjonen, Oslo universitetssykehus, Rikshospitalet, Norway.
authors: Vegard Bruun
authors: VB
authors: Wyller
authors: Lars
authors: L
authors: Aaberge
authors: Erik
authors: E
authors: Thaulow
authors: Gaute
authors: G
authors: Døhlen
mesh_terms: D000293:Adolescent; D002404:Catheterization / Q000009:adverse effects / Q000379:methods; D002648:Child; D002983:Clinical Competence; D017023:Coronary Angiography; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D018579:Patient Selection; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000151:congenital / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000151:congenital / Q000601:surgery*; D016896:Treatment Outcome