Risk of coronary artery compression among patients referred for transcatheter pulmonary valve implantation: a multicenter experience.
BACKGROUND
The Melody transcatheter pulmonary valve (TPV) was approved for implantation in obstructed right ventricular outflow tract conduits in 2010 after a multicenter trial demonstrating improvements in conduit obstruction, regurgitation, and right ventricular pressure. A recognized risk and contraindication to TPV implantation is the demonstration of coronary artery (CA) compression during balloon angioplasty or stent placement in the overlying conduit. This study is the first to characterize the risk of CA compression in this population.


RESULTS
From 2007 to 2012, 404 patients underwent 407 catheterizations for potential TPV implantation (median age, 18 years) at 4 centers. Three hundred forty-three patients (85%) underwent valve implantation. Twenty-one patients (5%) had evidence of CA compression with simultaneous right ventricular outflow tract angioplasty and CA angiography. Sixty-eight patients (17%) had abnormal CA anatomy. Fifteen of 21 (71%) patients with CA compression had abnormal CA anatomy. Eight patients with tetralogy of Fallot and 7 patients with transposition of the great arteries demonstrated compression. Of the 34 patients with tetralogy of Fallot and abnormal CA, 7 (21%) demonstrated CA compression.


CONCLUSIONS
CA compression following TPV implantation can be catastrophic. CA compression was observed in 5% of patients during test balloon angioplasty. No patients in this study developed clinically apparent CA compression after TPV implantation. CA compression was significantly associated with the presence of abnormal CA anatomy, especially in patients with tetralogy of Fallot or transposition of the great arteries. Preimplantation coronary angiography with simultaneous test angioplasty is an important step to evaluate for the presence of CA compression during TPV implantation.
Department of Cardiology, Boston Children's Hospital, Boston, MA.
Brian H
BH
Morray
Doff B
DB
McElhinney
John P
JP
Cheatham
Evan M
EM
Zahn
Darren P
DP
Berman
Patrick M
PM
Sullivan
James E
JE
Lock
Thomas K
TK
Jones
D000293:Adolescent; D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D002407:Catheterization, Swan-Ganz; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000209:etiology; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000378:metabolism* / Q000473:pathology; D012017:Referral and Consultation; D012189:Retrospective Studies; D012306:Risk; D013771:Tetralogy of Fallot / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
catheterization; heart defects, congenital; tetralogy of Fallot; transposition of great vessels; truncus arteriosus