title: Feasibility and short-term outcomes of percutaneous transcatheter pulmonary valve replacement in small (<30 kg) children with dysfunctional right ventricular outflow tract conduits.
abstract: BACKGROUND
  In 2010, the Melody transcatheter pulmonary valve (TPV) received Food and Drug Administration approval for treatment of dysfunctional right ventricular outflow tract conduits in patients ≥30 kg. Limited data are available regarding use of this device in smaller patients.
  
  
  RESULTS
  We evaluated technical and short-term clinical outcomes of 25 patients <30 kg (10 patients <20 kg) who underwent TPV replacement for treatment of conduit dysfunction at 3 centers. Median age and weight were 8.0 years (3.4-14.4) and 21.4 kg (13.8-29.0). The median conduit diameter at the time of surgical implant was 17 mm (12-23). Two patients did not undergo TPV implant (risk of coronary compression in 1; inability to advance the delivery sheath beyond the common femoral vein in 1). After successful TPV implant, the peak conduit gradient fell from 29±16 to 9±6 mm Hg (P<0.001), and all but 2 patients had no/trivial regurgitation (down from moderate or severe preimplant in 20). TPV implant was via the femoral vein in 17 patients, the right internal jugular vein in 4, and the left subclavian vein in 2 patients. At a median follow-up of 16 months, 1 patient underwent conduit replacement for recurrent conduit stenosis, 2 developed stent fracture requiring a second TPV, and 2 developed bacterial endocarditis treated with antibiotics, 1 of whom then underwent conduit replacement. The average Melody valve mean Doppler gradient and conduit regurgitation were unchanged from early postimplant.
  
  
  CONCLUSIONS
  Percutaneous TPV replacement can be performed in small children with good procedural and early hemodynamic results in the majority of patients.
authors.affiliation: From the Division of Cardiology, Miami Children's Hospital, FL (D.P.B., E.M.Z.); Department of Cardiology, Children's Hospital Boston, MA (D.B.M.); Departments of Pediatrics, Medicine, and Cardiothoracic Surgery, New York University, NY (D.B.M.); Division of Cardiology, Morgan Stanley Children's Hospital, New York, NY (J.A.V., W.E.H.); Division of Pediatric Cardiology, Yale University, New Haven, CT (W.E.H.); and Congenital Heart Program, Cedars-Sinai Medical Center, Los Angeles, CA (E.M.Z.).
authors.forename: Darren P
authors.initials: DP
authors.lastname: Berman
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.forename: Julie A
authors.initials: JA
authors.lastname: Vincent
authors.forename: William E
authors.initials: WE
authors.lastname: Hellenbrand
authors.forename: Evan M
authors.initials: EM
authors.lastname: Zahn
mesh_terms: D000293:Adolescent; D049628:Body Size / Q000502:physiology; D001835:Body Weight / Q000502:physiology*; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000601:surgery*
keywords: cardiac catheterization; congenital; heart defects, congenital; pulmonary valve