title: Results of transcatheter pulmonary valvulation in native or patched right ventricular outflow tracts.
abstract: BACKGROUND
  Although widely accepted worldwide, indications for percutaneous valve replacement are limited to treatment of dysfunction of prosthetic conduits inserted in the right ventricular outflow tract (RVOT). There has been little evaluation of the use of the Melody(®) valve for patched non-circular pulmonary pathways.
  
  
  OBJECTIVE
  To evaluate the outcomes of Melody valve insertion in patients with a patched non-circular RVOT.
  
  
  METHODS
  We analysed procedural and outcomes data from 34 patients who underwent Melody valve implantation for a non-circular RVOT. RVOT preparation was done in all patients, using different techniques (conventional, Russian doll and/or PA jailing). Melody valve insertion was performed concomitantly in most patients.
  
  
  RESULTS
  All procedures were successful. Sixteen patients had complex additional procedures, including the jailing technique (n=5), the Russian doll technique (n=6) and multiple stent implantations (Russian jailing; n=5). The remaining patients were treated using the conventional technique with systematic prestenting. Three early complications occurred: one haemoptysis; one residual RVOT obstruction needing recatheterization 48 hours after percutaneous pulmonary valve implantation; and one stent embolization during advancement of the Ensemble(®) delivery system. The mean follow-up period was 2.6 years postprocedure. There was no stent fracture, migration or embolization. Two patients developed a significant paraprosthetic leak and one received a second Melody valve.
  
  
  CONCLUSIONS
  Careful patient selection, balloon sizing and RVOT preparation with prestenting are required to create a safe landing zone for the Melody valve. Short-term follow-up shows excellent results with no stent fracture or migration and appears promising.
authors.affiliation: Centre de référence malformations cardiaques congénitales complexes - M3C, Necker Hospital for Sick Children, Georges-Pompidou European Hospital, Assistance Publique des Hopitaux de Paris, Paediatric Cardiology, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Malekzadeh-Milani
authors.affiliation: Centre de référence malformations cardiaques congénitales complexes - M3C, Necker Hospital for Sick Children, Georges-Pompidou European Hospital, Assistance Publique des Hopitaux de Paris, Paediatric Cardiology, Paris, France.
authors.forename: Magalie
authors.initials: M
authors.lastname: Ladouceur
authors.affiliation: Centre de référence malformations cardiaques congénitales complexes - M3C, Necker Hospital for Sick Children, Georges-Pompidou European Hospital, Assistance Publique des Hopitaux de Paris, Paediatric Cardiology, Paris, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Centre de référence malformations cardiaques congénitales complexes - M3C, Necker Hospital for Sick Children, Georges-Pompidou European Hospital, Assistance Publique des Hopitaux de Paris, Paediatric Cardiology, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Iserin
authors.affiliation: Centre de référence malformations cardiaques congénitales complexes - M3C, Necker Hospital for Sick Children, Georges-Pompidou European Hospital, Assistance Publique des Hopitaux de Paris, Paediatric Cardiology, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75270 Paris cedex 06, France. Electronic address: younes.boudjemline@nck.aphp.fr.
authors.forename: Younes
authors.initials: Y
authors.lastname: Boudjemline
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cardiopathies congénitales; Congenital heart diseases; Melody; Melody valve; Percutaneous valve implantation; Remplacement valvulaire pulmonaire percutané; Tetralogy of Fallot; Tétralogie de Fallot