title: A new percutaneous pulmonary valve implantation technique for complex right ventricular outflow tracts: the "folded melody valve".
abstract: OBJECTIVE
  This article sought to describe a new modification of the Melody valve that allows percutaneous pulmonary valve implantation (PPVI) in complex outflow tracts.
  
  
  BACKGROUND
  PPVI has been validated as a valuable therapeutic option for the management of patients with dysfunctional right ventricular outflow tracts (RVOT). However, complex and unfavourable RVOT anatomy continue to limit the indications for PPVI.
  
  
  METHODS
  Between April 2012 and November 2013, PPVI was performed in 10 patients (mean age = 16, 3 ± 5 years old) using a new modification of the Melody® valve consisting in a manual shortening of the Melody by folding the two extremities of the stent. We reviewed the results of this technique.
  
  
  RESULTS
  Indications were short RVOT in three patients, prevention of retrosternal compression in two patients, bioprosthetic valves in four and coronary arteries proximity in one. No complication occurred during procedures. All patients had excellent hemodynamic results [mean post PPVI RV-PA gradient was 14 ± 6 mm Hg, three patients had trivial pulmonary regurgitation (PR) and the remaining had no PR]. After a mean follow-up of 11 months (range 5-21 months), no patient had reintervention. No valve dysfunction or stent fractures were observed.
  
  
  CONCLUSIONS
  The "Folded valve technique" is a safe modification of the Melody valve. By shortening the valve, this technique allowed PPVI in short and complex RVOTs with vulnerable neighborhood.
authors.affiliation: Department of Congenital and Pediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Pediatric Cardiology, Paris, France; Department of Congenital Adult Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, George Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Unit for Adults with Congenital Heart Defects, Paris, France; Department of Pediatric and Adult Congenital Heart defects, University Hospital of Bordeaux, Pessac, France.
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Jalal
authors.forename: Sophie
authors.initials: S
authors.lastname: Malekzadeh-Milani
authors.forename: Michael
authors.initials: M
authors.lastname: Hofbeck
authors.forename: Khalid
authors.initials: K
authors.lastname: Al Najashi
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: Thambo
authors.forename: Younes
authors.initials: Y
authors.lastname: Boudjemline
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods*; D002648:Child; D005260:Female; D005602:France; D005858:Germany; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011859:Radiography; D020127:Recovery of Function; D012529:Saudi Arabia; D013997:Time Factors; D016896:Treatment Outcome; D016278:Ventricular Function, Right
keywords: pulmonary valve; stent; transcatheter valve