title: Aortic Root Distortion and Aortic Insufficiency During Balloon Angioplasty of the Right Ventricular Outflow Tract Prior to Transcatheter Pulmonary Valve Replacement.
abstract: OBJECTIVE
  To describe the significance of aortic root distortion (AD) and/or aortic valve insufficiency (AI) during balloon angioplasty of the right ventricular outflow tract (RVOT) performed to rule out coronary artery compression prior to transcatheter pulmonary valve (TPV) implantation.
  
  
  METHODS
  AD/AI was assessed by retrospective review of all procedural aortographies performed to evaluate coronary anatomy prior to TPV implantation. AD/AI was also reviewed in all pre-post MPV implant echocardiograms to assess for progression.
  
  
  RESULTS
  From 04/2007 to 3/2015, 118 pts underwent catheterization with intent for TPV implant. Mean age and weight were 24.5 ± 12 years and 64.3 ± 20 kg, respectively. Diagnoses were: TOF (53%), D-TGA/DORV (18%), s/p Ross (15%), and Truncus (9%). Types of RV-PA connections were: conduits (96), bioprosthetic valves (14), and other (7). Successful TPV implant occurred in 91 pts (77%). RVOT balloon angioplasty was performed in 43/118 pts (36%). Aortography was performed in 18/43 pts with AD/AI noted in 6/18 (33%); 2 with D-TGA (1 s/p Lecompte, 1 s/p Rastelli), 2 with TOF, 1 Truncus and 1 s/p Ross. Procedure was aborted in the 2 who developed severe AD/AI. TPV was implanted in 3/4 patients with mild AD/AI. Review of pre-post TPV implantation echocardiograms in 83/91 pts (91%) revealed no new/worsened AI in any patient.
  
  
  CONCLUSIONS
  AD/AI is relatively common on aortography during simultaneous RVOT balloon angioplasty. Lack of AI progression by echocardiography post-TPV implant suggests these may be benign findings in most cases. However, AD/AI should be carefully evaluated in certain anatomic subtypes with close RVOT/aortic alignments.
authors.affiliation: Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, New York.
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Torres
authors.affiliation: Stanford University Medical Center, Palo Alto, California.
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.affiliation: Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, New York.
authors.forename: Brett R
authors.initials: BR
authors.lastname: Anderson
authors.affiliation: Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, New York.
authors.forename: Mariel E
authors.initials: ME
authors.lastname: Turner
authors.affiliation: Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, New York.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Crystal
authors.affiliation: Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, New York.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Timchak
authors.affiliation: Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, New York.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Vincent
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D006328:Cardiac Catheterization / Q000379:methods; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D004452:Echocardiography / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D011664:Pulmonary Valve / Q000601:surgery*; D012189:Retrospective Studies; D014694:Ventricular Outflow Obstruction / Q000601:surgery*; D055815:Young Adult
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