Aortic root compression during transcatheter pulmonary valve replacement.
OBJECTIVE
To describe the incidence of aortic root compression (ARC) during transcatheter pulmonary valve replacement (TPVR).


BACKGROUND
ARC can occur during balloon sizing of the right ventricular outflow tract (RVOT) or during coronary compression testing (BS/CCT) prior to TPVR, causing aortic valve dysfunction and/or root distortion with or without coronary compression. This has limited the use of TPVR in patients with native RVOTs, including those with a transannular patch (TAP). The characteristics of this patient cohort have not previously been described.


METHODS
A retrospective review was performed of all patients with congenital heart disease who presented for TPVR at UCLA from 2010 to 2015. ARC characteristics during BS/CCT were noted for all relevant cases.


RESULTS
Inclusion criteria were met by 174 patients. ARC occurred in 16 patients (9%), of whom 14 had Tetralogy of Fallot with a native/TAP RVOT (14/42, 33%, of all native/TAP patients). Five ARC patients also had concomitant coronary artery compression. Isolated coronary compression occurred in six patients. Two patients underwent successful TPVR despite ARC by implanting the valves in the distal RVOT. One patient required surgical PVR and Sapien valve explantation after TPVR caused severe ARC.


CONCLUSIONS
The majority of cases of ARC occur in patients with native/TAP RVOTs. ARC during BS/CCT may identify those at risk for ARC following TPVR. While ARC is a real phenomenon, it is unclear if it can be accurately predicted, what its clinical significance will be and how it is best avoided. Further studies are necessary to answer these questions. © 2016 Wiley Periodicals, Inc.
The Division of Pediatric Cardiology, UCLA Medical Center, University of California at Los Angeles, California.|Ahmanson-UCLA Adult Congenital Heart Disease Center, University of California at Los Angeles, Los Angeles, California.
Ian
I
Lindsay
The Division of Pediatric Cardiology, UCLA Medical Center, University of California at Los Angeles, California.|Ahmanson-UCLA Adult Congenital Heart Disease Center, University of California at Los Angeles, Los Angeles, California.
Jamil
J
Aboulhosn
Department of Pediatrics, Division of Cardiology, Kaiser Permanente, Los Angeles, California.
Morris
M
Salem
The Division of Pediatric Cardiology, UCLA Medical Center, University of California at Los Angeles, California.|Ahmanson-UCLA Adult Congenital Heart Disease Center, University of California at Los Angeles, Los Angeles, California.
Daniel
D
Levi
D000293:Adolescent; D000328:Adult; D000792:Angiography; D001013:Aorta, Thoracic; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
adults; complications; congenital heart disease; pediatric catheterization/intervention; pediatrics; percutaneous intervention; percutaneous valve therapy; pulmonary valve disease; transcatheter valve implantation