title: Transhepatic implant of a trimmed Melody™ valved stent in tricuspid position in a 1-year-old infant.
abstract: Percutaneous valved stent implantation is precluded in small infants because large delivery sheaths and large devices. We describe a procedure in a 1-year-old boy in whom a 19 mm Epic™ valve in tricuspid position had become dysfunctional. As the internal diameter of the prosthetic valve was about 16 mm, the only available valve was the Melody™ valved stent. Technical modifications were required to address issues like venous access, the bulky delivery system, and the length of the valved stent. The Melody™ valved stent was surgically trimmed and mounted on a 16 mm Tyshak balloon, access was provided transhepatically through a short 18 Fr sheath. After deployment, the intrahepatic route was sealed with two vascular plugs (8 and 10 mm) in tandem. The procedure was uncomplicated with perfect valve function 18 months after implant. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Pediatric and Congenital Cardiology, University Hospital Leuven, Belgium.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Cools
authors.affiliation: Pediatric and Congenital Cardiac Surgery, University Hospital Leuven, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Rega
authors.affiliation: Pediatric and Congenital Cardiology, University Hospital Leuven, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
mesh_terms: D063126:Balloon Valvuloplasty; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D058385:Cardiac Valve Annuloplasty; D002406:Catheterization, Peripheral / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006503:Hepatic Veins; D006801:Humans; D007223:Infant; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011677:Punctures; D020127:Recovery of Function; D012008:Recurrence; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D014264:Tricuspid Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
keywords: congenital heart disease; pediatric intervention; surgery; transcatheter valve implantation; valvular