title: Three dimensional rotational angiography for assessment of coronary arteries during melody valve implantation: introducing a technique that may improve outcomes.
abstract: BACKGROUND
  Adverse events from Melody valve implantation may be catastrophic. To date a role for three dimensional rotational angiography of the aortic root (3DRAA) during Melody valve implantation has not been established.
  
  
  OBJECTIVE
  To describe the role of 3DRAA in the assessment of Melody valve candidacy and to demonstrate that it may improve outcomes.
  
  
  METHODS
  All patients who underwent cardiac catheterisation for Melody valve implantation and 3DRAA between August 2013 and February 2015 were reviewed.
  
  
  RESULTS
  31 patients had 3DRAA with balloon sizing. Ten were deemed not Melody candidates (5 coronary compression, 2 aortic root distortion with cusp flattening, 2 RVOT was too large, and 1 had complex branch stenosis and a short landing zone). Of the 21 patients who were Melody candidates, 12 had conduits, 6 prosthetic valves and 3 native RVOTs. In patients with conduits, the technique of stenting the conduit prior to dilation was used after measuring the distance between the conduit and the coronary arteries on 3DRAA. In the Melody patients, we had 100% procedural success and no serious adverse events (coronary compression, tears, stent fracture or endocarditis).
  
  
  CONCLUSIONS
  As a tool for case selection, 3DRAA may facilitate higher procedural success and decreased risk of serious adverse events. Furthermore, 3D rotational angiography allows stenting of the conduit prior to dilation, which may prevent tears and possibly endocarditis.
authors.affiliation: Rady Children's Hospital, San Diego, University of California, San Diego, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Pockett
authors.affiliation: Rady Children's Hospital, San Diego, University of California, San Diego, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Moore
authors.affiliation: Rady Children's Hospital, San Diego, University of California, San Diego, USA. helsaid@rchsd.org.
authors.forename: H G
authors.initials: HG
authors.lastname: El-Said
keywords: 3D angiography; Aortic root distortion; Coronary angiography; Coronary compression; Percutaneous pulmonary valve