Transcatheter Right Ventricular Outflow Tract Intervention
The Risk to the Coronary Circulation
A 14-year-old male with degeneration of his right ventricular to pulmonary artery homograft conduit was referred to us for percutaneous pulmonary valve implantation (PPVI).1 Magnetic resonance imaging indicated close proximity of the left anterior descending coronary artery to the homograft (Figure, A). To test whether PPVI would compress the coronary artery, an 18-mm Mullins balloon (NuMed Inc, Hopkinton, NY) was inflated within the homograft, bringing it to its maximum diameter and mimicking stent implantation. Simultaneous selective coronary angiography demonstrated significant compression of the left anterior descending coronary artery (Figure, B). The balloon was deflated, after which normal coronary flow was restored (Figure, C), and thus PPVI was not performed. The patient was referred for surgery.
Sources of Funding
Dr Coats has received a British Heart Foundation Junior Fellowship Grant. Dr Taylor’s work is funded by an HEFCE grant. Dr Bonhoeffer has received a British Heart Foundation Programme Grant.
Dr Coats has received honoraria from Sanofi Aventis and Medtronic. Dr Taylor serves as a consultant for Medtronic. Professor Bonhoeffer serves as a consultant for Medtronic and NuMed. Drs Sridharan and Khambadkone report no conflicts.
Khambadkone S, Coats L, Taylor AM, Boudjemline Y, Derrick G, Tsang V, Cooper J, Muthurangu V, Hegde SR, Razavi RS, Pellerin D, Deanfield J, Bonhoeffer P. Transcatheter pulmonary valve implantation in humans: initial results in 59 consecutive patients. Circulation. 2005; 112: 1189–1197.