Abstract 4623: Transvascular Implantation of Pulmonary Valve in Patients After Tetralogy of Fallot, Ross and Rastelli Operations
The aim of the study was to assess the early results of the transcatheter pulmonary valve implantation (TPVI) in pts with homograft dysfunction.
Methods: TPVI was performed in 8 pts (5 men), aged 27–31 years, with pulmonary homograft dysfunction 2–10 y after total repair of tetralogy of Fallot (4 pts), Ross procedure (3 pts) and Rastelli operation (1 pt). Five pts underwent in the past 2–4 surgical or/and catheter interventions. Indication for TPVI was based on clinical evaluation, echocardiographic studies and assessment of morphological and functional features of the right ventricle (RV) and homograft with the use of cardiac magnetic resonance (CMR). Pulmonary stenosis (max. pulmonary gradient 50–119 mmHg) was observed in 7 pts and/or significant pulmonary regurgitation in 3 pts. The procedure was performed in general anesthesia. The deployment of a valved stent in the pulmonary valve position was preceded by a metal stent implantation. Results were evaluated by echocardiography two days after the procedure and by echocardiography and CMR 1 month later.
Results: Time of the procedure varied from 60 to 150 min. TPVI was successfully performed in all pts without complications. Average reduction of pulmonary gradient after the procedure assessed by echocardiography was 49% after 2 days (20–55 mm Hg) and 50% after one month (19–52 mm Hg). Mild pulmonary regurgitation was observed in one pt. In all pts end-systolic (ESV) and end-diastolic volumes (EDV) of RV were reduced (from mean 126 ml/m2 to 107 ml/m2 for RVEDV, p=0.11 and from 73 ml/m2 to 58 ml/m2 for RVESV, p=0.01) with concomitant insignificant increase of these parameters for the left ventricle (from 94 ml/m2 to 98 ml/m2, p=0.3 and from 41 ml/m2 to 42 ml/m2, p=0.91, respectively).
Conclusions: Pulmonary artery valve transvascular implantation is an effective and safe method of non-surgical treatment for patients with homograft dysfunction.