Coronary artery compression three months after transcatheter pulmonary valve implantation

Dehghani, Payam; Kraushaar, Greg; Taylor, Dylan

doi:10.1002/ccd.25628

Cited by 13 publications

(7 citation statements)

References 11 publications

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“…Coronary artery compression during PPVI has been reported in multiple case series with outcomes varying from symptomatic acute coronary syndrome to cardiac arrest [5,6,7,8,9,10,11]. Morray and colleagues retrospectively evaluated coronary artery testing in 404 patients referred for PPVI in a multi-institutional study [4].…”

Section: Discussionmentioning

confidence: 99%

Continuous Assessment of a Stented Coronary Artery Using a Pressure Wire During Percutaneous Pulmonary Valve Implantation

Boe¹,

Cheatham²,

Cheatham³

2017

jshd

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A 52-year-old woman with tetralogy of Fallot status post-complete surgical repair with infundibular resection, pulmonary valvotomy, and patch closure of the ventricular septal defect presented with severe pulmonary regurgitation and depressed right ventricular function. During intended percutaneous pulmonary valve implantation (PPVI), multiple stenotic lesions were discovered in her left anterior descending (LAD) coronary artery, and the procedure was aborted. She underwent treatment of these lesions using drug-eluting stents by our adult interventional colleagues and returned to the congenital catheterization laboratory for PPVI 18 months following her initial procedure. Given the potential risk of crush injury to the coronary arterial stents, the distal LAD artery was continuously monitored during the procedure via a pressure wire with the capability of re-expanding the stent if needed.Copyright © 2017 Science International Corp. Key Words Congenital catheterization • Intervention • Valve implantation IntroductionPercutaneous pulmonary valve implantation (PPVI) is an effective method for treating right ventricular outflow tract (RVOT) obstruction and regurgitation in patients with congenital heart disease [1,2,3]. A rare but catastrophic complication of PPVI is mechanical coronary artery compression due to implantation of a stent and/or valve within the RVOT [4]. Coronary artery testing is recommended during balloon angioplasty of the RVOT to assess coronary artery compression or distortion. However, the presence of an existing coronary artery stent may render coronary artery testing with balloon angioplasty/compliance testing a higher risk procedure. Here, we report the first use of a pressure wire within a stented left anterior descending (LAD) coronary artery in close proximity to the RVOT during PPVI to assess for coronary artery stent compromise and to maintain access for treatment of compression with redilation of the stent or re-stent if necessary. Case PresentationA 52-year-old woman with tetralogy of Fallot presented to our adult congenital cardiology program for evaluation. She underwent complete surgical repair at 8 years of age consisting of infundibular resection, pulmonary valvotomy, and patch closure of a ventricular septal defect. Her residual atrial septal defect was closed with a CardioSEAL™ Occlusion Device (Nitinol Medical Technologies, Ind., Boston, Massachusetts) at 38 years of age. Past medical history was also significant for diabetes mellitus and hypertension. As a result of her surgical palliation, the patient had severe pulmonary valve regurgitation with decreased right ventricular function and was referred for PPVI. Prior to RVOT intervention, multiple stenotic lesions were discovered within her LAD, and the procedure was aborted (Figure 1). Over the next few months, the patient underwent percutaneous coronary intervention by our adult interventional colleagues with a total of three drug-eluting stents placed along her proximal, mid, and distal LAD. After surveillance corona...

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Section: Discussionmentioning

confidence: 99%

Continuous Assessment of a Stented Coronary Artery Using a Pressure Wire During Percutaneous Pulmonary Valve Implantation

Boe¹,

Cheatham²,

Cheatham³

2017

jshd

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“…[2, 3, 7–9]. Abnormal coronary artery patterns present higher risks for coronary artery compression [10]. However, none of our disqualified patients had such coronary artery patterns.…”

Section: Discussionmentioning

confidence: 99%

“…Several series, including the sentinel US FDA clinical trial [17], contain anecdotal patients which demonstrate clinical coronary artery compression after valve implant. There are also notable cases of patients whose coronary arteries were evaluated using conventional methods, who presented with clinically significant coronary artery compression up to one-year post implantation [10]. Furthermore, implant procedures are performed in the artificial state of general anaesthesia with controlled heart rates and low cardiac outputs.…”

Section: Discussionmentioning

confidence: 99%

“…We disqualified two patients because we were concerned that distortion or cusp flattening might cause long-term sub-critical coronary insufficiency and lead to ventricular dysfunction. We believe that patients reported with dynamic coronary artery compression during exercise following Melody valve implantation support this concern [10]. In addition, subtle distortion of the aortic root may also lead to aortic valve insufficiency and dysfunction [16].…”

Section: Discussionmentioning

confidence: 99%

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Three dimensional rotational angiography for assessment of coronary arteries during melody valve implantation: introducing a technique that may improve outcomes

2016

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BackgroundAdverse 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.ObjectivesTo describe the role of 3DRAA in the assessment of Melody valve candidacy and to demonstrate that it may improve outcomes.MethodsAll patients who underwent cardiac catheterisation for Melody valve implantation and 3DRAA between August 2013 and February 2015 were reviewed.Results31 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).ConclusionAs 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.

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“…On balloon compression testing,~6% of patients have been excluded for percutaneous pulmonary valve implantation (PPVI) [38]. There is a case report of late-presenting coronary compression with exercise due to dissection of the ostium of the right coronary artery (RCA) [39]. In this case, prior to the procedure, the cardiac MRI was not concerning for coronary artery compression and the patient did not have a balloon occlusion test prior to valve deployment.…”

Section: Pulmonic Valvementioning

confidence: 96%

Transcatheter valve-in-valve therapy: What does the pediatric cardiologist need to know?

Leventhal

Shah

Osten

et al. 2014

Progress in Pediatric Cardiology

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Coronary artery compression three months after transcatheter pulmonary valve implantation

Cited by 13 publications

References 11 publications

Continuous Assessment of a Stented Coronary Artery Using a Pressure Wire During Percutaneous Pulmonary Valve Implantation

Continuous Assessment of a Stented Coronary Artery Using a Pressure Wire During Percutaneous Pulmonary Valve Implantation

Three dimensional rotational angiography for assessment of coronary arteries during melody valve implantation: introducing a technique that may improve outcomes

Transcatheter valve-in-valve therapy: What does the pediatric cardiologist need to know?

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