Impact of Percutaneous Pulmonary Valve Implantation on the Timing of Reintervention for Right Ventricular Outflow Tract Dysfunction

Torres-Alba, Fernando De; Kaleschke, Gerrit; Baumgartner, Helmut

doi:10.1016/j.rec.2018.05.001

Cited by 8 publications

(7 citation statements)

References 76 publications

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“…In addition, it avoids the need for frequent reoperations with associated morbidity and mortality [ 4 , 8 , 14 ]. Recreation of the neo-RVOT should enable percutaneous placement of a pulmonary valve [ 15 , 16 ] when the child is fully grown; this could be done in the future using a tissue-engineered valve [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Novel concepts and early results of repairing common arterial trunk

Yacoub

Hosny

Afifi

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Common Arterial Trunk (CAT) continues to have a very poor prognosis globally. To address that, we have developed a novel technique targeting key concepts for the correction of all components of the anomaly, using autologous arterial tissue. This aims to enhance results, availability worldwide, and importantly to avoid the need for repeated reoperations. METHODS From January 2019 to 4 January 2021, all patients with isolated CAT had repair of the defect using autologous arterial trunk tissue with direct right ventricle (RV) to pulmonary artery (PA) connection. Clinical outcomes, follow-up which included multi-slice computed tomography 3D segmentation and 4D cardiovascular magnetic resonance flow, are presented. RESULTS Twenty patients were included in the study (median age 4.5 months). There were 2 hospital deaths due to systemic infection and pulmonary hypertensive crisis, respectively. Following discharge all patients remained asymptomatic with no signs of heart failure and improved pattern of growth (median follow-up: 8 months). Early postoperative 3D segmentation showed a conical shaped neo-right ventricular outflow chamber connecting the body of the RV to the main PA through a valveless ostium, and normal crossing of PA and neo-aorta. 4D cardiovascular magnetic resonance pattern of flow showed normal rapid laminar flow through the atrioventricular valves followed by a vortex towards the outflow tracts. There was laminar flow through the neo-aorta and neo-PA with velocity not exceeding 2.5 m/s. The PA regurgitant fraction was 25 ± 5% and was limited to early diastole. CONCLUSIONS The initial results of utilizing the key concepts, using autologous arterial tissue for the repair of CAT, are encouraging, both clinically and by multimodality imaging.

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Section: Discussionmentioning

confidence: 99%

Novel concepts and early results of repairing common arterial trunk

Yacoub

Hosny

Afifi

et al. 2021

European Journal of Cardio-Thoracic Surgery

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“…However, the question of asymptomatic PI persists. The deleterious effects of progressive RV dilation with respect to increased mortality are well known, however it has not been convincingly proven that SPVR improves mortality or the incidence of ventricular arrhythmias[ 7 ]. There have been multiple studies to investigate what threshold of RV dilation should be used to pursue PVR in an asymptomatic patient which allows a reasonable chance of reversal of structural abnormalities[ 8 ].…”

Section: Indications For Interventionmentioning

confidence: 99%

Transcatheter pulmonic valve implantation: Techniques, current roles, and future implications

Law¹,

Chatterjee²

2021

WJC

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Right ventricular outflow tract (RVOT) obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot, pulmonary atresia/stenosis and other conotruncal abnormalities etc. After surgical repair, these patients develop RVOT residual abnormalities of pulmonic stenosis and/or insufficiency of their native outflow tract or right ventricle to pulmonary artery conduit. There are also sequelae of other surgeries like the Ross operation for aortic valve disease that lead to right ventricle to pulmonary artery conduit dysfunction. Surgical pulmonic valve replacement (SPVR) has been the mainstay for these patients and is considered standard of care. Transcatheter pulmonic valve implantation (TPVI) was first reported in 2000 and has made strides as a comparable alternative to SPVR, being approved in the United States in 2010. We provide a comprehensive review in this space–indications for TPVI, detailed procedural facets and up-to-date review of the literature regarding outcomes of TPVI. TPVI has been shown to have favorable medium-term outcomes free of re-interventions especially after the adoption of the practice of pre-stenting the RVOT. Procedural mortality and complications are uncommon. With more experience, recognition of risk of dreaded outcomes like coronary compression has improved. Also, conduit rupture is increasingly being managed with transcatheter tools. Questions over endocarditis risk still prevail in the TPVI population. Head-to-head comparisons to SPVR are still limited but available data suggests equivalence. We also discuss newer valve technologies that have limited data currently and may have more applicability for treatment of native dysfunctional RVOT substrates.

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“…44 Research has shown that 2 causes of death in TOF patients are arrhythmias and sudden cardiac death, and the only clinical symptom to predict these complications is prolonged QRS complex (QRS duration ≥180 ms). [45][46][47][48][49][50][51] It is assumed that these clinical symptoms can be related to the NKX2.5 gene, but no study has yet been conducted on the association of NKX2.5 mutations with these symptoms. NKX2.5 plays an outstanding role in the development of normal conduction pathways.…”

Section: Jag1mentioning

confidence: 99%

The Contribution of Gene Mutations to the Pathogenesisof Tetralogy of Fallot

Safari-Arababadi

Behjati-Ardakani

Kalantar

et al. 2019

Int J Basic Sci Med

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Congenital heart disease (CHD) is considered as an important and developing area in the medical community. Since these patients can reach maturity and have children, the role of genetic determinants in increasing risk of CHD is extremely evident among children of these patients. Because genetic studies related to CHD are increasing, and each day the role of new genetic markers is more and more clarified, this review re-examined the effects of gene mutations in the pathogenesis of tetralogy of Fallot (TOF) as an important pathological model among other CHDs. Due to the complexity of heart development, it is not astonishing that numerous signaling pathways and transcription factors, and many genes are involved in pathogenesis of TOF. This review focuses on the jag1, nkx2.5, gata4, zfpm2/fog2 and cited2 genes previously reported to be involved in TOF.

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Impact of Percutaneous Pulmonary Valve Implantation on the Timing of Reintervention for Right Ventricular Outflow Tract Dysfunction

Cited by 8 publications

References 76 publications

Novel concepts and early results of repairing common arterial trunk

Novel concepts and early results of repairing common arterial trunk

Transcatheter pulmonic valve implantation: Techniques, current roles, and future implications

The Contribution of Gene Mutations to the Pathogenesisof Tetralogy of Fallot

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