Percutaneous Pulmonary Valve Implantation: Current Status and Future Perspectives

Abstract

Patients with congenital heart disease (CHD) with right ventricle outflow tract (RVOT) dysfunction need sequential pulmonary valve replacements throughout their life in the majority of cases. Since their introduction in 2000, the number of percutaneous pulmonary valve implantations (PPVI) has grown and reached over 10,000 procedures worldwide. Overall, PPVI has been proven safe and effective, but some anatomical variations can limit procedural success. This review discusses the current status and future perspectives of the procedure.

Bicuspidization reconstruction for regurgitant quadricuspid pulmonary valve concomitant pulmonary artery aneurysm graft replacement

“…Both the valvular replacement and repair are the resolutions for PR. Although the transcatheter pulmonary valve replacement (TPVR) has been invented, 4 TPVR was not found suitable for this PR patient with concomitant PAA due to the risk of dissection or rupture. Compared with the valvular replacement or reconstruction by the pericardium patch, restoration of native leaflets could avoid anticoagulant agents and the complications due to the pericardial calcification for the long term.…”

Role of computed tomography in transcatheter replacement of ‘other valves’: a comprehensive review of preprocedural imaging

“…Moreover, a right ventricular ejection fraction less than 30% is also associated with major adverse clinical outcomes, whereas a peak instantaneous gradient more than 64 mmHg regardless of symptoms (or <64 mmHg with symptoms or decreased right ventricular function) or a mean gradient of 35 mmHg are utilized for pulmonary valve stenosis. 79 Stenosis and regurgitation of the pulmonary valve are common defects in congenital heart disease associated with right ventricular outflow tract (RVOT) abnormalities; moreover, pulmonary valve disease and RVOT dysfunction may result from surgery for congenital heart disease or occur as a consequence of acquired conditions such as bacterial endocarditis, carcinoid heart disease and rheumatic heart disease. [79][80][81][82] Although in the past, study of the pulmonary valve and RVOT was exclusively performed using transthoracic and transesophageal echocardiography, in recent years, CT has progressively replaced echocardiography by providing an accurate preoperative assessment of anatomical details of the pulmonary valve, perivalvular structures and RVOT.…”

Percutaneous pulmonary valve implantation in India: Quo Vadis?

“…[ 39 40 ] There are growing options with number of devices available now including Melody, Sapien-S3, Venus P valve, Medtronic Harmony transcatheter pulmonary valve, Pulsta, Alterra present, and Med-Zenith PT amongst others. [ 11 12 41 ] Hybrid surgical procedures and other innovative technologies will certainly continue to expand the field of PPVI. The long-term effects of a foreign material in RVOT, durability of stents and valve prosthesis, and finally outcome analysis are important: All of these need continued careful follow-up.…”

“…Others have recommended PVR in patients with RV/LV EDV >2 or LV ejection fraction <55% or in patients requiring open heart surgery for other reasons with less stringent criteria. [ 11 12 ] Following PVR, symptomatic improvement, improved exercise performance, reduction in RV volumes, and in QRS duration is reported in some, but not in all studies. [ 13 14 ] However, there may be no change in QRS duration if it was >160 ms preoperatively.…”

“…There is a tremendous increase in the number of PVR procedures done recently, both surgically and percutaneously. [ 11 12 31 32 ] The enthusiasm of newly found effective technology for an unmet need of patients might explain some of the increase. However, it could also reflect self-referral and enthusiasm of interventional cardiology community in the face of an uncertain and evolving field of postoperative TOF patients, akin to adult interventional cardiology practices.…”