Semilunar Valve Interventions for Congenital Heart Disease

Morray, Brian H.; McElhinney, Doff B.

doi:10.1016/j.jacc.2020.10.052

Cited by 12 publications

(9 citation statements)

References 62 publications

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“…The first‐line treatment for congenitally diseased PVs is almost always repair in order to preserve the native tissue 12,14 . For example, pulmonary stenosis may be treated with balloon pulmonary valvuloplasty, wherein the expansion of a transcatheter balloon forces the stenotic leaflets open 9,53,54 . However, PV replacement is often inevitable, 12,14 such as when valvuloplasty or valvectomy eventuates in significant pulmonary regurgitation 9 .…”

Section: Current Pediatric Pulmonary Valve Replacementsmentioning

confidence: 99%

Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

Crago

Winlaw

Farajikhah

et al. 2023

Bioengineering & Transla Med

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Congenital heart diseases (CHDs) frequently impact the right ventricular outflow tract, resulting in a significant incidence of pulmonary valve replacement in the pediatric population. While contemporary pediatric pulmonary valve replacements (PPVRs) allow satisfactory patient survival, their biocompatibility and durability remain suboptimal and repeat operations are commonplace, especially for very young patients. This places enormous physical, financial, and psychological burdens on patients and their parents, highlighting an urgent clinical need for better PPVRs. An important reason for the clinical failure of PPVRs is biofouling, which instigates various adverse biological responses such as thrombosis and infection, promoting research into various antifouling chemistries that may find utility in PPVR materials. Another significant contributor is the inevitability of somatic growth in pediatric patients, causing structural discrepancies between the patient and PPVR, stimulating the development of various growthaccommodating heart valve prototypes. This review offers an interdisciplinary perspective on these challenges by exploring clinical experiences, physiological understandings, and bioengineering technologies that may contribute to device development. It thus aims to provide an insight into the design requirements of next-generation PPVRs to advance clinical outcomes and promote patient quality of life.

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Section: Current Pediatric Pulmonary Valve Replacementsmentioning

confidence: 99%

Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

Crago

Winlaw

Farajikhah

et al. 2023

Bioengineering & Transla Med

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“…Oftentimes, regurgitation transpires during disease progression of stenotic semilunar valves or as an iatrogenic consequence of prior intervention. 4…”

Section: Introductionmentioning

confidence: 99%

Trileaflet Semilunar Valve Reconstruction: Acute Porcine in Vivo Evaluation

Hanse

Tjørnild

Karunanithi

et al. 2023

World J Pediatr Congenit Heart Surg

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Objective: The surgical treatment of malformed semilunar valves in congenital heart defects is challenging in terms of providing both longevity and the potential to grow with the recipient. We investigated a new surgical technique “Trileaflet Semilunar Valve Reconstruction” in an acute porcine model, a technique with geometrical properties that could remain sufficient and allow for some growth with the child. Methods: An acute 60-kg porcine model was used. With echocardiography, baseline pulmonary valvular geometry and hemodynamics were investigated. On cardiopulmonary bypass, the pulmonary leaflets were explanted, and the Trileaflet Semilunar Valve Reconstruction was performed with customized homograft-treated pericardial neo-leaflets. Off bypass, hemodynamics was reassessed. Results: Twelve animals were investigated. The neo-valves were found sufficient in ten animals and with minimal regurgitation in two animals. The neo-valve had a peak gradient of 3 ± 2 mm Hg with a peak velocity of 0.8 ± 0.2 m/s. The coaptation in the neo-valve had a mean increase of 4 ± 3 mm, P < .001. The neo-valve had a windmill shape in the echocardiographic short-axis view, and the neo-leaflets billowed at the annular plane in the long-axis view. Conclusions: In this acute porcine model, the neo-valve had no clinically significant regurgitation or stenosis. The neo-valve had an increased coaptation, a windmill shape, and leaflets that billowed at the annular plane. These geometric findings may allow for sustained sufficiency as the annular and pulmonary artery dimension increase with the child's growth. Further long-term studies should be performed to evaluate the efficacy and the growth potential.

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“…TPVR is increasingly used to treat patients with dysfunctional RVOT conduits or surgical bioprosthetic valves. 1 Technical success has been reported up to 97.4% with the use of the balloon-expandable SAPIEN transcatheter heart valve device. 1,2 However, the use of TPVR in native RVOT anatomy or surgical homografts carries significant risk and challenges.…”

mentioning

confidence: 99%

“…1 Technical success has been reported up to 97.4% with the use of the balloon-expandable SAPIEN transcatheter heart valve device. 1,2 However, the use of TPVR in native RVOT anatomy or surgical homografts carries significant risk and challenges. The pulsatile nature of RVOT and diameter variation makes sizing very challenging and increases the risk of valve embolization.…”

mentioning

confidence: 99%