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Michael Hofbeck, Oliver Kretschmar, Ludger Sieverding, Bilateral percutaneous pulmonary valve implantation in dual conduits from the subpulmonary ventricle to the pulmonary arteries, European Heart Journal, Volume 32, Issue 22, November 2011, Page 2907, https://doi.org/10.1093/eurheartj/ehr234
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Extract
Percutaneous pulmonary valve implantation (PPVI) of bovine valves mounted in a stent (Melody®, Medtronic) has become a well-established therapy in patients with significant dysfunction of conduits between the right ventricle and the pulmonary arteries. Increasing experience with this technique has allowed to extend the limits of application. We report PPVI in a 32-year-old patient who was referred with heart failure due to complex congenital heart disease including atrial situs inversus, double discordance of atrioventricular and ventriculoarterial connexions, and pulmonary atresia. At the age of 13 and 20 years, he had undergone surgery with interposition of 18 and 14 mm valveless Goretex conduits between the subpulmonary ventricle and the pulmonary arteries. Reevaluation revealed severe obstruction of the first conduit at the bifurcation (Panel A; see supplementary video 1) which was treated by stent implantation and severe regurgitation of the second conduit connecting to the right pulmonary artery (Panel B; see supplementary video 2). Since repeat surgery would have been associated with significant risk, bilateral PPVI appeared as an attractive alternative. The procedure was performed under general anaesthesia. We chose a jugular venous approach to obtain a better angle to enter the pulmonary artery conduits. The jugular vein was dilated with dilators up to 22 Fr and both Melody® valves were implanted subsequently using 18 mm delivery systems. Angiographies following deployment showed competence of both pulmonary valves with substantial improvement of flow to both pulmonary arteries (Panels C and D; see supplementary videos 3 and 4).
