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Percutaneous pulmonary valve implantation preceded by routine prestenting with a bare metal stent
Author(s) -
Demkow Marcin,
Biernacka Elżbieta Katarzyna,
Śpiewak Mateusz,
Kowalski Mirosław,
Siudalska Hanna,
Wolski Piotr,
Sondergaard Lars,
Miśko Jolanta,
Hoffman Piotr,
Rużyłło Witold
Publication year - 2011
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.22700
Subject(s) - medicine , cardiology , ejection fraction , pulmonary valve , pulmonary regurgitation , ventricular outflow tract , regurgitant fraction , stent , stenosis , percutaneous , diastole , heart disease , tetralogy of fallot , heart failure , blood pressure
Objectives: To evaluate the effectiveness and safety of percutaneous pulmonary valve implantation (PPVI) with routine prestenting with a bare metal stent (BMS). Background: PPVI is a relatively new method of treating patients with repaired congenital heart disease (CHD). Results of PPVI performed with routine prestenting have never been reported. Methods: Consecutive patients who underwent PPVI for homograft dysfunction with prestenting with BMS were studied. The schedule of follow‐up assessment comprised clinical evaluation, cardiovascular magnetic resonance, transthoracic echocardiography, and chest X‐ray to screen for device integrity. Results: PPVI was performed with no serious complications in all patients ( n = 10, mean age 26.8 ± 4.0 years, 60% males). In nine patients with significant pulmonary stenosis, peak right ventricular outflow tract (RVOT) gradient was reduced from a mean of 80.6 ± 22.7 to 38.8 ± 10.4 mm Hg on the day following implantation ( P = 0.001). At 1‐month and 6‐month follow‐ups, mean RVOT gradient was 34.0 ± 9.8 and 32.0 ± 12.2 mm Hg, respectively. In patients with significant pulmonary regurgitation, mean pulmonary regurgitation fraction decreased from 19% ± 6% to 2% ± 1% ( P = 0.0008). Relief of RVOT obstruction and restoration of pulmonary valve competence were associated with significant decrease in right ventricular (RV) end‐diastolic and end‐systolic volumes (125.5 ± 48.6 to 109.2 ± 42.9 mL/m 2 ; P = 0.002 and 68.4 ± 41.5 vs. 50.9 ± 40.6 mL/m 2 ; P = 0.001) as well as improvement in RV ejection fraction (48.8% ± 13.1% to 57.6% ± 14.4%; P = 0.003) and New York Heart Association class ( P = 0.003). All patients completed 6‐month follow‐up. No stent fractures were observed. Conclusions: PPVI with routine prestenting with BMS is a safe and effective method of treatment in patients with repaired CHD. © 2010 Wiley‐Liss, Inc.