Objective
To describe the significance of aortic root distortion (AD) and/or
aortic valve insufficiency (AI) during balloon angioplasty of the right
ventricular outflow tract (RVOT) performed to rule out coronary artery
compression prior to transcatheter pulmonary valve (TPV) implantation.
Methods
AD/AI were assessed by retrospective review of all procedural
aortographies performed to evaluate coronary anatomy prior to TPV
implantation. AD/AI was also reviewed in all pre-post MPV implant
echocardiograms to assess for progression.
Results
From 04/2007 to 3/2015, 118pts underwent catheterization with intent
for TPV implant. Mean age and weight were 24.5 ± 12 years and 64.3
± 20 kg respectively. Diagnoses were: TOF (53%), D-TGA/DORV
(18%), s/p Ross (15%), and Truncus (9%). Types of
RV-PA connections were: conduits (96), bioprosthetic valves (14), and other (7). Successful TPV implant occurred in 91pts
(77%). RVOT balloon angioplasty was performed in 43/118pts
(36%). Aortography was performed in 18/43pts with AD/AI noted in
6/18 (33%); two with D-TGA (1 s/p Lecompte, 1 s/p Rastelli), 2 with
TOF, 1 Truncus and 1 s/p Ross. Procedure was aborted in the 2 who developed
severe AD/AI. TPV was implanted in 3/4 pts with mild AD/AI. Review of
pre-post TPV implantation echocardiograms in 83/91pts (91%) revealed
no new/worsened AI in any pt.
Conclusion
AD/AI is relatively common on aortography during simultaneous RVOT
balloon angioplasty. Lack of AI progression by echocardiography post-TPV
implant suggests these may be benign findings in most cases. However, AD/AI
should be carefully evaluated in certain anatomic subtypes with close
RVOT/aortic alignments.