Is the “porcellain homograft” a contraindication for transcatheter pulmonary valve implantation? A

Abstract

S t r e s z c z e n i ePrzeznaczyniowa implantacja zastawki płucnej jest nową metodą leczenia chorych ze złożonymi wrodzonymi wadami serca, u których po operacyjnej rekonstrukcji drogi odpływu prawej komory doszło do zwężenia lub niedomykalności zastawki pnia płucnego. Najlepszymi kandydatami do zabiegu są chorzy z homograftem płucnym lub innym pełnym konduitem w drodze odpływu prawej komory. W pracy opisano pacjenta po rekonstrukcji drogi odpływu prawej komory za pomocą homograftu aortalnego, u którego wystąpiło powikłanie w trakcie zabiegu nieoperacyjnego wszczepienia zastawki płucnej.Słowa kluczowe: przeznaczyniowe wszczepienie zastawki, zastawka płucna, homograft aortalny, płucny, pęknięcie homograftu A b s t r a c t A male patient had a repeat surgical right ventricular outflow reconstruction with the aortic homograft, for pulmonary atresia at the age of 7 years. At the age of 17 a homograft dysfunction (with predominant stenosis) developed and he was admitted for transcatheter pulmonary valve implantation. Severe calcifications of the total homograft wall were recognized. A homograft rupture with contrast extravasation to the mediastinal space occurred at the superior margin of the stent implanted for valve presenting. A covered stent was implanted to cover the leak, but this resulted in a second homograft rupture at the distal margin of the stent. The extravasation was estimated to be small and stable, and a Melody pulmonary valve was successfully implanted on a 20 mm system. Repeat planned angiography 4 days after the procedure revealed significant enlargement of the pseudoaneurysm and the patient was sent for surgery. Right ventricular outflow was uneventfully reconstructed with a pulmonary homograft. Excised old aortic homograft walls had an eggshell appearance. We suggest that a "porcelain" aortic homograft should be a contraindication for transcatheter pulmonary valve implantation.

Methods and techniques A new strategy to identify potentially dangerous coronary arterial patterns before percutaneous pulmonary valve implantation

“…This procedure can be performed with excellent short- and mid-term results, with low morbidity and mortality [ 3 – 5 ]. One of the most serious potential complications is coronary arterial compression [ 6 , 7 ]. Preprocedural imaging (computed tomography (CT) or cardiovascular magnetic resonance (CMR)), careful patient selection, and a patient-modified approach during the procedure can guide a safe and successful intervention [ 4 ].…”