Opportunities in pulmonary valve replacement

Abstract

Pulmonary regurgitation is the most important residual lesion after initial surgical correction for pulmonary (sub)valvular stenosis in the early life of patients with tetralogy of Fallot or isolated pulmonary stenosis. Symptomatic or asymptomatic patients with severe right ventricular dilatation due to pulmonary regurgitation may benefit from pulmonary valve replacement. Surgery is ideally performed before the right ventricle becomes irreversibly damaged as a result of longstanding volume overload. However, the beneficial effects must be weighed up against the problems associated with degradation of the allograft, which often result in (numerous) reoperations. Owing to the higher risk of thromboembolic events in mechanical prosthesis and the lifetime need for anticoagulation, allografts are the most widely used prosthesis. Degradation of the allograft often leads to reoperation, mostly 10-20 years after initial implantation. For a patient receiving his first allograft at 20 years of age, several reoperations will have to be performed later in life. Percutaneous pulmonary valve implantation has the potential to decrease the number of surgical reoperations.

Follow-Up After Pulmonary Valve Replacement in Adults With Tetralogy of Fallot

“…In response to the regurgitated volume, the RV dilates to overcome the increased loading conditions (1,16). Long-standing PR will eventually lead to dysfunction of the RV, and patients may experience reduced exercise tolerance (17).…”

“…Progressive pulmonary regurgitation (PR) is a common complication after total surgical correction of tetralogy of Fallot (TOF) (1). Long-standing PR leads to right ventricular (RV) dilation, which in turn causes RV dysfunction and reduced exercise tolerance (2,3).…”

Defining structural heart disease in the adult patient: current scope, inherent challenges and future directions

“…47,48 Other structural heart interventions In adult patients, numerous additional structural heart disease processes are increasingly approached via percutaneous methods. Some of these include pulmonary valve implantation, 49 closure of sinus of valsava aneurysm rupture, 50 and treatment of vascular fistulae. 51 Although many of these treatments are relatively novel, with emerging data, the face of structural heart disease will undoubtedly continue to evolve.…”

What Is the Potential of Tissue-Engineered Pulmonary Valves in Children?

“…(2) Most children who undergo RVOTR need multiple re-interventions later in life, because existing heart valve substitutes cannot accommodate patient growth. (3) In contrast, tissue-engineering provides a promising method to create living heart valves with growth potential that may last a lifetime. (4)(5)(6)(7) In this approach, a valve-shaped scaffold is implanted in the patients' heart that recruits cells from the bloodstream and surrounding tissues and gradually transforms into an autologous valve while the scaffold degrades.…”