Percutaneous Pulmonary Valve Implantation‐Associated Ventricular Tachycardia in Congenital Heart Disease

Loar, Robert W.; Qureshi, Athar M.; Miyake, Christina Y.; Valdés, Santiago O.; Kim, Jeffrey; Uz, Caridad M. de la

doi:10.1111/joic.12344

Cited by 16 publications

(20 citation statements)

References 18 publications

(24 reference statements)

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“…Considering the QRS-axis, the etiology of the arrhythmias seemed to be associated to the manipulated RVOT. Significant incidence of new PVCs and NSVT immediately post-PPVI is already described by other groups (23,24). Most of these new arrhythmias resolved after a certain time after the procedure.…”

Section: Discussionsupporting

confidence: 53%

Percutaneous pulmonary valve implantation (PPVI) in non-obstructive right ventricular outflow tract: limitations and mid-term outcomes

Esmaeili¹,

Khalil²,

Behnke-Hall³

et al. 2019

Transl Pediatr

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Background: Percutaneous pulmonary valve implantation (PPVI) has been established as a safe and effective alternative to surgery treating patients with a failing pulmonary valve conduit. Nevertheless, the majority of patients in need of a valve have a native, non-obstructive right ventricular outflow tract (RVOT).The current approved stent-valves have a balloon-expandable design. Pre-stenting of the RVOT to create a landing zone and also protect the valve stability is usually mandatory; large, non-obstructive RVOTs need pre-stenting to reduce the RVOT-diameter for a balloon-expandable valve implantation.Methods: A retrospective study design was used to analyze the medium-term outcome after PPVI in a series of 26 patients with native or reconstructed RVOT.Results: PPVI was successfully performed in all, but 1 (96%). Within the follow-up of a minimum of 2 years, the percutaneous implanted valves remained competent; a significant pressure gradient was not detected. Furthermore, no PPVI-related complications such as endocarditis, migration or stent fractures were observed. The electrocardiogram at rest, in particular the QRS duration remained unchanged immediate post-PPVI as well as at medium-term follow-up of 24 months. However, ventricular arrhythmias were documented in 3 patients (11.5%); all patients were successfully treated with antiarrhythmic drugs, utilizing metoprolol. A trial of an invasive catheter based RVOT-ablation in one remained unsuccessful; pre-stented RVOT did not allow a successful intervention.Conclusions: Medium-term follow-up showed excellent results of the mechanical valve function.PPVI utilizing balloon-expandable stent-valves in a native RVOT remains an off-label use. Despite our encouraging results, advanced manipulations of the patched or native RVOT might be associated with significant ventricular arrhythmias. There is a need for less invasive RVOT reduction devices.

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Section: Discussionsupporting

confidence: 53%

Percutaneous pulmonary valve implantation (PPVI) in non-obstructive right ventricular outflow tract: limitations and mid-term outcomes

Esmaeili¹,

Khalil²,

Behnke-Hall³

et al. 2019

Transl Pediatr

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“…In a retrospective study, non‐sustained PPVI‐related ventricular tachycardia (VT) was detected in 7.5% of patients in whom a stent‐valve was implanted in a conduit‐repaired RVOT. Beta‐blocker therapy was the treatment of choice; no patient needed surgical removal of the percutaneous placed valve . Similar experience was made at our heart center, however need for intervention occurred to a lesser extent.…”

Section: Discussionmentioning

confidence: 61%

Percutaneous pulmonary valve implantation for reconstruction of a patch‐repaired right ventricular outflow tract

Esmaeili

Bollmann

Khalil

et al. 2017

J Interven Cardiology

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Percutaneous pulmonary valve implantation (PPVI) is nowadays an accepted treatment option to repair post-surgical conduit dysfunction of the right ventricular outflow tract (RVOT). In addition, many patients need a pulmonary valve to reconstruct a hemodynamically incompetent native or conduit free outflow tract. Based on our experience with percutaneous stent-valve placement in a cohort of 125 patients, we report here transvenous reconstruction of a conduit-free, patch repaired outflow tract by utilizing balloon-expandable stent-valves in 23 patients with a median age of 22 years (5-60 years). In 20 patients, the step-by-step procedure was performed uneventful with the aimed success. Severe RVOT dysfunction in term of a clinical relevant regurgitation could be changed to mild, as it was confirmed by follow-up color Doppler echocardiography. In a 5-year-old girl a Melody® valve was placed as a surgical-interventional hybrid approach. In one patient, the procedure was complicated by stent embolization during preparation of the RVOT for stent-valve implantation. Reposition of the embolized stent was nevertheless successful for finishing percutaneous valve-implantation. In one patient, surgical approach became necessary because of the inability to advance the balloon-mounted stent-valve through a pre-stented RVOT. Considering the current available balloon-expandable stent-valves, transvenous pulmonary valve implantation is feasible to treat even an incompetent conduit-free RVOT. However, preparation of the RVOT by pre-stenting, in most patients with more than two stents in telescope technique remains challenging. Reconstruction of RVOT by the current available valves is promising only for a carefully selected group of patients.

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“…However, the hypothesis that PVR alone decreases the risk for severe VA and sudden death has been largely refuted [ 17 , 18 ] because it does not address the arrhythmogenic substrate directly. Some series, including mostly adult patients, have described the occurrence of minor VA following PPVI [ 12 – 14 , 19 ]. To our knowledge, this is the first entirely pediatric study to specifically investigate the occurrence of severe VA post-PPVI.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Arrhythmias and Sudden Death Following Percutaneous Pulmonary Valve Implantation in Pediatric Patients

et al. 2022

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Reports have suggested a transient increase in ventricular ectopy early after percutaneous pulmonary valve implantation (PPVI). Little is known about the potential for more serious ventricular arrhythmias (VA) in children who undergo PPVI. We sought to evaluate the incidence of severe VA following PPVI in a pediatric population and to explore potential predictive factors. A retrospective cohort study was conducted of patients who underwent PPVI under 20 years of age in our institution from January 2007 to December 2019. The primary outcome of severe VA was defined as sustained and/or hemodynamically unstable ventricular tachycardia (VT), inducible sustained VT, or sudden death of presumed arrhythmic etiology. A total of 21 patients (mean age 16.2 ± 2.1 years; 66.7% male) underwent PPVI. The majority of patients (N = 15; 71.4%) had tetralogy of Fallot (TOF) or TOF-like physiology, with the most common indication being pulmonary insufficiency (N = 10; 47.6%). During a median follow-up of 29.6 months (IQR 10.9–44.0), severe VA occurred in 3 (14.3%) patients aged 15.6 (IQR 14.7–16.1) a median of 12.3 months (IQR 11.2–22.3) after PPVI. All events occurred in patients with TOF-like physiology following Melody valve implant. In conclusion, severe VA can occur long after PPVI in a pediatric population, particularly in those with TOF-like physiology. Further studies are required to elucidate underlying mechanisms and assess strategies to mitigate risks.

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Percutaneous Pulmonary Valve Implantation‐Associated Ventricular Tachycardia in Congenital Heart Disease

Abstract: PPVI may be associated with transient VT in the acute peri-procedural period. Patients of smaller size may be more susceptible. All patients were managed conservatively and none of the patients had a recurrence, which is suggestive of a transient phenomenon.

Cited by 16 publications

References 18 publications

Percutaneous pulmonary valve implantation (PPVI) in non-obstructive right ventricular outflow tract: limitations and mid-term outcomes

Percutaneous pulmonary valve implantation (PPVI) in non-obstructive right ventricular outflow tract: limitations and mid-term outcomes

Percutaneous pulmonary valve implantation for reconstruction of a patch‐repaired right ventricular outflow tract

Ventricular Arrhythmias and Sudden Death Following Percutaneous Pulmonary Valve Implantation in Pediatric Patients

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