Registro español de implante percutáneo de la válvula pulmonar Melody en menores de 18 años

Experiencia inicial con el implante percutáneo de la válvula Melody® en un centro hospitalario de la ciudad de México

“…Centro Médico Nacional 20 de Noviembre, ISSSTE, Ciudad de México, México CARTA CIENTÍFICA La corrección quirúrgica de las cardiopatías congénitas (CC) que involucran el tracto de salida del ventrículo derecho (TSVD) propicia en el postoperatorio tardío alteraciones anatómicas y funcionales de la válvula y tronco de la arteria pulmonar. Para la corrección de estas alteraciones, el paciente debe someterse a nuevos eventos quirúrgicos requiriendo la implantación de dispositivos biológicos como homoinjertos y bioprótesis entre otros, los cuales usualmente se deterioran como consecuencia de una respuesta adaptativa del paciente, modificando su geometría, propiciando la reducción del calibre, la reducción del flujo sanguíneo y manifestándose clínicamente con deterioro de la clase funcional; sin mencionar el alto índice de morbimortalidad asociado a estas reintervenciones [1][2][3][4] .…”

Initial experience with the percutaneous implant of the Melody® valve in a hospital center in Mexico City

“…Surgical correction of congenital heart diseases (CHDs) that involve the right ventricle outflow tract (RVOT) favors anatomical and functional alterations of the pulmonary artery valve and trunk in the late post-operative period. For the correction of these alterations, the patient must undergo new surgical events that require implantation of biological devices such as allografts and bioprostheses, among others, which usually deteriorate as a consequence of an adaptive patient response that modifies their geometry, favors caliber reduction and blood flow reduction, which clinically is observed as functional class deterioration, with significantly high morbidity and mortality rate being associated with these reoperations [1][2][3][4] .…”

“…Since most patients with CHD that involves RVOT will require reoperation during their lifetime, the need for options to improve approaching strategies and decrease primary correction reoperation complications was a reason for the development of new technologies aiming to restore the blood flow to the pulmonary circulation, with percutaneous technology appearing for the implantation of pulmonary bioprostheses [1][2][3][4][5][6][7][8][9] .…”

“…The Melody ® valve consists of a 34-mm platinum-iridium bare stent (CP stent, NuMED Inc.; Hopkinton, New York, USA), with one valve made with a bovine jugular vein segment. The device is attached to a balloon catheter and released on a 22-Fr sleeve [1][2][3][4][5][6][7][8][9][10] . Despite its size, the use of the Melody ® valve was intended for those patients with RVOT diameters of < 24 mm, which limited the benefit to a specific group of patients.…”

“…EDV > 150 mL/m 2 BSA or ESV > 80 ml/m 2 BSA; (b) RV systolic dysfunction, RVEF < 45%; (c) sustained atrial/ventricular tachycardia; (d) RVOT obstruction, RV systolic pressure (RVSP) > 75% of systemic pressure or higher than 80 mmHg; and (e) significant progressive tricuspid regurgitation. -In symptomatic patients: (a) moderate to severe respiratory failure and (b) significant stenosis: RVSP > 60 mmHg [3][4][5][8][9][10][11]17 . One of the principles for the decision of this alternative for RVOT dysfunction is to precisely understand the anatomy.…”