Transcatheter valve implantation for right atrium‐to‐right ventricle conduit obstruction or regurgitation after modified Björk–fontan procedure

Abstract

Percutaneous transcatheter valve deployment to treat a dysfunctional RA-RV connection after a Björk modification of the Fontan procedure is a viable alternative to surgery, with low procedural risk, and appears to offer good early and intermediate results.© 2016 Wiley Periodicals, Inc.

Complex Catheter-Based Structural Heart Reconstruction in a Patient With Tricuspid Atresia and Björk Palliative Conduit

“…Transcatheter valve implantation has become an increasingly desirable therapeutic option. Successful THV implantation has been described in patients with RA-RV conduit dysfunction after modified Björk-Fontan procedure with favorable results ( 5 ). However, our patient had unfavorable anatomy (as described earlier) and required a creative and tailored personalized solution.…”

Converting Fontan-Björk to 1.5- or 2-Ventricle Circulation

“…Patients with tricuspid atresia (TA) and ventricular septal defect (VSD) occasionally are treated with the "Björk" modification, which includes creation of a valveless right atrial (RA) to right ventricular outflow tract (RVOT) communication [1]. Long-term complications occur due to the free regurgitant flow, calcification and/or stenosis of the homograft, RA dilatation, atrial arrhythmias, liver congestion, thromboembolism, and ventricular dysfunction [2,3]. In the majority of patients after Björk modification, no additional surgery is considered, other than orthotopic heart transplant.…”

“…For some patients with Fontan-Björk physiology who face complications due to the regurgitant flow in the RA-RV connection, a percutaneous valve in the "tricuspid" position is a possible intervention [2,[5][6][7]. Shah et al described 16 patients who underwent percutaneous valve implantation for RA-RV regurgitation and RA dilation.…”

“…Shah et al described 16 patients who underwent percutaneous valve implantation for RA-RV regurgitation and RA dilation. While these patients showed hemodynamic improvement, the patients who remained symptomatic were those with uncontrolled atrial flutter [2]. Studies have shown that patients who undergo Fontan conversion with surgical treatment of tachyarrhythmias at the time of Fontan conversion are superior to conversion without arrhythmia surgery [3,8].…”

Percutaneous tricuspid valve implantation in failing bioprosthesis

“…The failing bioprosthesis in TV position usually is an ideal landing zone for a percutaneously implanted valve, if the dimensions are well defined and the valve size is adequately selected. So far, an increasing number of patients have been treated by PTVI and longer follow-up is gathered in PTVIregistries (13)(14)(15)(16)(17)(18)(19)(20).…”