eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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2/2021
vol. 17
 
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abstract:
Original paper

Contrast-free percutaneous pulmonary valve replacement: a safe approach for valve-in-valve procedures

Barry O’Callaghan
1
,
Jenny Zablah
1
,
Ryan Leahy
1
,
Michael Shorofsky
1
,
Joseph Kay
1
,
Gareth Morgan
1

  1. The Heart Institute, Children’s Hospital Colorado, Aurora, USA
Adv Interv Cardiol 2021; 17, 2 (64): 200–209
DOI: https://doi.org/10.5114/aic.2021.107500
Online publish date: 2021/07/09
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Introduction
Percutaneous pulmonary valve replacement (PPVI) continues to gather pace in pediatric and adult congenital practice. This is fueled by an expanding repertoire of devices, techniques and equipment to suit the heterogenous anatomical landscape of patients with lesions of the right ventricular outflow tract (RVOT). Contrast-induced nephropathy is a real risk for teenagers and adults with congenital heart disease (CHD).

Aim
To present a series of patients who underwent PPVI without formal RVOT angiography and propose case selection criteria for patients who may safely benefit from this approach.

Material and methods
We retrospectively collected PPVI data from the preceding 2 years at our institution identifying patients who had been listed as suitable for consideration for contrast-free PPVI from our multidisciplinary team (MDT) meeting based on predefined criteria. Demographic, clinical, imaging and hemodynamic data were collected. Data were analyzed using SPSS.

Results
Twenty-one patients were identified. All patients had a technically successful implantation with improvements seen in invasive and echocardiographic hemodynamic measurements. 90% of patients had a bio-prosthetic valve (BPV) in situ prior to PPVI. One patient had a complication which may have been recognized earlier with post-intervention RVOT contrast injection.

Conclusions
Zero-contrast PPVI is technically feasible and the suitability criteria for those who might benefit are potentially straightforward. The advent of fusion and 3D imaging in cardiac catheterization laboratories is likely to expand our capacity to perform more procedures with less contrast. Patients with bio-prosthetic valves in the pulmonary position may benefit from contrast-free percutaneous pulmonary valve implantation.

keywords:

congenital heart disease, tetralogy of Fallot, percutaneous pulmonary valve implantation, pediatric cardiac catheterization, adult congenital heart disease
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