Percutaneous pulmonic valve implantation
- Andreas Eicken, MD, PhD, FESC
Andreas Eicken, MD, PhD, FESC
- Professor of Medicine
- German Heart Centre
Percutaneous pulmonic valve implantation (PPVI) was developed as a nonsurgical treatment for patients with right ventricular outflow tract (RVOT) dysfunction . PPVI devices are intended for use in a dysfunctional (stenotic or regurgitant) right ventricle-to-pulmonary artery conduit. PPVI is intended to extend the lifetime of a right ventricle-to-pulmonary artery conduit and hence reduce the total number of open-heart surgeries required over a patient’s lifetime.
Some centers have extended the application of PPVI to treat patients with tetralogy of Fallot without a conduit [2,3] and to treat patients with tetralogy of Fallot with failing pulmonic bioprosthetic valves [4,5].
INDICATIONS AND EXCLUSIONS
Our approach — We recommend percutaneous pulmonic valve implantation (PPVI) for patients with right ventricle to pulmonary artery conduits, native right ventricle outflow tracts, or failing bioprosthetic valves in the pulmonary position meeting the following criteria for severe right ventricular outflow (RVOT) obstruction or severe pulmonic regurgitation [3,4,6-8]:
●Severe RVOT obstruction with no or mild pulmonary regurgitation, with either of the following:
•Symptoms related to RVOT obstruction (<65 percent of expected exercise tolerance) plus a peak continuous wave Doppler velocity of >3.5 m/s or
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- INDICATIONS AND EXCLUSIONS
- Our approach
- Major society guidelines
- IMPLANTATION TECHNIQUE
- Balloon test
- Valve types
- Melody valve
- Sapien valve
- Coronary artery compression
- Conduit rupture
- Stent fracture
- SUMMARY AND RECOMMENDATIONS