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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
In patients with pulmonary stenosis, if the RV systolic pressure rises above 60 mmHg, balloon dilatation and/or surgery of the valve is recommended (Table 7.32). No treatment is usually required for pulmonary regurgitation unless RV failure develops. Percutaneous pulmonary valve implantation is used, particularly in patients with PR following surgical repair of tetralogy of Fallot.
Valve Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
In 2000, Dr. Phillip Bonhoeffer performed the first percutaneous pulmonary valve implantation (PPVI) within a calcified degenerate valve conduit in Tetralogy of Fallot. Since then, the number of patients receiving PPVI has increased steadily because it provides a nonsurgical and less invasive alternative for patients. To date, thousands of percutaneous pulmonary valve implantations have been performed worldwide.
Pediatric And Adult Congenital Cardiac Interventions
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Sawsan M. Awad, Qi-Ling Cao, Ziyad M. Hijazi
While atrial septal defect (ASD) and patent foramen ovale (PFO) are covered in Chapter 46, in this chapter, we discuss additional congenital cardiovascular conditions for which interventional therapy has been established as the preferred management strategy, including ventricular septal defect (VSD) device closure, semilunar valvuloplasty for congenital aortic and pulmonary valve stenosis, and right ventricular outflow tract (RVOT) stent in tetralogy of Fallot (TOF). In addition, we summarize the value of interventional therapies for selected adult congenital cardiac lesions, such as coarctation of the aorta (COA), pulmonary artery stenosis (PAS), coronary artery fistula, aortopulmonary collaterals (APCs), pulmonary arteriovenous fistula (AVF), and finally, the established percutaneous pulmonary valve implantation (PPVI) for patients with severe pulmonary insufficiency and/or stenosis.
Applications of computational fluid dynamics to congenital heart diseases: a practical review for cardiovascular professionals
Published in Expert Review of Cardiovascular Therapy, 2021
Gianluca Rigatelli, Claudio Chiastra, Giancarlo Pennati, Gabriele Dubini, Francesco Migliavacca, Marco Zuin
The Tetralogy of Fallot (ToF) is a major congenital cardiac disease including pulmonary stenosis, ventricular septal defect, overriding aorta and right ventricle (RV) hypertrophy, which result in cyanosis and accounts for 7%–10% of all CHDs [46]. The surgical widening of the right ventricular outflow tract usually produces a certain degree of pulmonary valve regurgitation (PR), which can result in RV volume and pressure overload over time. PR could also play a role in the formation of vortex flow in PAs, although the etiology is still poorly understood. In general, flow vortices are associated with alteration in WSS and affect endothelial function [47]. CFD could potentially identify parameters suitable for the prediction of outcomes in patients with repaired ToF and refine the timing for pulmonary valve replacement. Moreover, CFD coupled with virtual procedure simulation could be used to anticipate the results and tailor possible percutaneous pulmonary valve implantation according to the patients’ anatomy and flow patterns, as already showed by Capelli et al. [48].
Percutaneous techniques for treatment of tricuspid valve dysfunction in congenital heart disease – an emerging therapy
Published in Expert Review of Cardiovascular Therapy, 2021
Two transcatheter valves, which are commonly used in pulmonic position, have been used in an off-label indication to treat patients with degenerated TV bioprostheses. The Melody valve (Medtronic, Minneapolis, MN, USA) is a bovine jugular valve sewn into a 34-mm 8z Cheatham platinum stent. It received the CE mark for percutaneous pulmonary valve implantation in Canada and Europe in 2006 and FDA approval occurred in 2010. The Sapien valve (Edwards, Irvine, CA, USA) is a tri-leaflet bovine pericardial valve, hand sutured onto a rigid chrome-cobalt stent frame, and is available in four sizes, 20, 23, 26, and 29 mm external diameter. The valve is crimped using a special crimping tool onto a 30-mm long, noncompliant high-pressure balloon. It was approved by the FDA for percutaneous implantation in the pulmonic position in the year 2016. The Melody valve performed equally well compared to surgically implanted bioprosthesis in the pulmonic position in one recently published comparative long-term follow-up study [38].
Cangrelor use in a 6-year-old patient undergoing complex percutaneous coronary intervention after post-surgical myocardial infarction
Published in Platelets, 2020
Domenico Sirico, Nuccia Morici, Francesco Soriano, Stefano Maria Marianeschi, Giovanna Pedrazzini, Sergio Leonardi, Gabriele Vignati
Coronary artery compression by RV-to-PA conduit is a rare but life-threatening complication, which has been occasionally reported [1]. Furthermore, coronary compression represents a well-known complication of percutaneous pulmonary valve implantation (PPVI) with 5-6% of patients at risk and an occurrence rate of 1.3% [2,3]. In support of the proximity between coronary arteries and PA, extrinsic compression of the LMCA by a dilated pulmonary artery trunk (LMPCA) has been described in adult and pediatric patients with severe pulmonary hypertension [4,5].