Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paediatric Cardiology, Paris, France.
Arch Cardiovasc Dis. 2012 Aug-Sep;105(8-9):404-13. doi: 10.1016/j.acvd.2012.05.002. Epub 2012 Jul 17.
Although globally accepted, the indication for implantation of the Melody(®) (Medtronic Inc., Minneapolis, MN, USA) transcatheter pulmonary valve is limited to the treatment of haemodynamically dysfunctional right ventricular outflow tract (RVOT) with right ventricle to pulmonary artery (PA) obstruction. The use of the Melody valve for haemodynamically significant isolated pulmonary regurgitation has not been evaluated.
We evaluated the outcomes of Melody valve insertion in patients with a large patched RVOT.
We analysed procedural and short-term outcomes data from 13 patients who underwent Melody valve implantation for a large RVOT with significant pulmonary regurgitation as the primary lesion. RVOT preparation was done in all patients using the Russian dolls technique and/or the PA jailing technique. Melody valve insertion was performed concomitantly in 10 patients and after 1 to 3 months in three patients.
All procedures were successful. The mean follow-up period was 30 ± 4 months after the procedure. There was no incidence of stent fracture, migration or embolization. Only one patient who underwent the jailing technique developed a significant paraprosthetic leak and is scheduled for redilatation of the Melody valve.
Careful patient selection, balloon sizing and RVOT preparation with prestenting using the Russian dolls technique and/or the PA jailing technique are required to modify the RVOT for transcatheter valve implantation. Short-term follow-up showed competent valves with no stent fracture or migration and appears promising. Wider experience with long-term outcomes may be required to standardize the procedure in such a subset of patients.
尽管全球范围内都认可，但 Melody（®）（美敦力公司，明尼苏达州明尼阿波利斯，美国）经导管肺动脉瓣的植入适应证仅限于治疗右心室流出道（RVOT）血流动力学功能障碍伴右心室至肺动脉（PA）阻塞。尚未评估 Melody 瓣膜用于血流动力学显著的孤立性肺动脉瓣反流的效果。
我们评估了在 RVOT 较大的患者中植入 Melody 瓣膜的结果。
我们分析了 13 例因 RVOT 较大且伴有严重肺动脉瓣反流的患者接受 Melody 瓣膜植入的程序和短期结果数据。所有患者均采用俄罗斯套娃技术和/或 PA 监禁技术进行 RVOT 准备。10 例患者同期植入 Melody 瓣膜，3 例患者在 1 至 3 个月后植入。
所有手术均成功。程序后平均随访 30 ± 4 个月。未发生支架断裂、移位或栓塞。仅 1 例采用监禁技术的患者出现严重瓣周漏，计划对 Melody 瓣膜进行再次扩张。
需要仔细选择患者、球囊测量大小以及使用俄罗斯套娃技术和/或 PA 监禁技术进行 RVOT 预处理，以对 RVOT 进行经导管瓣膜植入术改造。短期随访显示瓣膜功能良好，无支架断裂或移位，前景可期。需要更广泛的长期结果经验来规范此类患者亚组的手术。
