Sivaprakasam Muthukumaran C, Reddy J Raja Vijendra, Gunasekaran Sengottuvelu, Sivakumar Kothandam, Pavithran Sreeja, Rohitraj Gopalavilasam Rajagopalan, Jayranganath M, Francis Edwin
Department of Pediatric Cardiology, Apollo Children's Hospital, Chennai, Tamil Nadu, India.
Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India.
Ann Pediatr Cardiol. 2021 Jul-Sep;14(3):293-301. doi: 10.4103/apc.apc_242_20. Epub 2021 Aug 26.
Transcatheter pulmonary valve implantation (TPVI) is a surgical alternative for correcting dysfunctional right ventricular outflow tract conduits in previously operated patients. MyVal transcatheter heart valve (THV) (Meril Life Sciences, India), a new transcatheter valve designed for aortic position has not been used for TPVI.
Patients with stenosed dysfunctional conduits from the right ventricle to pulmonary artery (RV-PA) were prestented after initial computed tomography and balloon interrogation before the implantation of MyVal. Size of MyVal was chosen based on the final diameter of the prestent. Procedural details and post-TPVI follow-up were analyzed.
Seven patients aged 17-60 years (median 26 years) had stenosed RV-PA conduits implanted 5-17 years (median 9 years) ago for tetralogy of Fallot in three, following Ross procedure in two, repair of pulmonary stenosis, and following PA debanding in one patient each. Prestenting improved the conduit diameter from 9.3 ± 2.8 mm to 20.8 ± 1.1 mm and relieved the gradient from 87.3 ± 31.7 mmHg (50-137 mmHg) to 12.7 ± 6.4 mmHg (5-20 mmHg). A 23 mm MyVal was implanted in all the seven patients successfully; one patient needed an additional 24.5 mm MyVal valve in valve implantation for residual regurgitation. The mean fluoroscopic time and dose area product were 38.7 ± 25.3 min and 66.917 ± 39.211Gray. cm2, respectively. At a median follow-up duration of 16 months (10-22 months), all patients were asymptomatic receiving dual antiplatelet therapy with no PR and the gradient was 12.5 ± 5.8 mmHg on echocardiography. Although one patient needed an additional valve-in-valve implantation, there were no valve-related adverse events.
Early experience of TPVI with MyVal THV in prestented conduits is encouraging with procedural success in all patients and acceptable mid-term outcomes.
经导管肺动脉瓣植入术（TPVI）是一种用于纠正既往接受过手术患者功能失调的右心室流出道管道的手术替代方法。MyVal经导管心脏瓣膜（THV）（印度梅里尔生命科学公司）是一种专为主动脉位置设计的新型经导管瓣膜，尚未用于TPVI。
对右心室至肺动脉（RV-PA）狭窄功能失调管道的患者，在植入MyVal之前，先进行计算机断层扫描和球囊探查，然后置入预扩张支架。根据预扩张支架的最终直径选择MyVal的尺寸。分析手术细节和TPVI术后随访情况。
7例年龄在17至60岁（中位数26岁）的患者，其RV-PA管道狭窄，分别于5至17年（中位数9年）前因法洛四联症植入管道3例，Ross手术后植入2例，肺动脉狭窄修复术后植入1例，肺动脉去带术后植入1例。预扩张支架置入后，管道直径从9.3±2.8毫米增加到20.8±1.1毫米，压力阶差从87.3±31.7毫米汞柱（50至137毫米汞柱）降至12.7±6.4毫米汞柱（5至20毫米汞柱）。7例患者均成功植入23毫米的MyVal；1例患者因残余反流需要额外植入24.5毫米的MyVal瓣膜进行瓣中瓣植入。平均透视时间和剂量面积乘积分别为38.7±25.3分钟和66.917±39.211格雷·平方厘米。中位随访时间为16个月（10至22个月），所有患者均无症状，接受双联抗血小板治疗，无PR，超声心动图显示压力阶差为12.5±5.8毫米汞柱。虽然1例患者需要额外进行瓣中瓣植入，但未发生与瓣膜相关的不良事件。
在预扩张支架管道中使用MyVal THV进行TPVI的早期经验令人鼓舞，所有患者手术成功，中期结果可接受。
