A case report of a complicated fatal percutaneous valve implantation

Pulmonary valve dysfunction, also called right ventricle outflow tract dysfunction, is one of the known anomalies in patients with congenital heart disease. Percutaneous pulmonary valve implantation (PPVI) has been developed as an alternative to surgical correction. Although it is largely considered a safe procedure, life-threatening complications can happen and institutions must be able to resolve these immediately and adequately. We present a case of pulmonary valve migration to the right ventricle during a PPVI. This complication needed immediate cardiac surgery due to resulting hemodynamic instability. The percutaneous valve prosthesis was removed and a bioprosthetic valve was surgically implanted in the correct position. This case emphasizes the need of prompt cardiac surgery support and the readiness of the anesthesia team to deal with emergency open cardiac surgery. Citation: Sampaio A, Norte G, Godinho L, Raimundo A, Cuervo M. A case report of a complicated fatal percutaneous valve implantation. Anaesth pain & intensive care 2019;23(4)__ Received: 24 September 2019, Reviewed: 24, 26 October 2019, Accepted: 22 November 2019

Landmark lecture on interventional cardiology: interventional cardiac catheterisation for CHD: the past, present, and the future

CHD affects millions of patients worldwide. Interventional therapies for CHD goes back to the mid-1960s when Bill Rashkind performed balloon atrial septostomy on a cyanotic baby with transposition of the great vessels. This was followed by development of balloon catheters to perform balloon valvuloplasties and angioplasties in the early to late 1980s. Although King and Mills performed the first transcatheter closure of secundum atrial septal defect in the mid-1970s, this procedure was better realised in the mid-1990s. More intracardiac defect closures were performed in the late 1990s and early 2000. This brings us to the current era of percutaneous valve implantation as developed by Bonhoeffer. In this paper, we will discuss the past, present, and future of interventional cardiac catheterisation for CHD patients.

Aortic stenosis

Diagnosis and risk stratification of patients with aortic stenosis are presented. Indications for surgical therapy and percutaneous valve implantation based on the recommendations of ACC/AHA and ESC are summarized and tabulated.

Abstract 16608: Building of a Right Ventricular Conduit in Native Outflow Tract in Preparation of Edwards Sapien Valve Implantation

Background: Percutaneous valve implantation (PPVI) is now considered feasible and safe especially in patients with conduit between the right ventricle and the pulmonary arteries. However there are still no clear indications on valvolization in native outflow tract (RVOT), traditionally considered at risk because of the dynamic characteristics of the RVOT Aim: The aim of this study is to demonstrate the feasibility and safety of building a percutaneous conduit using a stent in the native RVOT before valve implant performing PPVI two months after stent implant, on the basis of previous animal studies, where endotelitation of the stent was shown to be reached within 60 days. Methods: From October 2010 to April 2014, 19 pts, with tetralogy of Fallot, (mean age 15 ± 6 yrs) previously corrected by transannular patch technique, underwent a cardiac catheterization in order to build a stent-conduit in the native RVOT. After a complete right catheterization a balloon was inserted through a long sheath in the RVOT. During the inflation of the balloon a right ventricular angiography and a left coronary artery angiography are performed. In the presence of a complete occlusion of the RVOT and no coronary compression, a stent was deployed in the RVOT. Two months later an Edwards Sapien Pulmonary valve was implanted. Results: Twenty two stents were implanted in 19 pts. The mean time of the procedures was 185 ± 89 min with a mean fluoroscopy time of 72 ± 33 min. Two main complications occurred: in 1 pt the stent partially occluded the right pulmonary artery and in a second pt the stent was dislocated in RVOT. In both cases the patients were treated surgically. In all other patients the procedure was successful and patients were discharged home two days later, on Aspirin therapy. The correct position of the stent was confirmed at the 1 month of follow-up by echocardiographic examination. Among the 19 pts , 152 underwent implantation of Edwards Sapien Pulmonary Valve, two months later. No complications occurred during the procedure and during the FU. Two patients are still waiting PPVI procedure Conclusions: A two-step procedure approach increases the safety of PPVI with no impact on clinical conditions or complications