Abstract
We report our experience of pulmonary valve replacement in animals with large right ventricular outflow tracts (RVOTs) using a percutaneous approach. We intended to implant a device to percutaneously reduce the diameter of the pulmonary artery (PA). Following its insertion, we intended to implant a valved stent inside the restriction. Animals were killed acutely (group 1, n = 6) and after a mean follow-up of 1 (group 2, n = 3) and 2 mo (group 3, n = 9). In group 1, all reducers were successfully deployed and allowed the reduction of the PA to a diameter of 12-mm. In one animal, the proximal part of the reducer did not reach its final configuration. Another reducer embolized when manipulating the stiff wire. The insertion of valves was therefore possible in 17/18 animals. One animal died from an arrhythmia during positioning of the valve. Angiographic evaluations showed no leak between devices and the pulmonary wall. During the follow-up, there was no device migration. At autopsy, reducers were fixed to the pulmonary wall and completely covered by a fibrous tissue. In conclusion, with the use of an intravascular reducer, implantation of a pulmonary valve is possible in sheep through a transcatheter approach when the RVOT exceeds 22-mm in diameter.
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Abbreviations
- PA:
-
pulmonary artery
- PVR:
-
pulmonary valve replacement
- RVOT:
-
right ventricular outflow tract
References
Bonhoeffer P, Boudjemline Y, Saliba Z, Hausse AO, Aggoun Y, Bonnet D, Sidi D, Kachaner J 2000 Transcatheter implantation of a bovine valve in pulmonary position: a lamb study. Circulation 102: 813–816
Bonhoeffer P, Boudjemline Y, Saliba Z, Merckx J, Aggoun Y, Bonnet D, Acar P, Le Bidois J, Sidi D, Kachaner J 2000 Percutaneous replacement of pulmonary valve in a right ventricle to pulmonary-artery prosthetic conduit with valve dysfunction. Lancet 356: 1403–1405
Bonhoeffer P, Boudjemline Y, Qureshi SA, Le Bidois J, Iserin L, Acar P, Merckx J, Kachaner J, Sidi D 2002 Percutaneous insertion of the pulmonary valve. J Am Coll Cardiol 39: 1664–1669
Boudjemline Y, Agnoletti G, Piechaud JF, Iserin L, Vouhe P, Bonnet D, Sidi D, Bonhoeffer P 2003 Percutaneous pulmonary valve replacement: towards a modification of the prosthesis. Arch Mal Coeur Vaiss 96: 461–466
Khambadkone S, Coats L, Taylor A, Boudjemline Y, Derrick G, Tsang V, Cooper J, Muthurangu V, Hegde SR, Razavi RS, Pellerin D, Deanfield J, Bonhoeffer P 2005 Percutaneous pulmonary valve implantation in humans: results in 59 consecutive patients. Circulation 112: 1189–1197
Boudjemline Y, Schievano S, Bonnet C, Coats L, Agnoletti G, Khambadkone S, Bonnet D, Deanfield J, Sidi D, Bonhoeffer P 2005 Off-pump replacement of the pulmonary valve in large right ventricular outflow tracts: a hybrid approach. J Thorac Cardiovasc Surg 129: 831–837
Berdat PA, Carrel T 2006 Off-pump pulmonary valve replacement with the new Shelhigh Injectable Stented Pulmonic Valve. J Thorac Cardiovasc Surg 131: 1192–1193
Schreiber C, Vogt M, Bauernschmitt R, Prodan Z, Tassani P, Eicken A, Lange R 2006 Pulmonary valve implantation with a self-expanding stented valve: 1-year follow-up in the first patient. Ann Thorac Surg 82: 2340
Boudjemline Y, Agnoletti G, Bonnet D, Sidi D, Bonhoeffer P 2004 Percutaneous pulmonary valve replacement in a large right ventricular outflow tract: an experimental study. J Am Coll Cardiol 43: 1082–1087
Mollet A, Stos B, Bonnet D, Sidi D, Boudjemline Y 2006 Development of a device for transcatheter pulmonary artery banding: evaluation in animals. Eur Heart J 27: 3065–3072
European convention for protection of laboratory animals 1999 Official Journal of European Community L222/29 to L222/37
De Ruijter FT, Weenink I, Hitchcock FJ, Meijboom EJ, Bennink GB 2002 Right ventricular dysfunction and pulmonary valve replacement after correction of tetralogy of Fallot. Ann Thorac Surg 73: 1794–1800
Graham TP 2002 Management of pulmonary regurgitation after tetralogy of fallot repair. Curr Cardiol Rep 4: 63–67
Discigil B, Dearani JA, Puga FJ, Schaff HV, Hagler DJ, Warnes CA, Danielson GK 2001 Late pulmonary valve replacement after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 121: 344–351
Acknowledgements
The authors thank Philippe Marx who developed this new stent in cooperation with Younes Boudjemline.
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This study was supported by the “Ville de Paris” grant 2006, Paris, France.
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Mollet, A., Basquin, A., Stos, B. et al. Off-Pump Replacement of the Pulmonary Valve in Large Right Ventricular Outflow Tracts: A Transcatheter Approach Using an Intravascular Infundibulum Reducer. Pediatr Res 62, 428–433 (2007). https://doi.org/10.1203/PDR.0b013e318142aa3e
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DOI: https://doi.org/10.1203/PDR.0b013e318142aa3e
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