Page 16 - Journal of Structural Heart Disease Volume 3, Issue 3

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Review Article
Figure 5 (video): Note slow balloon in ation and ne tuning of valve position to landing zone. Balloon bursts at full in ation but valve is fully deployed and stable. View supplementary video at http://dx.doi.org/10.12945/j.jshd.2017.016.14.vid.06.
Figure 6 (video): Note circular Edwards valve con guration for optimal function. View supplementary video at http://dx.doi. org/10.12945/j.jshd.2017..016.14.vid.07.
Figure 7: Valve-in-valve device with pre-stenting of RVOT. Courtesy of Dr. Eric Horlick.
landing zone. This may require perseverance and usu- ally requires steady forward push but avoid rotation. It is essential to maintain the wire position in the pul- monary artery, although sometimes gentle traction is needed to straighten the course. Occasionally, it may be necessary to push the delivery system to create a loop in the right atrium in order to reach the land- ing zone, but this should be used only when neces- sary, as it may kink the wire or damage the delivery system and may cause damage to the heart. Once the valve is in an optimal position, the balloon is gently in ated to the predetermined volume for the valve size using the Atrion in ation device. The balloon is in ated gradually to give the operator chance to ne tune the valve position either by pushing the delivery system forward or pushing the wire to retract the sys- tem proximally. For large RVOT where there is marked movement during the cardiac cycle, fast ventricular pacing may be used to achieve stability; this can be as- sessed during balloon interrogation of the RVOT. If the procedure is being carried out under anesthesia, the operator can request apnea to minimize movement during valve deployment. It is important to in ate the balloon fully with the pre-determined volume. Occasionally, one may anticipate that a larger volume than the nominal may be required in which case the Atrion syringe may be lled with an additional 1–3 cc but only to give additional volume if it appears that
DeGiovanni, J.
Pulmonary Valve Replacement