Page 32 - Journal of Structural Heart Disease Volume 3, Issue 4

Case Report
Journal of Structural Heart Disease, August 2017, Volume 3, Issue 4:119-127
DOI: https://doi.org/10.12945/j.jshd.2017.017.17
Received: March 29, 2017 Accepted: April 19, 2017 Published online: August 2017
Continuous Assessment of a Stented Coronary Artery Using a Pressure Wire During Percutaneous Pulmonary Valve Implantation
Brian A. Boe, MD*, Sharon L. Cheatham, PhD, APRN, ACNP-BC, FSCAI, John P. Cheatham, MD, MSCAI The Heart Center, Nationwide Children’s Hospital, Columbus, Ohio, USA
Abstract
A 52-year-old woman with tetralogy of Fallot status post-complete surgical repair with infundibular resec- tion, pulmonary valvotomy, and patch closure of the ventricular septal defect presented with severe pul- monary regurgitation and depressed right ventricular function. During intended percutaneous pulmonary valve implantation (PPVI), multiple stenotic lesions were discovered in her left anterior descending (LAD) coronary artery, and the procedure was aborted. She underwent treatment of these lesions using drug-elut- ing stents by our adult interventional colleagues and returned to the congenital catheterization laboratory for PPVI 18 months following her initial procedure. Given the potential risk of crush injury to the coronary arterial stents, the distal LAD artery was continuously monitored during the procedure via a pressure wire with the capability of re-expanding the stent if needed. Copyright © 2017 Science International Corp.
Key Words
Congenital catheterization • Intervention • Valve implantation
Introduction
Percutaneous pulmonary valve implantation (PPVI) is an e ective method for treating right ventricular out ow tract (RVOT) obstruction and regurgitation in patients with congenital heart disease [1, 2, 3]. A rare but catastrophic complication of PPVI is mechanical coronary artery compression due to implantation of
a stent and/or valve within the RVOT [4]. Coronary artery testing is recommended during balloon an- gioplasty of the RVOT to assess coronary artery com- pression or distortion. However, the presence of an existing coronary artery stent may render coronary artery testing with balloon angioplasty/compliance testing a higher risk procedure. Here, we report the rst use of a pressure wire within a stented left ante- rior descending (LAD) coronary artery in close prox- imity to the RVOT during PPVI to assess for coronary artery stent compromise and to maintain access for treatment of compression with redilation of the stent or re-stent if necessary.
Case Presentation
A 52-year-old woman with tetralogy of Fallot pre- sented to our adult congenital cardiology program for evaluation. She underwent complete surgical repair at 8 years of age consisting of infundibular resection, pulmonary valvotomy, and patch closure of a ventricular septal defect. Her residual atrial sep- tal defect was closed with a CardioSEALTM Occlusion Device (Nitinol Medical Technologies, Ind., Boston, Massachusetts) at 38 years of age. Past medical his- tory was also signi cant for diabetes mellitus and hy- pertension. As a result of her surgical palliation, the patient had severe pulmonary valve regurgitation with decreased right ventricular function and was referred for PPVI.
* Corresponding Author:
Brian Boe, MD
The Heart Center
Nationwide Children’s Hospital
700 Children’s Drive Columbus, OH 43205-2664, USA
Tel.: +1 614 722 2459; Fax: +1 614 722 5030; E-Mail: brian.boe@nationwidechildrens.org
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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http://structuralheartdisease.org/