Page 14 - Journal of Structural Heart Disease Volume 4, Issue 1

5 Original Scienti c Article
Figure 4. Series of cineangiographic images in frontal projection in a 20-year-old female patient (same as in Figure 3) with severe pulmonary regurgitation. Panel A. Angiography of the main pulmonary artery showing severe regurgitation and mild narrowing (arrow). Panel B. Cine uoroscopy during balloon sizing and simultaneous ascending aortography showing indentation at the pulmo- nary annulus (arrow) measuring 22–24 mm. Panel C. Cine uoroscopy of the valve assembly in the main pulmonary artery. Panel D. Cine uoroscopy during gradual deployment of a 26-mm Venus P-valve. Panel E. Cine uoroscopy after complete valve deployment. Panel F. Cineangiography of the main pulmonary artery showing competent valve.
are performed before it is fully deployed. When the middle segment of the valve is exposed, if it is fully opposed to the main PA, and because this stent seg- ment is fully covered, there may be hypotension or bradycardia from low pulmonary blood flow for a brief period. The valve has to be deployed rapidly to allow normalization of cardiac output. After deploy- ment and release of the valve, RV and PA pressures should be measured and angiography performed in the main PA to assess valve function. Hemostasis of the femoral venous access site can be achieved us- ing direct pressure or a gure-of-eight suture. Alter- natively, prior to introducing the large sheath, one or two Perclose ProGlide 6-F Suture-Mediated Closure Systems (Abbott Vascular, Santa Clara, California, USA) may be used [22].
After the procedure, the patient should be moni- tored in a cardiac intensive care unit or cardiac ward, depending on the hospital system. The patient should receive 81 mg aspirin for 6–12 months. Electrocardio- gram (ECG), chest X-ray, and transthoracic echocardi-
ography (TTE) should be performed before discharge. Patients should be followed up in the outpatient clinic at 1-, 3-, and 6-month intervals and yearly thereafter. The follow-up includes clinical evaluation, ECG, chest X-ray, and TTE. In addition, 6 months after the proce- dure, a CMR can be performed to assess RV volume and performance. Figures 3 and 4 show a patient with severe PR who underwent tPVR using a 26-mm Venus P-valve. Note the sustained competent valve function and remodeling of the RV upon follow-up.
Clinical Experience
The early results with this valve are encouraging. The rst clinical human experience using a self-ex- panding percutaneous stent valve (Venus P-valve) was reported by Cao et al. [20]. In this study, ve pa- tients (four females) with a mean weight of 54.9 kg were selected for attempted valve deployment. Pa- tients were NYHA class II (n = 3) or class III (n = 2) at baseline. Pulmonary insu ciency was grade 4 in all
Alkashkari W. et al.
Transcatheter Pulmonary Valve Replacement