Page 32 - Journal of Structural Heart Disease Volume 5, Issue 1

Case Report
Journal of Structural Heart Disease, February 2019, Volume 5, Issue 1:21-24
DOI: https://doi.org/10.12945/j.jshd.2019.003.18
Received: March 01, 2018 Accepted: March 30, 2018 Published online: February 2019
Transcatheter Intervention for Paravalvular Leak in Mitroflow Bioprosthetic Pulmonary Valve
Vishal R. Kaley, MBBS, MD1, E. Oliver Aregullin, MD, FAAP1,2, Bennett P. Samuel, MHA, BSN, RN1, Joseph Vettukattil, MBBS, MD, DNB, CCST, FRCPCH1,2*
1 Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
2 Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
Abstract
Paravalvular leak (PVL) is a complication caused by development of gaps due to dehiscence between the annulus and implanted valve. Clinically significant PVL in bioprosthetic pulmonary valves are extremely rare. Currently, surgical intervention is the first line of treat- ment. However, surgery is associated with greater risk for morbidity and mortality when compared to prima- ry repair or valve replacement. We present a 22-year- old male who underwent successful transcatheter in- tervention for pulmonary PVL with hemodynamic and symptomatic improvement.
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Key Words
Paravalvular leak • Percutaneous • Pulmonary valve replacement • Regurgitation • Tetralogy of Fallot.
Introduction
Paravalvular leak (PVL) is a known complication due to suture dehiscence between the sewing ring and na- tive tissue causing regurgitation around the replaced valve [1]. Large leaks may result in complications such as hemolysis, arrhythmias, and congestive heart fail- ure [2]. The incidence of PVL following aortic and mi- tral valve replacement is 1-5%, and 2-12% respectively [1]. Clinically significant PVL following bioprosthetic pulmonary valve replacement is extremely rare.
The standard treatment for pulmonary PVL is sur- gery with valve replacement and repair due to the variability in implant location in the trabeculated and often dilated right ventricular (RV) outflow tract [3]. However, surgery is associated with greater risk for morbidity and mortality when compared to primary repair or valve replacement [4]. Transcatheter inter- vention for aortic and mitral valve PVL is effective with low rates of procedural complications [5], and may also be useful in the setting of pulmonary PVL.
Case Presentation
A 22-year-old male with tetralogy of Fallot and bilateral peripheral pulmonary artery (PA) stenosis presented with multiple episodes of syncope, chronic dyspnea on exertion and worsening lower extremity edema. He had a transannular patch repair early in life. Due to severe pulmonary regurgitation, his pulmo- nary valve was replaced with a 27 mm Mosaic tissue valve (Medtronic, Minneapolis, MN, USA) at 8-years of age. He was noted to have free pulmonary regurgi- tation, and depressed systolic function at 15-years of age. Subsequently, he underwent pulmonary valve replacement with a 25 mm Mitroflow bioprosthetic valve (Sorin, Saluggia, Italy) and intraoperative stent- ing of the branch PAs. His post-operative period was complicated requiring extracorporeal membrane
* Corresponding Author:
Joseph Vettukattil, MBBS, MD, DNB, CCST, FRCPCH Congenital Heart Center
Spectrum Health Helen DeVos Children’s Hospital 100 Michigan NE (MC248), Grand Rapids, MI , USA Tel. +1 616 267 0988; Fax: +1 616 267 1408;
E-Mail: joseph.vettukattil@helendevoschildrens.org
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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