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Percutaneous pulmonary valve implantation; first experiences from Turkey/Perkutan pulmoner kapak implantasyonu; Turkiye'den ilk deneyimler.

Since many years, conduits have been used by surgeons in the treatment of certain congenital heart diseases. However all conduits become dysfunctional by the time and should be replaced (1). Percutaneous pulmonary valve implantation (PPVI) is an alternative treatment option to surgery (2, 3). In this article, we aimed to present early and short term results of PPVI from our center.

There were 10 implantations performed since October 2010 to June 2012. Eight of the patients were males and two were female, aged between 13 and 39 years (19.2 [+ or -] 7.8 years), and weighed between 32 and 76 kg (58.2 [+ or -] 14.1kg). Informed consent form was obtained from all patients before procedure. Patients' diagnoses were within a wide spectrum, including tetralogy of Fallot to corrected transposition of great arteries. Different types of conduit were used in order to establish right ventricle to pulmonary artery continuity, including; Freestyle conduit, in three patients; Gore-tex conduit were used in two patients; a Contegra conduit was used in one patient; a Hemashield, Xenograft and pulmonary homograft were used in the others. A native pulmonary valve was present in one of the patients. Conduit dysfunction was defined as pulmonary regurgitation more than mild with/without stenosis (4). Two of the patients who underwent PPVI had significant pulmonary insufficiency, while the remaining eight had both insufficiency and obstruction.

Edwards Sapien transcatheter heart valves (Edwards Lifesciences LLC, Irvine California) were used in seven of the patients, while Melody valves (Medtronic, Inc., Minneapolis, Minnesota) were used in the remaining three for implantation. The selection of the implanted valve type was based upon the conduit size and the lesion type.

Right ventricular (RV) pressure evidently decreased in all patients having had high RV pressure before procedure, except in one patient who had pulmonary hypertension. The RV pressure value and RV/aorta pressure ratio measured following the intervention were significantly lower than pre-intervention values (p<0.005 and p<0.001, respectively). Except for patient who had native pulmonary artery, pulmonary insufficiency was not detected in any of the patients following the interventional treatment.

Duration of the procedure was 175.55 [+ or -] 40.5 minutes, mean radiation dosage was 11352 [+ or -] 5341 cyg/c[m.sup.2], and hospitalization period following intervention was 2 [+ or -] 0.5 days. No major complications developed in any of the patients.

Median follow-up duration was 9.1 [+ or -] 7.4 months (3-24 months). Functional capacities and effort tests of patients were evaluated prior to and 3 months after the intervention. Six of 8 patients who completed the three months of follow-up were NYHA-3, and 2 were NYHA-2 pre-intervention. Six of the patients regressed to NYHA-1, and 2 patients to NYHA-2 after the intervention, and an increase in functional capacity was observed in all patients. Significant increases in physical exercise capacities on cardiopulmonary exercise test at the end of the 3rd month were observed in all patients. None of the patients developed restenosis, and stent fracture was not observed in any of them. Valve sufficiency was outstanding in all patients.

In conclusion, the early-term results of the first experiences from Turkey about PPVI are encouraging. PPVI successfully reduces RV pressure, and assures valve competence and clinical improvement. It is highly safe in selected patients, a good alternative to surgical pulmonary valve and conduit replacement, and should be the first option to be considered where feasible.

Ender Odemis, Alper Guzeltas, Murat Saygi, Ihsan Bakir *

Departments of Pediatric Cardiology and * Pediatric Cardiothoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and

Cardiovascular Surgery Center and Research Hospital, Istanbul-Turkey

References

(1.) Homann M, Haehnel JC, Mendler N, Paek SU, Holper K, Meisner H, et al. Reconstruction of the RVOT with valved biological conduits: 25 years experience with allografts and xenografts. Eur J Cardiothorac Surg 2000; 17: 624-30. [CrossRef]

(2.) Bonhoeffer PBoudjemline Y Saliba Z, Merckx J, Aggoun Y Bonnet D, et al. Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary artery prosthetic conduit with valve dysfunction. Lancet 2000; 356: 1403-5. [CrossRef]

(3.) Nordmeyer J, Coats L, Bonhoeffer P Current experience with percutaneous pulmonary valve implantation. Semin Thorac Cardiovasc Surg 2006; 18: 122-5. [CrossRef]

(4.) Khambadkone S, Coats L, Taylor A, Boudjemline Y, Derrick G, Tsang V, et al. Percutaneous pulmonary valve implantation in humans: results in 59 consecutive patients. Circulation 2005; 112: 1189-97. [CrossRef]

Address for Correspondence/Yazisma Adresi: Dr. Ender Odemis

Atakent Mah. Ikitelli Cad. Ihlamurevleri Sitesi Kucukcekmece, Istanbul-Turkiye Phone: +90 212 692 00 00-1154

E-mail: odemisender@gmail.com

doi: 10.5152/akd.2013.125
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Article Details
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Author:Odemis, Ender; Guzeltas, Alper; Saygi, Murat; Bakir, Ihsan
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Article Type:Letter to the editor
Geographic Code:7TURK
Date:Jun 1, 2013
Words:752
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