A Series Of Interventional Treatments For Right Ventricular Outflow Tract Dysfunction After Surgical Correction Of Complex Congenital Heart Diseas

Background:Transcatheter pulmonary valve replacement(TPVR)is an effective way to treat pulmonary valve insufficiency after surgical correlation of congenital heart disease.The long-term outcomes of self-expanding valve,namely Venus-P valve,has not been reported.Aims:We sought to evaluate the clinical outcomes of Venus-P valve using multimodality imaging assessment.Methods:The study retrospectively included 38 patients who received TPVR with Venus-P valve(mean age 24.2±13.2 years,male 61%).Chest X-ray,echocardiography,cardiac computer tomography(CCT)and cardiac magnetic resonance were performed regularly.Adverse events including valve dysfunction,stent fracture,endocarditis,and valve thrombosis were recorded.Results:Venus-P valves were successfully implanted in all patients.Trivial pulmonary regurgitation(PR)at discharge was observed in all patients.During a median follow-up of 4.8 years(0.3-8.1),5-year incidence for valve dysfunction was 10.7%(2.4-18.9)and recurrent PR was seen in 3 patients at a mean time of 2.2 years.Stent fracture occurred in 7 patients at a mean time of 2 years and 5-year incidence of stent fracture was 16.5%(6.8-26.2).There was no valve dysfunction resulting from stent fracture.Three patients were diagnosed as endocarditis at 1,3,and 12 months after implantation respectively,causing 1 death and 1 surgical explant.No valve thrombosis was detected.Conclusion:Venus-P valve is associated with favorable outcomes during a relative long-term period,justifying its clinical safety and effectiveness.Multimodality imaging assessment plays an important role in the post-implant evaluation of TPVR procedure.Background:Implanted transcatheter aortic valves with eccentric geometry were associated with a series of adverse events,but data is still scanty in terms of self-expanding pulmonary valves(SEPV).The role of stable anchoring has not been defined given the highly variable anatomy of native right ventricular outflow tract(RVOT).Aims:To evaluate the geometrical characteristics and landing strategies of SEV in different types of RVOT.Methods:A total of 35 patients underwent transcatheter pulmonary valve replacement with SEPV were retrospectively included.RVOT was classified as 4 phenotypes:type Ⅰ,pyramid shape;type II,tubular shape;type Ⅲ,inverted trapezoidal shape,type Ⅳ,main pulmonary ectasia.The frame geometry was assessed on post-implant computer tomography(CT)scanning by calculating the non-circularity[circularity ratio(minimum diameter/maximum diameter)<0.9]and under-expansion[expansion ratio(derived external valve area/nominal external valve area)<0.9)in the level of distal,valve and proximal.Balloon waist diameter(Db)and oversize rate(Db/valve diameter-1)were recorded.Adverse events(valve dysfunction,stent fracture and valve thrombosis)were recorded.Results:In the valve level,mean CR was 0.91±0.04,and 25%of stents were non-circular;mean ER was 0.92±0.08 and 31.3%of valves were under-expanded.There was no difference in CR and ER in patients with or without valve dysfunction/thrombosis.Patients with stent fracture showed a higher CR(0.91 ±0.04 vs.0.85±0.05,p<0.05).In type Ⅰ and Ⅳ RVOT,the distal flare has lower ER than other 2 levels,while type Ⅰ and Ⅲ RVOT,the valve level was most compressed with lowest ER.The oversize rates for the 4 types were 32%,19%,18%,and 25%respectively.Conclusion:SEPV is associated with favorable outcomes regardless of stent deformation.SEPV was anchored in distal flare in type Ⅰ and Ⅳ RVOT and require more oversizing in valve size selection.In type Ⅰ and Ⅲ RVOT,SPEV was released in annulus level with smaller oversize rate.Background:Pulmonary artery and conduit stenosis were commonly observed in patients underwent surgical correlation of complex congenital heart diseases.The subsequent right ventricular overload may lead to exercise incapacity,arrhythmia,and heart failure.Transcatheter interventions including balloon dilation(BD)and stent implantation(SI)could help to eliminate the stenosis in a less invasive way.Aim:To evaluate the clinical outcomes of transcatheter therapies in this patient population.Methods:A total of 30 patients received BD and SI were retrospectively included(mean age 15.8 ± 12.4 years,50%male).Echocardiography and cardiac CT were performed before intervention.Right ventricular systolic pressure(RVSP),pulmonary artery systolic pressure(PASP),and stenosis gradient(ΔP)were recorded.Adverse events including major cardiovascular events,technical success,and restenosis were recorded during follow-up.Results:There were 5 patients with branch artery stenosis(BS),22 with main artery/conduit stenosis(MS)and 3 with both.In BS group,6 received SI and 2 were balloon-dilated.Eight pulmonary stents were implanted(4 underwent valve implantation afterwards)in MS groups and the rest received balloon dilation.ΔP was both decreased in BS and MS groups,from 75.3 ± 6.4 to 36.4±7.7mmHg(p=0.003),and 77.5 ± 28.8 to 42.7 ± 19.1mmHg(p<0.001)respectively.Technical success in 100%of BS patients and 76%of MS patients.Six unsuccessful cases all underwent balloon dilation.during a mean follow-up period of 2.3 years,there was no major cardiovascular events and restenosis was observed in 3 patients requiring intervention.Conclusion:Transcatheter therapies were associated with favorable clinical outcomes in patients with pulmonary artery/conduit stenosis.