Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-28T03:11:12.378Z Has data issue: false hasContentIssue false
  • English
  • Français

Percutaneous pulmonary valve implantation in patients after Ross procedure: role of intravascular ultrasound

Part of: Echocardiography

Published online by Cambridge University Press:  21 December 2018

Karol Zbroński Open the ORCID record for Karol Zbroński [Opens in a new window] ,
Lidia Tomkiewicz-Pająk ,
Janusz Kochman  and
Zenon Huczek
Karol Zbroński*
Affiliation:
First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Lidia Tomkiewicz-Pająk
Affiliation:
Department of Cardiac and Cardiovascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
Janusz Kochman
Affiliation:
First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Zenon Huczek
Affiliation:
First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
*
Author for correspondence: K. Zbroński, First Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland. Tel: +48-22-599-19-58; Fax: +48-22-599-19-57; E-mail: karol.zbronski@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Coronary compression exclusion during right ventricle outflow tract stenting is recommended and potential oversight may be fatal. Balloon inflation in right ventricle outflow tract with simultaneous aortography can be inconclusive or falsely negative. We present a case of 27-year-old male post Ross operation qualified for percutaneous pulmonary valve implantation. Neither of the conventional views obtained provided a definite exclusion of coronary compression, therefore an intravascular ultrasound of the left coronary artery before and during balloon inflation in right ventricle outflow tract was performed. Acquired images allowed excluding potential constriction, thus a covered stent and pulmonary valve were implanted and the procedure was concluded. Two hours later, the patient complained of chest pain. Transthoracic echocardiography demonstrated a significant pericardial effusion. Retrospective analysis of the final angiogram revealed a possibility of subtle extravasation at the distal part of the homograft. A hybrid procedure consisting of additional covered stent implantation, pericardial drainage, and second pulmonary valve implantation was performed with an acceptable result. To conclude, in case of doubtful or unconvincing images obtained from aortography or selective angiography during balloon inflation in right ventricle outflow tract, intravascular ultrasound might be a feasible and useful technique. Signs of homograft rupture may be subtle, whereas symptoms of cardiac tamponade delayed. In selected patients percutaneous treatment of homograft rupture is achievable and beneficial.

Keywords

Pulmonary valve implantationcoronary compression exclusionintravascular ultrasound
Type
Brief Report
Information
Cardiology in the Young , Volume 29 , Issue 2 , February 2019 , pp. 256 - 258
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Zbroński K, Tomkiewicz-Pająk L, Kochman J, Huczek Z. (2018) Percutaneous pulmonary valve implantation in patients after Ross procedure: role of intravascular ultrasound. Cardiology in the Young page 256 of 258. doi: 10.1017/S1047951118002202

References

1. Gillespie, MJ, McElhinney, DB. Transcatheter pulmonary valve replacement: a current review. Curr Pediatr Rep 2013; 1: 83–91.Google Scholar
2. Eicken, A, Ewert, P, Hager, A, et al. Percutaneous pulmonary valve implantation: two-centre experience with more than 100 patients. Eur Heart J 2011; 32: 1260–1265.Google Scholar
3. Biermann, D1, Schönebeck, J, Rebel, M, Weil, J, Dodge-Khatami, A. Left coronary artery occlusion after percutaneous pulmonary valve implantation. Ann Thorac Surg 2012; 94: e7–e9.Google Scholar
4. Mauri, L, Frigiola, A, Butera, G. Emergency surgery for extrinsic coronary compression after percutaneous pulmonary valve implantation. Cardiol Young 2012; 26: 1–3.Google Scholar
5. Ferrari, E, Niclauss, L, Berdajs, D, von Segesser, LK. Imaging for trans-catheter pulmonary stent-valve implantation without angiography: role of intravascular ultrasound. Eur J Cardiothorac Surg 2011; 40: 522–524.Google Scholar
6. Pockett, CR, Moore, JW, El-Said, HG. Three dimensional rotational angiography for assessment of coronary arteries during melody valve implantation: introducing a technique that may improve outcomes. Neth Heart J 2017; 25: 82–90.Google Scholar
7. Góreczny, S, Eicken, A, Ewert, P, et al. A new strategy to identify potentially dangerous coronary arterial patterns before percutaneous pulmonary valve implantation. Postepy Kardiol Interwencyjnej 2014; 10: 294–297.Google Scholar