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BACKGROUND: There are limited studies with medium-term follow-up following percutaneous pulmonary valve implantation and no studies with a gender-specific analysis. AIMS: To report clinical outcomes up to five years following percutaneous pulmonary valve implantation using the two most common balloon expandable valves in a mixed population of paediatric and adult patients with an age and gender-specific analysis. METHODS: This was a single-centre retrospective observation study. Relevant data were obtained retrospectively from the case files. Age and gender- specific analysis was performed using SPSS. RESULTS: Totally, 58 patients (13 children, 45 adults) underwent percutaneous pulmonary valve implantation. Statistically significant reduction in median right ventricular outflow tract flow velocity following valve implantation was maintained for the whole five years in adults but not in children. There were no gender-specific differences despite the study being adequately powered. Independent of valve type used, there was significant reduction of the right ventricular outflow tract flow velocity in the immediate post valve implantation period (Edwards P = 0.001, Melody P = 0.013). There was a significant negative correlation between implanted valve Z-score and subsequent right ventricular outflow tract gradient during the first two years following valve implantation. CONCLUSION: Gender does not significantly affect valve function following percutaneous pulmonary valve implantation. It is important to consider patients' age and body surface area in relation to existing right ventricular outflow tract size during decisions for percutaneous pulmonary valve implantation.
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BACKGROUND: Transcatheter pulmonary valve implantation (TPVI) is an effective non-surgical treatment method for patients with right ventricle outflow tract dysfunction. The Medtronic Melody and the Edwards Sapien are the two valves approved for use in TPVI. Since TPVI patients are typically younger, even a modest annual incidence of infective endocarditis (IE) is significant. Several previous studies have shown a growing risk of IE after TPVI. There is uncertainty regarding the overall incidence of IE and differences in the risk of IE between the valves. METHODS: A systematic search was conducted in the MEDLINE, EMBASE, PubMed, and Cochrane databases from inception to 1 January 2023 using the search terms 'pulmonary valve implantation', 'TPVI', or 'PPVI'. The primary outcome was the pooled incidence of IE following TPVI in Melody and Sapien valves and the difference in incidence between Sapien and Melody valves. Fixed effect and random effect models were used depending on the valve. Meta-regression with random effects was conducted to test the difference in the incidence of IE between the two valves. RESULTS: A total of 22 studies (including 10 Melody valve studies, 8 Sapien valve studies, and 4 studies that included both valves (572 patients that used the Sapien valve and 1395 patients that used the Melody valve)) were used for the final analysis. Zero IE incidence following TPVI was reported by eight studies (66.7%) that utilized Sapien valves compared to two studies (14.3%) that utilized Melody valves. The pooled incidence of IE following TPVI with Sapien valves was 2.1% (95% CI: 0.9% to 5.13%) compared to 8.5% (95% CI: 4.8% to 15.2%) following TPVI with Melody valves. Results of meta-regression indicated that the Sapien valve had a 79.6% (95% CI: 24.2% to 94.4%, p = 0.019; R2 = 34.4) lower risk of IE incidence compared to the Melody valve. CONCLUSIONS: The risk of IE following TPVI differs significantly. A prudent valve choice in favor of Sapien valves to lower the risk of post-TPVI endocarditis may be beneficial.
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The coexistence of tetralogy of Fallot and Ebstein's anomaly is extremely rare. There are only a few case reports in the literature, and surgical options for the treatment are controversial. There is insufficient data on long-term follow-up of patients and management of complications. In this case report, we present a 20-year-old adult with operated tetralogy of Fallot, Ebstein's anomaly, and Glenn anastomosis who underwent transcatheter pulmonary valve implantation for severe pulmonary insufficiency.
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Anomalía de Ebstein , Insuficiencia de la Válvula Pulmonar , Válvula Pulmonar , Tetralogía de Fallot , Adulto , Anastomosis Quirúrgica , Anomalía de Ebstein/complicaciones , Anomalía de Ebstein/cirugía , Humanos , Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/cirugía , Insuficiencia de la Válvula Pulmonar/etiología , Insuficiencia de la Válvula Pulmonar/cirugía , Tetralogía de Fallot/complicaciones , Tetralogía de Fallot/cirugía , Adulto JovenRESUMEN
BACKGROUND: The objective of this study is to describe the recent trends and in-hospital outcomes with percutaneous pulmonic valve implantation (PPVI) and surgical pulmonic valve replacement (SPVR) in adult hospitals in the US after the availability of both the Melody valve (Medtronic Inc., Minneapolis, Minnesota) and the Sapien XT valve (Edwards Lifesciences, Irvine, CA). METHODS: We queried the National Inpatient Sample database (NIS) from January 2016 to December 2017 to identify hospitalizations for PPVI and SPVR. RESULTS: We identified 5455 weighted discharges with PPVI and SPVR (PPVI=1140, SPVR=4305). PPVI procedures had increased in number over 2016 and 2017 (115 procedure at the first quarter of 2016, 195 procedures in the final quarter of 2017, P-trend=0.086), while SPVR volume remained constant. The incidence of in-hospital mortality was low with both procedures (SPRV: 1.6% vs. PPVI: 0.9%, p=0.071). SPVR had worse in-hospital outcomes, was associated with a longer length of stay [5 days vs. 1 day, p<0.001], and comparable cost of index hospitalization [$51,657 vs. $51,193] compared with PPVI. CONCLUSION: After approval of the Sapien valve for commercial use in 2016, PPVI procedures have increased in frequency. PPVI is associated with lower procedural complications than SPVR, however, both carry a low risk of mortality. Despite the higher cost of the valves and delivery systems, PPVI is associated with a slightly lower cost of index hospitalization compared with SPVR, likely due to the higher in-hospital complications and LOS of the latter.
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Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Válvula Pulmonar , Adulto , Cateterismo Cardíaco , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/cirugía , Resultado del TratamientoRESUMEN
This is a report of a rare complication during implantation of a Melody valve in an adult patient in whom the valve failed to expand due to balloon rupture. An 18-year-old patient was admitted with an increased right ventricular pressure and severe pulmonary regurgitation for scheduled cardiac catheterization. Angiography revealed a proximal stenosis of the left pulmonary artery (LPA). First, a prestenting was performed. Three months later he came back for planned percutaneous pulmonary valve implantation (PPVI). Because of the proximity of the right coronary artery (RCA) to the right ventricular outflow tract (RVOT) and thus a relatively short landing zone, the Melody valve had been doubly folded. During the inflation of the outer balloon, it ruptured. At this point, the Melody valve was still fixed to the inner balloon. A second catheter was placed through the Melody valve and successful valve implantation was possible. This procedure was difficult because to push the catheter through the partly inflated Melody valve, the inner balloon had to be slowly and simultaneously deflated. The final angiograms and pressure measurements showed a good functional result and absent pulmonary regurgitation. Open heart surgery could be avoided after incomplete Melody valve dilatation using the contralateral pulmonary artery as a safe rail.
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The incidence and prevalence of structural heart disease has risen due to the longevity of the population, placing an economic burden on society. Over the past 20 years, treatment options for structural heart disease has significantly evolved. Advances in technology and interventional techniques have now shifted therapeutic options to include minimally invasive approaches to correct valvular heart disease. Patients with congenital heart defects are candidates for minimally invasive approaches to correct valvular heart disease. An interdisciplinary team approach using a fusion of multimodal imaging is the best approach for the treatment of this complex patient population.
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Válvula Aórtica/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Válvula Mitral/cirugía , Procedimientos Quirúrgicos Cardíacos , HumanosRESUMEN
OBJECTIVE: This single center study compared the risk of bacterial endocarditis (BE) after surgical and percutaneous pulmonary valve implantation. METHODS: Between Jan 1st 2010 and Dec 31st 2015 all patients who received a biological pulmonary valve (surgical/interventional) were identified. The clinical follow-up was analyzed with regard to BE applying the modified Duke criteria and echocardiographic findings. RESULTS: We identified 246 patients who underwent a biological pulmonary valve implantation. The mean age was 15.9â¯years, (SD 12.7, Median 13.1). There were 166 surgical patients (67.5%), with 55 homografts (22.4%, mean diameter 27.4â¯mm), 106 Contegra® grafts (43.1%, mean diameter 17.4) and 5 Hancock® valves (2.0, mean diameter 25.6â¯mm) and 80 percutaneous pulmonary valve implantations (PPVI) (32.5%) with 51 Edwards Sapien® valves (20.7%, mean diameter 25.2â¯mm) and 29 Melody® valves (11.8%, mean diameter 21.9â¯mm). Patients with a bovione jugular conduit as the biologiocal substrate had an increased risk for BE and patients with Melody® valves had the highest risk for BE that was 5-8 times higher as compared to other valves. BE episodes were detected in 5/106 Contegras® (4,7%, 1.5 per 100 person-years), and in 6/29 of the Melody® valves (20.7%, 4.8 per 100 person-years). There were no cases of BE in patients treated with Edwards Sapien®, homografts or Hankock® valves. CONCLUSION: Whereas homografts and Edwards Sapien® valves seem to have a very low risk of BE, this risk is increased in Contegra® conduits and in Melody® valves.
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Bioprótesis/efectos adversos , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/etiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Insuficiencia de la Válvula Pulmonar/diagnóstico , Insuficiencia de la Válvula Pulmonar/cirugía , Adolescente , Animales , Bioprótesis/tendencias , Bovinos , Niño , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Implantación de Prótesis de Válvulas Cardíacas/tendencias , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/etiología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/etiología , Resultado del TratamientoRESUMEN
OBJECTIVES: This study sought to investigate the impact of tricuspid regurgitation (TR) on right ventricular function after percutaneous pulmonary valve implantation (PPVI). BACKGROUND: PPVI provides a less invasive alternative to surgery in patients with right ventricular-to-pulmonary artery (RV-PA) conduit dysfunction. Recovery of the right ventricle has been described after PPVI for patients with pulmonary stenosis and for those with pulmonary regurgitation. Additional TR enforces RV dysfunction by supplemental volume overload. Limited data are available on the potential of the right ventricle to recover in such a specific hemodynamic situation. METHODS: In a matched cohort study, we compared patients who underwent PPVI with additional TR with those without TR. RESULTS: The degree of TR improved in 83% of the patients. In our patients (n = 36) exercise capacity and right ventricular volume index improved similarly 6 months after PPVI in patients with and without important TR. None of them had significant TR in the long-term follow-up of median 78 months. CONCLUSIONS: PPVI improves not only RV-PA-conduit dysfunction, but also concomitant TR. In patients with a dysfunctional RV-PA conduit and TR, the decision whether to fix TR should be postponed after PPVI.
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Cateterismo Cardíaco/métodos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Insuficiencia de la Válvula Pulmonar/cirugía , Estenosis de la Válvula Pulmonar/cirugía , Válvula Pulmonar/cirugía , Insuficiencia de la Válvula Tricúspide/fisiopatología , Disfunción Ventricular Derecha/fisiopatología , Función Ventricular Derecha , Obstrucción del Flujo Ventricular Externo/fisiopatología , Remodelación Ventricular , Adolescente , Adulto , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Estudios de Casos y Controles , Niño , Ecocardiografía , Prueba de Esfuerzo , Tolerancia al Ejercicio , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Hemodinámica , Humanos , Imagen por Resonancia Cinemagnética , Masculino , Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/fisiopatología , Insuficiencia de la Válvula Pulmonar/diagnóstico por imagen , Insuficiencia de la Válvula Pulmonar/etiología , Insuficiencia de la Válvula Pulmonar/fisiopatología , Estenosis de la Válvula Pulmonar/diagnóstico por imagen , Estenosis de la Válvula Pulmonar/etiología , Estenosis de la Válvula Pulmonar/fisiopatología , Recuperación de la Función , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/etiología , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/etiología , Adulto JovenRESUMEN
INTRODUCTION: Three-dimensional rotational angiography (3DRA) has been used in the guidance of various transcatheter therapies including percutaneous pulmonary valve implantation (PPVI). The most recently available 3D image fusion software (VesselNavigator, Philips) extends this technology to use pre-registered computed tomography or magnetic resonance imaging datasets, promising reductions in contrast and radiation exposure along with shorter procedural times. METHODS: In this retrospective review, patients were assigned to three groups according to the mode of imaging guidance: two-dimensional angiography (2DA), 3DRA and VesselNavigator (VN) assisted valve implantation. Patient characteristics and catheterisation data were reviewed with a focus on contrast and radiation exposure, fluoroscopy, and procedural times. RESULTS: Between July 2012 and June 2016, 21 patients underwent PPVI: 8 with 2D guidance, 6 patients with 3DRA and most recently 7 patients with VN assistance. Patents in the VN group received significantly less absolute and weight indexed contrast when compared with those with 2DA or 3DRA guided PPVI. Patients in the 2DA group received a significantly higher total dose area product radiation dose and air kerma in comparison with patients with 3DRA and VN guided intervention. Application of VN resulted in the shortest fluoroscopy time, although not statistically significant, and a significantly shorter study time when compared with 2DA. CONCLUSIONS: Utilisation of pre-intervention image manipulation with VesselNavigator for 3D guidance of PPVI results in a reduction in contrast and radiation exposure and study time as compared with traditional 2D guidance, and contrast usage as compared with 3DRA.
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OBJECTIVE: Percutaneous pulmonary valve implantation (PPVI) has emerged as a new approach to treat patients with dysfunctional pulmonary valve conduits. Short- and midterm results have outlined hemodynamic improvements and increase in exercise performance. However, there is a lack of knowledge about quality of life at short term follow-up. PATIENTS AND METHODS: From July 2007 to March 2013, we investigated 59 patients (17 female; median age 22.8 years) undergoing PPVI in our institution. 46 had predominant pulmonary stenosis (PS) and 13 had predominant pulmonary regurgitation (PR). They answered the quality of life questionnaire (SF-36) and underwent a cardiopulmonary exercise test and Cardiovascular Magnetic Resonance before and 6 months after PPVI. RESULTS: Peak oxygen uptake improved significantly from 27.2 (18.9; 34.0) ml/min/kg to 29.2 (22.4; 35.3) ml/min/kg (p<.0001), and from 69.6 (55.9; 83.6) %predicted to 76.3 (67.9; 92.7) %predicted, respectively. Improvements were seen in both, the PS (71.9 to 78.3 %predicted; p<.0001) and PR (62.7 to 73.0 %predicted; p<.0001) group. Self-estimated quality of life was good already before PPVI but increased in almost all domains 6 months after PPVI in PS and PR group. Significant improvements developed in "physical function", "general health perception" and "health transition" in both groups, and "physical role functioning", "vitality" and "mental health" only in the PS group. CONCLUSIONS: In patients with dysfunctional pulmonary valve conduits exercise performance and quality of life improve substantially 6months after successful percutaneous pulmonary valve implantation.
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Tolerancia al Ejercicio/fisiología , Implantación de Prótesis de Válvulas Cardíacas/tendencias , Insuficiencia de la Válvula Pulmonar/cirugía , Estenosis de la Válvula Pulmonar/cirugía , Calidad de Vida , Adulto , Femenino , Estudios de Seguimiento , Implantación de Prótesis de Válvulas Cardíacas/psicología , Humanos , Masculino , Estudios Prospectivos , Insuficiencia de la Válvula Pulmonar/fisiopatología , Insuficiencia de la Válvula Pulmonar/psicología , Estenosis de la Válvula Pulmonar/fisiopatología , Estenosis de la Válvula Pulmonar/psicología , Calidad de Vida/psicología , Adulto JovenRESUMEN
El Sarcoma de Kaposi (SK) es un tumor vascular que puede comprometer la piel. En 1872 el dermatólogo vienés Moritz Kaposi describió por primera esta entidad. Tradicionalmente se la ha considerado un proceso crónico, decurso lento, que afecta sobre todo a hombres ancianos del este de Europa. No recibió mayor atención hasta que apareció como epidemia en hombres que tienen sexo con hombres (HSH) en la década de los 80 y fue reconocido como marcador clínico de SIDA. Describimos nuestra experiencia en la Unidad de Atención y Control en Salud Sexual (UNACESS) de dos varones PPVI: uno con lesión en cara mucosa del prepucio y otro con lesiones palatinas.
Kaposis Sarcoma (KS) is a vascular tumor that can involve the skin. In 1872 the Viennese dermatologist Moritz Kaposi first described this entity. Traditionally it has been considered a chronic, slow flowing, mainly affecting elderly men of Eastern Europe. KS received no more attention until it appeared as an epidemic among men who have sex with men (MSM) in the 80s and was recognized as a clinical marker of AIDS. We describe our experience in Care and Control Unit Sexual Health (UNACESS) in two men living with VIH infection, one with penile mucosa injury and another with palatal lesions.
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Humanos , Masculino , Adulto , Membrana Mucosa/lesiones , Sarcoma de Kaposi/patología , Síndrome de Inmunodeficiencia Adquirida/patología , Infecciones por VIH/patología , Neoplasias Palatinas/patología , Neoplasias del Pene/patología , Sarcoma de Kaposi/terapiaRESUMEN
The Melody® transcatheter pulmonary valve (TPV) is a percutaneous valve system designed for the treatment of obstruction and/or regurgitation of prosthetic conduits placed between the right ventricle and pulmonary arteries in patients with congenital heart disease. In 2000, Melody TPV became the first transcatheter valve implanted in a human; in 2006 it became the first transcatheter valve commercially available anywhere in the world; and in 2010 it was launched as the first commercially available transcatheter valve in the United States. In this review, we present the clinical background against which the Melody valve was developed and implemented, introduce the rationale for and challenges of transcatheter valve technology for this population, outline the history and technical details of its development and use, and summarize currently available data concerning the performance of the device.