Author + information
- Alain Fraisse,
- Anass Assaidi,
- Sophie Malekzadeh-Milani,
- Mehul Patel,
- Jean-Benoit Thambo,
- Damien Bonnet,
- Laurence Iserin,
- Issam Kammache and
- Younes Boudjemline
Coronary compression (CC) may occur during percutaneous pulmonary valve implantation (PPVI) and is potentially life threatening when undiagnosed before right-ventricular outflow tract (RVOT) stenting. We sought to evaluate its incidence, diagnosis and outcome.
All consecutive patients who underwent transcatheter RVOT treatment from May 2008 to December 2011 in 4 institutions were studied. Baseline demographics, diagnosis and outcomes of CC were reviewed with analysis of risk factors.
CC occurred in 6 out of 100 patients(6%) at a median age of 24(13 to 49) years, with RVOT conduit stenosis as the primary lesion in all cases. The initial congenital heart disease was pulmonary atresia-ventricular septal defect(n=3), complex transposition of the great arteries(n=2) and critical aortic stenosis status-post Ross operation(n=1). The RVOT initial median conduit diameter at surgical implantation was 23(17 to 24) mm and conduit types were homograft(n=3), bioprothesis(n=2) and a pericardial patch(n=1). CC was diagnosed by coronary angiogram during balloon dilation of the RVOT in all cases whereas it was suspected on pre-procedure computed tomography (CT-scan) in only 2 cases. Compression occurred on the left main coronary artery in 5 cases and on a single coronary artery in one patient. No risk factor was found but there was a significantly higher incidence of CC in one of the 4th institutions(p=0.04). CC was well-tolerated and resolved after the balloon was deflated in all the cases. No patients underwent RVOT stenting or PPVI. Surgical conduit replacement was electively performed in 3 patients. Two patients with moderate residual RVOT stenosis are followed. One patient with encephalopathy and respiratory insufficiency died 9 months after catheterization.
CC is efficiently diagnosed by coronary angiogram during balloon dilation in a small proportion of patients undergoing transcatheter interventions on RVOT. Diagnosis by pre procedure CT-scan is not accurate. No specific risk factors exist. Surgical conduit replacement is indicated when balloon dilation fails to improve the RVOT obstruction.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Percutaneous Therapies
Abstract Category: 14. Congenital Cardiology Solutions: Therapy
Presentation Number: 1204-132
- 2013 American College of Cardiology Foundation