Author + information
- Received July 11, 2012
- Revision received July 24, 2012
- Accepted August 7, 2012
- Published online February 12, 2013.
A 73-year-old woman presented with intractable right heart failure (RHF) attributable to severe pulmonary insufficiency (A,Online Video 1). Six years previously, she had undergone a Ross procedure for severe aortic stenosis, with implantation of a decellularized porcine xenograft valve (Matrix P, Auto Tissue Berlin GmbH, Berlin, Germany). Because of the patient's poor general condition, the surgical risk was considered too high, and a catheter approach was performed (B–F,Online Video 2). A sizing balloon determined the diameter of the present narrowing of the distal anastomosis (18.9 mm). Simultaneously, coronary angiography excluded the possibility that the planned procedure could burden the left coronary artery (C). A 45-mm covered stent mounted on a 26-mm Z-Med II balloon (both Numed Inc., Denton, Texas) was implanted in the distal anastomosis (D). Finally, a 26-mm Edwards SAPIEN valve (Edwards Lifesciences, Irvine, California) was implanted within the stent (“valve in stent”) (E). Postprocedural angiography revealed excellent functional results (F). There were no complications during the procedure or during follow-up. During subsequent days, an impressive decline in the patient's signs of right heart failure was observed, and she was discharged 3 days after the procedure.
Our case shows that transcatheter pulmonary valve implantation can be safely performed in patients with failure of pulmonary grafts after the Ross procedure.
- Received July 11, 2012.
- Revision received July 24, 2012.
- Accepted August 7, 2012.
- American College of Cardiology Foundation