Transcatheter Pulmonary Valve implantation · Transcatheter Pulmonary Valve implantation The role...

Transcatheter Pulmonary Valve

implantation

The role of imaging for patients selection

and procedure monitoring

Mario Carminati - IRCCS Policlinico San Donato, Milan

Policlinico San Donato IRCCS

• 18mm Contegra modified-bovine jugular vein with valve segment

• NuMed Platinum Iridium Stent

– 28 mm length

– Crimped down to 6mm, re-expanded 18mm up to 22mm

• Balloon Expandable system

Melody®

Transcatheter Pulmonary Valve

Melody® Indications

• Extend the functional life of

the RV-PA conduit

• Restore & maintain pulmonary

valve competence

• Relieve conduit stenosis

without inducing regurgitation

FALLOT

PA + VSD

TGA+VSD+PS

TRUNCUS

Others

RVOT disfunction: target population

RV outflow tract obstruction (RVOTO)

– RV systolic pressure ≥ 2/3 of systemic

Moderate to severe regurgitation (PR)

– Impaired exercise capacity (<65% of predicted)

– Significant RV dilatation / dysfunction

Patient Selection

Patient evaluation

• Clinical/functional (CPEX)

• ECG/Holter

• Echocardiography

• Cardiac MRI

Echocardiography

Severe Tricuspid regurgitation

ooooooooooooooooo

Magnetic resonance imaging

• RVOT morphology

• Pulmonary trunk/branches anatomy

• RV size and function

• Evaluation of pulmonary

stenosis/regurgitation (regurgitant fraction)

Magnetic resonance imaging

• RVOT morphology (suitability?)

X ? ? ?

Courtesy dr Schievano Policlinico San Donato IRCCS

MR + 3D reconstruction

MR-Angiogram

Distal conduit stenosis

Melody

LPA severe hypoplasia

Melody

CT as an alternative to MR

RVOT too large????

RVOT sizing

Extensive conduit calcification

Prestenting + Melody

VD, 32 y, TGA+VSD+PS, Rastelli with RV-PA homograft 18

Conduit severe stenosis and calcification

Prestenting with CP covered stent

Incomplete stent expansion

Post-dil with Mullins high pressure balloon

Final Angio post Melody implantation

RV-PA conduit / coronaries

Balloon inflation and simultaneous aortogram

Matrix 25 mm conduit: stenosis and regurgitation

PA angiogram

26 Sapien implant

Final PA angiogram

Pre-procedure evaluation

• MR is the gold standard for:

* RVOT morphology

* RV volumes/function

Intraprocedure monitoring

• Angiography is the gold standard

(more sofisticated technology as rotational

angiography may be very helpful)

* Very little role, if any, of echo

Thank you for your attention!

Mario Carminati

Transcatheter Pulmonary Valve implantation · Transcatheter Pulmonary Valve implantation The role...

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