EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve...
Transcript of EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve...
![Page 1: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/1.jpg)
DEPARTMENT NAME
Rachel Arnold PA-C Physician Assistant Interventional Cardiology
EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION LAB
![Page 2: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/2.jpg)
DEPARTMENT NAME
Overview of interventional cases performed at Texas Children’s HospitalExciting cases
GOALS
![Page 3: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/3.jpg)
DEPARTMENT NAME
Cath Lab Case Distribution 2014- Jan 2019
23%
25%
49%
3%
Diagnostic
Biopsy
Interventional
Therapeutic
![Page 4: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/4.jpg)
DEPARTMENT NAME
CATH LAB INTERVENTIONS • Open things
• Balloon angioplasty and stenting of vessels
• Valvuloplasty
• Close things• Device closure of VSD, ASD or
PDA• Coil occlusion of collaterals • Device closure Fontan
fenestration
![Page 5: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/5.jpg)
DEPARTMENT NAME
Percutaneous Valves
![Page 6: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/6.jpg)
DEPARTMENT NAME
Indication for Percutaneous Pulmonary Valve
• Class IIa: It is reasonable to consider percutaneous pulmonary valve replacement in a patient with an RV-PA conduit with associated moderate-severe pulmonary regurgitation or stenosis provided the patient meets the inclusion/exclusion criteria for the available valve
![Page 7: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/7.jpg)
DEPARTMENT NAME
CONGENITAL HEART LESIONS REPAIRED WITH RV-PA CONDUITS
• Tetraology of Fallot• Truncus Arterious• Pulmonary Atresia • Others
https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/tetralogy-of-fallot
![Page 8: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/8.jpg)
DEPARTMENT NAME
Truncus with RV-PA conduit
![Page 9: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/9.jpg)
DEPARTMENT NAME
Patient case
• 17 year old male with history of TOF with absent pulmonary valve s/p repair with valved 21mm RV-PA conduit • Referred to cath lab with severe RV-PA conduit obstruction with
mean gradient of 63mmHg and moderately dilated RV with moderate dysfunction
![Page 10: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/10.jpg)
DEPARTMENT NAME
PATIENT CASE
![Page 11: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/11.jpg)
DEPARTMENT NAME
MELODY VALVE • Cow jugular vein hand sewn
onto platinum stent • Placed with a 22 Fr system to
femoral vein • 18mm, 20mm or 22mm valve
http://www.medtronic.com/melody/patient/therapy.html
![Page 12: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/12.jpg)
DEPARTMENT NAME
PATIENT CASE
![Page 13: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/13.jpg)
DEPARTMENT NAME
Patient case results
• Underwent implantation of 22mm Melody Valve • Post procedure echo: mean gradient of 18mmHg, now with mildly
decreased RV function (previously moderate)• Discharged the day after the procedure
![Page 14: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/14.jpg)
DEPARTMENT NAME
Percutaneous Pulmonary valve replacement
• Melody Valve and Edwards Valve• Historically placed in RV-PA conduits for patients with conduit
stenosis or severe regurgitation with dilated RV • Now have placed several in native RVOT. For example TOF with patch
repair instead of a conduit
![Page 15: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/15.jpg)
DEPARTMENT NAME
Patient case jm
• 14 year old male with TOF s/p repair with a 16mm RV-PA conduit
• He had echo moderate to severe pulmonary regurgitation and
moderate stenosis of the RV-PA conduit
• Initial cath: “Due to the left anterior descending coronary artery
coursing between the native RVOT and the RV to PA conduit, the
landing zone for a transcatheter pulmonary valve if placed in the
native RVOT is very short. Decision was made that he needs a shorter
valve, probably a 23 mm Edwards Sapien valve and that a melody
valve would not be appropriate at this time due to its longer length.”
![Page 16: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/16.jpg)
DEPARTMENT NAME
Patient Case #2
![Page 17: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/17.jpg)
DEPARTMENT NAME
Edwards
http://www.edwards.com/eu/Products/TranscatheterValves/Pages/sapien3.aspx?WT.ac=S3campaignprod
![Page 18: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/18.jpg)
DEPARTMENT NAME
Patient Case #2
![Page 19: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/19.jpg)
DEPARTMENT NAME
Case Results
• Placement of 23mm Edwards Sapien valve • Post procedure echo revealed mild conduit stenosis and trivial
regurgitation• Patient did well and went home the day after the procedure
![Page 20: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/20.jpg)
DEPARTMENT NAME
Summary
• Many new valves being developed right now. In all different shapes and sizes. • Several are in clinical trials right now.
http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2345036
![Page 21: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/21.jpg)
DEPARTMENT NAME
• Feltes, F.F., Bacha, E., Beekman, R.H., Cheatham, J.P., Feinstein, J.A., Gomes, A.S., et al. (2011). Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease. Circulation. 123, 2607-2652. doi: 10.1161/CIR.0b013e3821b1f10
• W. L. Gore & Associates; Product Overview. Retrieved from https://www.goremedical.com/products/cardioformeu?locale=mpd_euro
• St. Jude Medical; Products Overview. Retrieved from https://health.sjm.com/amplatzer-septal-occluder
• St. Jude Medical; Product Catalogy. Retrieved from https://health.sjm.com/amplatzer-septal-occluder
• Medtronic; Melody Transcatheter Pulmonary Valve (TPV) Therapy. Retrived from http://www.medtronic.com/melody/patient/therapy.html
• Edwards; Products. Retrived from http://www.edwards.com/eu/Products/TranscatheterValves/Pages/sapien3.aspx?WT.ac=S3campaignprod
• Medtronic; News room. Retrived from http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2345036
• American Heart Association; About congenital heart defects. Retrived from https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/tetralogy-of-fallot
![Page 22: EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve replacement • Melody Valve and Edwards Valve • Historically placed in RV-PA conduits](https://reader033.fdocuments.us/reader033/viewer/2022060423/5f19ec7602e20c7f7b65a6a8/html5/thumbnails/22.jpg)
DEPARTMENT NAME
COMMENTS/QUESTIONS?