Percutaneous pulmonary valve implantation in patients after Ross procedure: role of intravascular ultrasound.
Karol ZbrońskiLidia Tomkiewicz-PająkJanusz KochmanZenon HuczekPublished in: Cardiology in the young (2018)
Coronary compression exclusion during right ventricle outflow tract stenting is recommended and potential oversight may be fatal. Balloon inflation in right ventricle outflow tract with simultaneous aortography can be inconclusive or falsely negative. We present a case of 27-year-old male post Ross operation qualified for percutaneous pulmonary valve implantation. Neither of the conventional views obtained provided a definite exclusion of coronary compression, therefore an intravascular ultrasound of the left coronary artery before and during balloon inflation in right ventricle outflow tract was performed. Acquired images allowed excluding potential constriction, thus a covered stent and pulmonary valve were implanted and the procedure was concluded. Two hours later, the patient complained of chest pain. Transthoracic echocardiography demonstrated a significant pericardial effusion. Retrospective analysis of the final angiogram revealed a possibility of subtle extravasation at the distal part of the homograft. A hybrid procedure consisting of additional covered stent implantation, pericardial drainage, and second pulmonary valve implantation was performed with an acceptable result. To conclude, in case of doubtful or unconvincing images obtained from aortography or selective angiography during balloon inflation in right ventricle outflow tract, intravascular ultrasound might be a feasible and useful technique. Signs of homograft rupture may be subtle, whereas symptoms of cardiac tamponade delayed. In selected patients percutaneous treatment of homograft rupture is achievable and beneficial.
Keyphrases
- coronary artery
- pulmonary hypertension
- mitral valve
- pulmonary artery
- minimally invasive
- aortic stenosis
- ejection fraction
- ultrasound guided
- end stage renal disease
- aortic valve
- magnetic resonance imaging
- left ventricular
- newly diagnosed
- deep learning
- coronary artery disease
- chronic kidney disease
- pulmonary arterial hypertension
- peritoneal dialysis
- optical coherence tomography
- heart failure
- acute coronary syndrome
- spinal cord
- cross sectional
- atrial fibrillation
- depressive symptoms
- patient reported outcomes
- percutaneous coronary intervention
- antiplatelet therapy