Contrast-free percutaneous pulmonary valve replacement: a safe approach for valve-in-valve procedures

Figures

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  Figure 1. Patient identification, selection and exclusion for contrast-free evaluation PPVI – percutaneous pulmonary valve implantation, RVPA – right ventricular to pulmonary artery, BPV – bioprosthetic valve, RVOT – right ventricular outflow tract.

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  Figure 2. Radar chart demonstrating the difference (mm) between the true internal diameter (TID) of bioprosthetic valves (purple) (2) and the fully expanded implanted valve diameter (orange) in 19 patients (numbered) with BPV

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  Figure 3. A – Sapien 3 Valve balloon expanded within Sorin Mitroflow BPV (red line). B – Philips Vessel Navigator overlaying CT data of the RVOT and branch PA’s guiding positioning of an Edwards Valve within the Sorin Mitroflow (red line)

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  Figure 4. Intracardiac echocardiography to assess post-PPVI hemodynamics and function: A – the 2D anatomical image of the pre-procedural RVOT (yellow line) and the newly implanted Edwards valve (red line), B – 2D color doppler assessment of the valve which infers high speed flow and turbulence through the center of the valve, C – a pulsed wave (PW) Doppler assessment through the new valve predicting the maximum velocity of flow (Vmax) through the valve

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  Figure 5. Right ventricular pressure (RVp) in mm Hg before (pre) and after (post) percutaneous pulmonary valve implantation with statistical significance reported

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  Figure 6. RV to PA pressure gradient in mm Hg before and after percutaneous valve implantation (PPVI) with statistical significance reported

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  Figure 7. CT angiogram detailing: A – supracardinal patency of the airway and esophagus at the level of C2, caudal to this (B) there is a large organized hematoma (yellow line) at the level of aortic arch branching causing near obliteration of the bronchus (red asterisk) and complete esophageal obliteration (yellow asterisk). C – a sagittal section demonstrating a moderate sized pseudoaneurysm (dotted yellow line) at the point of interaction between the Sapien valve frame (red arrow) and the extensively calcified homograft (yellow arrow)