Transcatheter pulmonic valve implantation: Techniques, current roles, and future implications

Figure 1. Covered Cheatham Platinum stent placement after conduit disruption. 23 years old patient with truncus arteriosus status post repair with a 20 mm homograft. A: With high pressure dilation at 22 mm, disruption of wall of conduit is noted (orange arrow) but contained; B: Covered Cheatham Platinum stent placed with resolution of the extravasation.

Figure 2. Tetralogy of Fallot full repair with 20 mm homograft. 28-year-old with tetralogy of Fallot status post repair with 20 mm homograft. A: Left anterior descending (LAD) arise from the right coronary coursing around the homograft. With inflation of a 22 mm balloon, the mid LAD is compressed; B: The coronary flow returns back to baseline upon balloon deflation.

Figure 3. Melody transcatheter pulmonic valve. A: En-face view of Melody transcatheter pulmonic valve; B: Melody valve Ensemble with loaded valve demonstrating the two-stage balloon-in-balloon inflation (Reproduced with permission from Medtronic, Inc, Minneapolis, MN, United States); C: Angiogram after placement of a stainless steel pre-stent; D: 20 mm Melody valve in Antero-posterior and lateral projections.

Figure 4. Edwards Sapien XTTM. A: Edwards Sapien XTTM valve (Reproduced with permission of Edwards Lifesciences LLC, Irvine, CA, United States); B: Angiogram after placement of a 23 mm Edwards Sapien XTTM valve in a Contegra conduit stented with a stainless-steel stent up dilated up to 22 mm.

Figure 5. Transcatheter valve in valve with valve fracture: 21 years old with congenital pulmonary stenosis with a prior dysfunctional 21 mm Edwards MagnaTM valve- 22 mm. A: Atlas balloon inflated to 20 ATM fractured the valve ring (orange arrow); B: placement of 22 mm Melody valve.

Figure 6. Native transcatheter pulmonary valve implantation. A and B: 46 years old with prior surgical pulmonary valvotomy as a child presenting with severe insufficiency (A), balloon sizing performed with 40 mm Numed sizing balloon demonstrated a narrowed landing zone of 27 mm (B); C: Native implant with a 29 mm Sapien 3TM valve was feasible through a 26 F 65 cm Gore DrySeal sheath; D: Edwards Sapien 3TM valve (reproduced with permission from Edwards Lifesciences LLC, Irvine, CA, United States).

Figure 7. Medtronic Harmony transcatheter pulmonic valve (Reproduced with permission from Medtronic, Inc, Minneapolis, MN, United States).

Figure 8. Edwards native outflow tract prestent. A: Alterra Adaptive PrestentTM; B: Edwards Sapien 3TM valve implanted inside the Alterra prestent (Reproduced with permission from Edwards Lifesciences LLC, Irvine, CA, United States).