Early multicenter experience of a new balloon expandable MyVal transcatheter heart valve in dysfunctional stenosed right ventricular outflow tract conduits

Figure 1. MyVal transcatheter heart valve (a) is made of bovine pericardial leaflets on a nickel cobalt alloy frame whose the upper end has a single row of open hexagonal cells and lower end has two rows of closed cells. The polyethylene terephthlate skirt retards calcium deposition and reduces paravalvular regurgitation. It is mounted directly on the balloon of the Navigator delivery system (b) and introduced in the vascular system through the Python sheath (c)

Figure 2. Severe stenosis observed on a lateral view conduit angiogram (a) was prestented using a covered Cheatham platinum stent (b), resulting in restoration of the lumen (c). After measuring the landing zone (d) to be 22 mm, a 23 mm MyVal loaded on Navigator delivery system was deployed within the conduit stent (e). Final pulmonary angiogram (f) shows the absence of pulmonary regurgitation from the pulmonary trunk into the right ventricle

Figure 3. A recoil of the Cheatham Platinum stent (a) within the conduit was postdilated with high pressure balloons (b) before deploying a 23 mm MyVal within the stented conduit (c). Final angiogram from the pulmonary trunk showed the absence of pulmonary regurgitation (d)

Figure 4. Conduit angiogram in frontal (a) and lateral (b) projections after repair of tetralogy of Fallot, absent pulmonary valve syndrome showed dilated pulmonary trunk and regurgitation into the right ventricle. After stenting with an AndraXXL stent (c), the residual infundibular stenosis (d) required a second overlapping similar stent placement (e) before valvulation with a 23 mm MyVal (f) that eliminated the pulmonary regurgitation

Figure 5. Conduit angiogram in the lateral view (a) after Ross procedure showed severe stenosis and regurgitation of the conduit. Prestenting was done with one AndraXXL stent and two Cheatham Platinum stents (b) due to relieve the recoil of the stent. After deploying a 23 mm MyVal (c), there was no pulmonary regurgitation (d)

Figure 6. Valvulation of a prestented conduit after Ross surgery with a 23 mm MyVal (a) was followed by observation of severe regurgitation (b) from pulmonary trunk into the right ventricle and pressure traces from the pulmonary trunk confirmed persistent ventricularization (c). A second 24.5 mm MyVal deployed within the previous valve (d) resulted in good valve function (e) and diastolic separation of pressures (f) recorded from the pulmonary artery and right ventricle with a gradient of 10 mm of mercury