Autoimmune Reaction and the Management of Recurrent Bioprosthetic Pulmonary Valve Dysfunction

Figures

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  Visual Summary. Schematic for Diagnosis and Treatment of Allergic Etiology of Valve Dysfunction

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  Figure 1. Invasive Hemodynamic Evaluation Pre and Post Catheter Placement of Edwards Sapien 3 Pulmonary Valve Hemodynamic evaluation during (A) pre and (B) post catheter valve placement in the pulmonary position. (C) Contrast-enhanced images of pulmonary regurgitation noted pre-valve placement which was completely resolved. (D) Post-catheter valve placement.

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  Figure 2. Invasive Hemodynamic Assessment of Intracardiac Pressures With Dysfunctional Edwards Sapien Pulmonary Valve

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  Figure 3. Echocardiographic Evaluation After Surgical Placement of Mosaic Pulmonary Bioprosthetic Valve Postsurgical echocardiography images show minimal gradients across the pulmonary valve and absence of pulmonary valve regurgitation with (A) 2D color Doppler and (B) pulsed-wave Doppler.

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  Figure 4. Echocardiographic Assessment of Dysfunctional Mosaic Pulmonary Valve Two months post valve replacement, echocardiography showed moderate pulmonary regurgitation and mild pulmonary stenosis as shown by (A) 2D-color Doppler and (B) pulsed-wave echo Doppler.

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  Figure 5. Patch Testing to Various Parts of Medtronic Mosaic 305 CINCH Cardiac Valve In total, 6 patches were placed. Different parts of the valve tissue, (A) labeled in and their (B) corresponding hypersensitivity reaction to the skin. (C) Valve tissue with skin contact with the metal cage showing increased skin hypersensitivity.

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  Figure 6. Post-Treatment Echocardiographic Assessment of Mosaic Pulmonary Valve Posttreatment with mycophenolate and prednisone, pulmonary valve regurgitation decreased to mild, and gradients across the pulmonary valve decreased further, as did the clinical need for diuretics. Decrease in valvular regurgitation as noted by (A) color Doppler and (B) continuous wave Doppler.