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 XT^TM. A: Edwards Sapien XT^TM valve (Reproduced with permission of Edwards Lifesciences LLC, Irvine, CA, United States); B: Angiogram after placement of a 23 mm Edwards Sapien XT^TM 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 Magna^TM 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 3^TM valve was feasible through a 26 F 65 cm Gore DrySeal sheath; D: Edwards Sapien 3^TM 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 Prestent^TM; B: Edwards Sapien 3^TM valve implanted inside the Alterra prestent (Reproduced with permission from Edwards Lifesciences LLC, Irvine, CA, United States).