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J Thorac Cardiovasc Surg 2002;124:82-87
© 2002 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Percutaneous stent implantation to stenotic bioprosthetic valves in the pulmonary position

From the Department of Pediatrics and Surgery, Division of Cardiology, The Variety Club Catheterization Laboratories, and the Division of Cardiovascular Surgery, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.

Received for publication May 11, 2001. Revisions requested Oct 1, 2001; revisions received Nov 14, 2001. Accepted for publication Nov 28, 2001. Address for reprints: Lee Benson, MD, FRCPC, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada (E-mail: benson{at}sickkids.on.ca).

Background: We evaluated stent implantation across stenotic bioprosthetic pulmonary valves in 9 patients.
Methods: Nine patients (6 male patients) underwent stent implantation across stenotic bioprosthetic pulmonary valves between July 1996 and July 1999 at the Hospital for Sick Children, Toronto. Catheter intervention was indicated if echocardiography revealed Doppler estimates of right ventricular pressure of more than two thirds of systemic arterial pressure (or systolic septal flattening with an estimated gradient of >60 mm Hg across the valve prosthesis). Catheterization was performed during general anesthesia at an age (mean ± SD) of 9.3 ± 3.5 years and a weight of 32.0 ± 17.1 kg 5.9 ± 1.8 years after surgical insertion of a bioprosthetic valve in the pulmonary position: 7 patients with tetralogy of Fallot, 1 patient with congenital pulmonary stenosis-insufficiency, and 1 patient after a Rastelli operation. All had systolic septal flattening and right ventricular dilatation with moderate-to-severe pulmonary insufficiency before intervention. Fluoroscopy times were 33.1 ± 9.5 minutes. Seven patients received a single P4014 stent, and 2 received single P308 stents (Palmaz; Johnson & Johnson Interventional Systems, Warren, NJ) without significant complications.
Results: The right ventricular systemic pressure decreased acutely from 83% ± 16% to 41% ± 10% (P < .001, n = 9), and the transvalvular gradient decreased from 49.7 ± 8.5 to 11.0 ± 5.9 mm Hg (P < .001, n = 8). During the follow-up period (10.9 ± 8.1 months, n = 8), 1 patient had an unsuccessful attempt at redilation of the stent (right ventricular pressure, 60% systemic) and underwent uneventful surgical pulmonary valve replacement. None of the remaining patients had echocardiographic evidence of systolic septal flattening, and right ventricular dimensions did not change significantly.
Conclusion: Stent implantation is a safe and effective means of providing palliative relief of obstructed bioprosthetic valves in the pulmonary position and can safely delay the requirement for pulmonary valve replacement.

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