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J Thorac Cardiovasc Surg 2006;132:990
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Off-pump pulmonary valve implantation

Clinic of Cardiovascular Surgery, German Heart Center Munich at the Technical University Munich, Lazarettstrasse 36, 80636 Munich, Germany

(Email: schreiber{at}dhm.mhn.de).

To the Editor:

We would like to comment on the article by Berdat and Carrel¹ entitled "Off-pump pulmonary valve replacement with the new Shelhigh Injectable Stented Pulmonic Valve." They are to be congratulated for having embarked on a novel approach.

Because we have also reported recently on our first surgical experience implanting the Shelhigh valve, 2 points should be made.²

First, it is misleading to report on a pulmonary valve "replacement" in this setting. All 4 patients from the mentioned group had either undergone the transannular patch procedure during tetralogy of Fallot repair or commissurotomy. Likewise, we have also gained, to date, experience with a total of 6 patients (mean follow-up, 7.8 months; range, 2.0-13.5 months). All of these had previous tetralogy of Fallot repair. Therefore use of the Shelhigh valve in its current form allows only for valve "implantation" because the stented valve can only self-expand and the original pulmonary valve apparatus remains obviously in situ.

Second, we disagree with the judgment that a reduction plasty for an enlarged main pulmonary trunk of larger than 28 mm is mandatory to ensure an adequate position of the stented valve. Berdat and Carrel¹ made this statement on their experience with 1 patient only. In our experience with 6 patients (valve sizes, 23-31 mm), perioperative assessment included the whole right ventricular outflow tract, dimensions of the right ventricle to pulmonary trunk junction, sinus of Valsalva, pulmonary trunk, and pulmonary bifurcation. Interestingly, the final position of the stented valve was, in our experience, at different sites: at the level of the pulmonary valve, just above it, and even much more distally just in front of the bifurcation. Therefore we would rather emphasize the need for both transesophageal and epicardial echocardiographic navigation and "oversizing" of at least 2 mm to allow for a perfect fit of this new valve along its struts.

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1. Berdat PA, Carrel T. Off-pump pulmonary valve replacement with the new Shelhigh Injectable Stented Pulmonic Valve. J Thorac Cardiovasc Surg 2006;131:1192-1193.[Free Full Text]
   
2. Schreiber C, Bauernschmitt R, Augustin N, Libera P, Busley R, Eicken A, et al. Implantation of a prosthesis mounted inside a self-expandable stent in the pulmonary valvar area without use of cardiopulmonary bypass. Ann Thorac Surg 2006;81:1-3.
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Christian Schreiber Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schreiber, C. Articles by Lange, R. Search for Related Content PubMed PubMed Citation Articles by Schreiber, C. Articles by Lange, R. Related Collections Congenital - cyanotic Valve disease Related Article