Author + information
- Received March 16, 2013
- Revision received May 8, 2013
- Accepted May 9, 2013
- Published online February 1, 2014.
- Victor A. Jiménez, MD∗∗ (, )
- Andrés Íñiguez, MD∗,
- José A. Baz, MD∗,
- Jorge Sepúlveda, MD∗ and
- José L. Zunzunegui, MD†
- ∗Hemodynamics & Interventional Cardiology Department, Hospital Meixoeiro, Vigo, Spain
- †Pediatric Interventional Cardiology Unit, Hospital Gregorio Marañon, Madrid, Spain
- ↵∗Reprint requests and correspondence:
Dr. Victor A. Jiménez, Interventional Cardiology, Hospital Meixoeiro, Meixoeiro s/n, Vigo, Pontevedra 36200, Spain.
- adult congenital heart disease
- coronary angioplasty
- percutaneous valve therapy
- transcatheter pulmonary valve implantation
A 49-year-old man with a history of Ross procedure 7 years prior because of bicuspid aortic valve and bacterial endocarditis developed a symptomatic pulmonary homograft dysfunction (peak systolic transvalvular gradient of 98 mm Hg with moderate insufficiency) and right heart failure (Figs. 1A and 1B, Online Video 1). Because of the high surgical risk, percutaneous pulmonary valve implantation (PPVI) was planned. Pulmonary homograft valvuloplasty using an 18/30-mm Mullin-X balloon catheter was conducted (Fig. 1C, Online Video 2), followed by placement of a 35XL Andra stent (Andramed Gmbh, Reutlingen, Germany) (Fig. 1D, Online Video 3), with simultaneous selective coronary angiography, verifying patency of the left coronary artery. Because of stent underexpansion, balloon post-dilation was performed, causing asymmetric stent expansion (Fig. 1E) and extrinsic compression of the ostial left anterior descending coronary artery (LAD) (Fig. 1F, Online Video 4). Immediately, coronary angioplasty with implantation of a bare-metal stent 3.5/23-mm from the distal left main to the proximal LAD (Fig. 1G, Online Video 5) was performed, recovering coronary blood flow and hemodynamic stability. The echocardiogram revealed normal left ventricular function without mechanical complications. PPVI with an 18-mm Melody valve (Medtronic Inc., Minneapolis, Minnesota) was then successfully accomplished (Fig. 1H, Online Video 6). Clinical follow-up at 6 months confirmed a remarkable improvement in the patient’s functional class and symptoms.
PPVI is increasingly being used among adult interventional cardiologists (1) because of its lower morbidity, good patient acceptance, and efficacy. Coronary artery compression is an extremely rare and life-threatening procedure-related complication described mainly in children following repair of various forms of congenital heart disease or related to coronary anomalies (2). Even with documentation of unimpaired coronary flow with maximal balloon inflation, a provisional and protective approach before valve implantation (e.g., placement of an intracoronary wire in the LAD) must be taken into consideration in selected high-risk cases.
For accompanying videos, please see the online version of this paper.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 16, 2013.
- Revision received May 8, 2013.
- Accepted May 9, 2013.
- 2014 American College of Cardiology Foundation