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. 2018 Jul 16:11:333-338.
doi: 10.2147/JMDH.S165269. eCollection 2018.

Multidisciplinary approach and treatment options in right ventricular outflow tract malformations

Kristofer Skoglund  1 , Ludvig Clase  2 , Mikael Dellborg  3
Affiliations

Multidisciplinary approach and treatment options in right ventricular outflow tract malformations

Kristofer Skoglund et al. J Multidiscip Healthc. .

Abstract

Background: Among patients with congenital heart disease, implantation of a valved conduit is common practice for surgical reconstruction of malformations involving the right ventricular outflow tract (RVOT). The conduit has limited durability, and treatments with surgical replacement and transcatheter pulmonary valve replacement (TPVR) are common. Previous studies indicate that TPVR, despite being a less invasive alternative, is not used for the majority of these patients.

Methods and results: This is a descriptive study of the medical records of 100 consecutive adult patients with RVOT malformations who were evaluated a total of 118 times between January 1, 2008 and December 31, 2015, at meetings of the hospital's multidisciplinary heart patient review board, in which relevant specialists make all treatment decisions on each case through a consensus process. The most common overall outcome decision was surgical conduit implantation. In 51 cases, the patient had a pre-existing conduit and, of those, 16 cases were recommended for TPVR. In seven of those 16, TPVR could not be performed, most commonly due to the risk of coronary compression or unfavorable conduit anatomy.

Conclusion: Among patients with congenital heart disease involving the RVOT, surgical conduit implantation was the main treatment both in native RVOT malformations and in the case of a pre-existing dysfunctional conduit, despite the introduction of TPVR. Although the hospital's multidisciplinary heart patient review board often recommended TPVR, it was found to be unfeasible in many cases. The main reasons were risk of coronary compression and unfavorable conduit anatomy.

Keywords: Congenital heart disease; Melody®; conduit; multidisciplinary heart patient review board; transcatheter pulmonary valve replacement.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart for all 100 patients included in the study, of whom 47 had a pre-existing conduit and were thus eligible for TPVR. The final outcome was that TPVR treatment was actually performed in only nine cases. Abbreviations: RVOT, right ventricular outflow tract; TPVR, transcatheter pulmonary valve replacement.
See this image and copyright information in PMC

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