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. 2020 Aug 26;9(9):2769.
doi: 10.3390/jcm9092769.

Early Outcomes of Percutaneous Pulmonary Valve Implantation with Pulsta and Melody Valves: The First Report from Korea

Ah Young Kim  1   2 , Jo Won Jung  1   2 , Se Yong Jung  1   2 , Jae Il Shin  1   2 , Lucy Youngmin Eun  1   2 , Nam Kyun Kim  3 , Jae Young Choi  1   2
Affiliations

Early Outcomes of Percutaneous Pulmonary Valve Implantation with Pulsta and Melody Valves: The First Report from Korea

Ah Young Kim et al. J Clin Med. .

Abstract

Percutaneous pulmonary valve implantation (PPVI) is used to treat pulmonary stenosis (PS) or pulmonary regurgitation (PR). We described our experience with PPVI, specifically valve-in-valve transcatheter pulmonary valve replacement using the Melody valve and novel self-expandable systems using the Pulsta valve. We reviewed data from 42 patients undergoing PPVI. Twenty-nine patients had Melody valves in mostly bioprosthetic valves, valved conduits, and homografts in the pulmonary position. Following Melody valve implantation, the peak right ventricle-to-pulmonary artery gradient decreased from 51.3 ± 11.5 to 16.7 ± 3.3 mmHg and right ventricular systolic pressure fell from 70.0 ± 16.8 to 41.3 ± 17.8 mmHg. Thirteen patients with native right ventricular outflow tract (RVOT) lesions and homograft underwent PPVI with the new self-expandable Pulsta valve-a nitinol wire stent mounted with a trileaflet porcine pericardial valve. Following Pulsta valve implantation, cardiac magnetic resonance imaging showed a decreased PR fraction and that the right ventricular end-diastolic volume index decreased from 166.1 ± 11.9 to 123.6 ± 12.4 mL/m2. There were no mortality, severe procedural morbidity, or valve-related complications. At the mean 14.2 month (4-57 months) follow-up, no patients had more than mild PR. PPVI using Melody and Pulsta valves was first shown to provide excellent early outcomes without serious adverse event in most patients with RVOT dysfunction in Korea.

Keywords: heart diseases; heart valve prosthesis; pediatrics; pulmonary heart disease; pulmonary valve.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Peak pressure gradients between the right ventricle and the pulmonary artery before and after valve implantation by transthoracic echocardiography. There was no significant pulmonary valve stenosis over time. Values are presented as either the mean ± standard deviation or median (interquartile range). The box plot uses the median and the lower and upper quartiles (defined as the 25th and 75th percentiles). Extreme outliers are marked with an asterisk (*) on the boxplot. Mild outliers are data points that are more extreme than interquartile range, marked using a circle (o). RVOT, right ventricular outflow tract.
Figure 2
Figure 2
Changes in tricuspid valve regurgitation over time: before and after pulmonary valve implantation, as seen on transthoracic echocardiography. The proportion of greater than moderate tricuspid valve regurgitation decreased after pulmonary valve implantation.
Figure 3
Figure 3
Changes in right ventricular volume before and 1 year after valve implantation. The mean indexed RV (right ventricle) end-diastolic volume index was significantly decreased after valve implantation, as seen on a cardiac MRI (magnetic resonance image).
Figure 4
Figure 4
RV (right ventricle) ejection fraction (%) over time, as seen with cardiac MRI (magnetic resonance image). Values are presented as the mean ± standard deviation (range).
Figure 5
Figure 5
NYHA (New York Heart Association) functional class before and after PPVI (percutaneous pulmonary valve implantation). The NYHA functional class of patients improved to class I in all patients over time.
See this image and copyright information in PMC

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