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. 2022 Jan;43(1):8-16.
doi: 10.1007/s00246-021-02684-0. Epub 2021 Aug 7.

Coronary Artery Anomalies and Their Impact on the Feasibility of Percutaneous Pulmonary Valve Implantation

Anja Hanser  1 , Jörg Michel  1 , Andreas Hornung  1 , Ludger Sieverding  1 , Michael Hofbeck  2
Affiliations

Coronary Artery Anomalies and Their Impact on the Feasibility of Percutaneous Pulmonary Valve Implantation

Anja Hanser et al. Pediatr Cardiol. 2022 Jan.

Abstract

One of the major obstacles preventing successful percutaneous pulmonary valve implantation (PPVI) is related to the close proximity of coronary artery branches to the expected landing zone. The aim of this study was to assess the frequency of coronary artery anomalies (CAAs) especially those associated with major coronary branches crossing the right ventricular outflow tract (RVOT) and to describe their relevance for the feasibility of percutaneous pulmonary valve implantation (PPVI). In our retrospective single-center study 90 patients were evaluated who underwent invasive testing for PPVI in our institution from 1/2010 to 1/2020. CAAs were identified in seven patients (8%) associated with major branches crossing the RVOT due to origin of the left anterior descending (LAD) or a single coronary artery from the right aortic sinus. In 5/7 patients with CAAs balloon testing of the RVOT and selective coronary angiographies revealed a sufficiently large landing zone distal to the coronary artery branch. While unfavorable RVOT dimensions prevented PPVI in one, PPVI was performed successfully in the remaining four patients. The relatively short landing zone required application of the "folded" melody technique in two patients. All patients are doing well (mean follow-up 3 years). CAAs associated with major coronary branches crossing the RVOT can be expected in about 8% of patients who are potential candidates for PPVI. Since the LAD crossed the RVOT below the plane of the pulmonary valve successful distal implantation of the valve was possible in 4/7 patients. Therefore these coronary anomalies should not be considered as primary contraindications for PPVI.

Keywords: Congenital coronary artery anomaly; Congenital heart disease; Percutaneous pulmonary valve implantation.

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Conflict of interest statement

A. Hanser and A. Hornung have received research grants from the “Stiftung zur Förderung der Erforschung der Zivilisationerkrankungen.” A. Hanser reports grants from the Deutsche Herzstiftung e.V. The other authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Coronary angiography in pat. 5 (Table 3) shows origin of the RCA and LAD from the right coronary sinus (A). Angiography during placement of the stent in the landing zone confirms patency of the LAD (arrows) crossing the RVOT below (B). Final coronary angiography following placement of the folded Melody valve shows patent LAD (arrows) proximal to the valve (C, D)
Fig. 2
Fig. 2
Selective angiography of the right coronary artery in pat. 7 (Table 3) shows origin of the LAD (arrows) from the right coronary sinus crossing the RVOT (A). Selective angiography during balloon testing of the RVOT reveals that the LAD is located well below the expected landing zones both in the RVOT and in the PTFE conduit (B). Confirmation of coronary patency following placement of a Melody valve in the conduit and creation of a landing zone in the RVOT (C). Final pulmonary angiography shows good function of both valves
See this image and copyright information in PMC

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