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Case Reports
. 2023 Aug 2;7(8):ytad322.
doi: 10.1093/ehjcr/ytad322. eCollection 2023 Aug.

Pulmonary valve replacement in a large and tortuous right ventricle outflow tract with a 32 mm Myval valve under local anaesthesia: challenges and technical considerations: a case report

Ali Houeijeh  1   2 , Arnaud Sudre  3 , Francis Juthier  4 , François Godart  1
Affiliations
Case Reports

Pulmonary valve replacement in a large and tortuous right ventricle outflow tract with a 32 mm Myval valve under local anaesthesia: challenges and technical considerations: a case report

Ali Houeijeh et al. Eur Heart J Case Rep. .

Abstract

Background: Pulmonary valve replacement in patients with congenital heart diseases and heart failure is challenging.

Case summary: Here, we describe a case of a patient who had surgical fallot repair with chronic heart failure. Investigations found severe biventricular dysfunction and enlargement due to chronic pulmonary regurgitation. The right ventricle outflow tract was tortuous and large with a diameter of 35 mm. Percutaneous pulmonary valve implantation (PPVI) was done after a challenging pre-stenting. A 32 mm Myval valve over-sized to 35 mm was used for PPVI, which yielded a good result.

Discussion: A 32 mm Myval valve is effective at extending the possibilities of PPVI in a large and tortuous right ventricle outflow tract not accessible for the other valves.

Keywords: Case report; Fallot; Heart failure; Myval; Percutaneous pulmonary valve implantation.

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Conflict of interest statement

Conflict of interest: A.H. is a proctor for Occlutech.

Figures

Figure 1
Figure 1
(A) Three-dimensional model created by computed tomography scan reconstruction demonstrated a large infundibulum and a tortuous right ventricle outflow tract. The sole restriction zone was located at the level of the pulmonary annulus. (B and C) The angiogram in the left anterior oblique cranial and lateral views confirmed the presence of a large and tortuous right ventricle outflow tract measured at a maximum size of 35 × 33 mm. (D and E) Right ventricle outflow tract calibration with a 34 mm Amplatzer sizing balloon showed a short restriction measured at 35 × 36 mm. (F) The angiogram of the right ventricle with the 35 mm Cristal balloon inflated in the right ventricle outflow tract illustrated an almost full occlusion of the right ventricle. (G) The valve diameter inside the pre-stenting at the end of the inflation of the balloon was 34.3 mm. (H) A caudal view of the valve, which had a circular shape measured at 34.3 mm. RVOT, right ventricle outflow tract.
Figure 2
Figure 2
Demonstration of the double-balloon technique applied on a 3D printed model in the catheterization lab. (A) Dilatation of the stent with an introducer of 26 Fr. DrySeal sheath before crimping on the two 26 mm balloons. Then, the two balloons were easily inserted in the DrySeal sheath. (B) Inflation of the stent in the frontal incidence. The stent inflation was homogenous, and the two balloons are placed side by side. (C) Lateral view incidence at the end of the balloon inflation. There was a superposition of the two balloons. Balloon disposition was influenced by the pulmonary annular shape, giving an oval shape to the stent. (D) Stent shape as seen in frontal view. (E) Stent oval shape as seen in caudal view.
None
See this image and copyright information in PMC

References

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