Percutaneous pulmonary valve implantation for reconstruction of a patch‐repaired right ventricular outflow tract

Percutaneous pulmonary valve implantation (PPVI) is nowadays an accepted treatment option to repair post‐surgical conduit dysfunction of the right ventricular outflow tract (RVOT). In addition, many patients need a pulmonary valve to reconstruct a hemodynamically incompetent native or conduit free outflow tract. Based on our experience with percutaneous stent‐valve placement in a cohort of 125 patients, we report here transvenous reconstruction of a conduit‐free, patch repaired outflow tract by utilizing balloon‐expandable stent‐valves in 23 patients with a median age of 22 years (5‐60 years). In 20 patients, the step‐by‐step procedure was performed uneventful with the aimed success. Severe RVOT dysfunction in term of a clinical relevant regurgitation could be changed to mild, as it was confirmed by follow‐up color Doppler echocardiography. In a 5‐year‐old girl a Melody® valve was placed as a surgical‐interventional hybrid approach. In one patient, the procedure was complicated by stent embolization during preparation of the RVOT for stent‐valve implantation. Reposition of the embolized stent was nevertheless successful for finishing percutaneous valve‐implantation. In one patient, surgical approach became necessary because of the inability to advance the balloon‐mounted stent‐valve through a pre‐stented RVOT. Considering the current available balloon‐expandable stent‐valves, transvenous pulmonary valve implantation is feasible to treat even an incompetent conduit‐free RVOT. However, preparation of the RVOT by pre‐stenting, in most patients with more than two stents in telescope technique remains challenging. Reconstruction of RVOT by the current available valves is promising only for a carefully selected group of patients.