EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve...
Transcript of EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION … · Percutaneous Pulmonary valve...
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Rachel Arnold PA-C Physician Assistant Interventional Cardiology
EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION LAB
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Overview of interventional cases performed at Texas Children’s HospitalExciting cases
GOALS
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Cath Lab Case Distribution 2014- Jan 2019
23%
25%
49%
3%
Diagnostic
Biopsy
Interventional
Therapeutic
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CATH LAB INTERVENTIONS • Open things
• Balloon angioplasty and stenting of vessels
• Valvuloplasty
• Close things• Device closure of VSD, ASD or
PDA• Coil occlusion of collaterals • Device closure Fontan
fenestration
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Percutaneous Valves
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Indication for Percutaneous Pulmonary Valve
• Class IIa: It is reasonable to consider percutaneous pulmonary valve replacement in a patient with an RV-PA conduit with associated moderate-severe pulmonary regurgitation or stenosis provided the patient meets the inclusion/exclusion criteria for the available valve
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CONGENITAL HEART LESIONS REPAIRED WITH RV-PA CONDUITS
• Tetraology of Fallot• Truncus Arterious• Pulmonary Atresia • Others
https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/tetralogy-of-fallot
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Truncus with RV-PA conduit
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Patient case
• 17 year old male with history of TOF with absent pulmonary valve s/p repair with valved 21mm RV-PA conduit • Referred to cath lab with severe RV-PA conduit obstruction with
mean gradient of 63mmHg and moderately dilated RV with moderate dysfunction
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PATIENT CASE
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MELODY VALVE • Cow jugular vein hand sewn
onto platinum stent • Placed with a 22 Fr system to
femoral vein • 18mm, 20mm or 22mm valve
http://www.medtronic.com/melody/patient/therapy.html
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PATIENT CASE
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Patient case results
• Underwent implantation of 22mm Melody Valve • Post procedure echo: mean gradient of 18mmHg, now with mildly
decreased RV function (previously moderate)• Discharged the day after the procedure
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Percutaneous Pulmonary valve replacement
• Melody Valve and Edwards Valve• Historically placed in RV-PA conduits for patients with conduit
stenosis or severe regurgitation with dilated RV • Now have placed several in native RVOT. For example TOF with patch
repair instead of a conduit
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Patient case jm
• 14 year old male with TOF s/p repair with a 16mm RV-PA conduit
• He had echo moderate to severe pulmonary regurgitation and
moderate stenosis of the RV-PA conduit
• Initial cath: “Due to the left anterior descending coronary artery
coursing between the native RVOT and the RV to PA conduit, the
landing zone for a transcatheter pulmonary valve if placed in the
native RVOT is very short. Decision was made that he needs a shorter
valve, probably a 23 mm Edwards Sapien valve and that a melody
valve would not be appropriate at this time due to its longer length.”
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Patient Case #2
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Edwards
http://www.edwards.com/eu/Products/TranscatheterValves/Pages/sapien3.aspx?WT.ac=S3campaignprod
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Patient Case #2
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Case Results
• Placement of 23mm Edwards Sapien valve • Post procedure echo revealed mild conduit stenosis and trivial
regurgitation• Patient did well and went home the day after the procedure
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Summary
• Many new valves being developed right now. In all different shapes and sizes. • Several are in clinical trials right now.
http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2345036
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• Feltes, F.F., Bacha, E., Beekman, R.H., Cheatham, J.P., Feinstein, J.A., Gomes, A.S., et al. (2011). Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease. Circulation. 123, 2607-2652. doi: 10.1161/CIR.0b013e3821b1f10
• W. L. Gore & Associates; Product Overview. Retrieved from https://www.goremedical.com/products/cardioformeu?locale=mpd_euro
• St. Jude Medical; Products Overview. Retrieved from https://health.sjm.com/amplatzer-septal-occluder
• St. Jude Medical; Product Catalogy. Retrieved from https://health.sjm.com/amplatzer-septal-occluder
• Medtronic; Melody Transcatheter Pulmonary Valve (TPV) Therapy. Retrived from http://www.medtronic.com/melody/patient/therapy.html
• Edwards; Products. Retrived from http://www.edwards.com/eu/Products/TranscatheterValves/Pages/sapien3.aspx?WT.ac=S3campaignprod
• Medtronic; News room. Retrived from http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2345036
• American Heart Association; About congenital heart defects. Retrived from https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/tetralogy-of-fallot
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COMMENTS/QUESTIONS?