Transcatheter Pulmonary Valve implantation · Transcatheter Pulmonary Valve implantation The role...
Transcript of Transcatheter Pulmonary Valve implantation · Transcatheter Pulmonary Valve implantation The role...
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Transcatheter Pulmonary Valve
implantation
The role of imaging for patients selection
and procedure monitoring
Mario Carminati - IRCCS Policlinico San Donato, Milan
Policlinico San Donato IRCCS
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• 18mm Contegra modified-bovine jugular vein with valve segment
• NuMed Platinum Iridium Stent
– 28 mm length
– Crimped down to 6mm, re-expanded 18mm up to 22mm
• Balloon Expandable system
Melody®
Transcatheter Pulmonary Valve
Policlinico San Donato IRCCS
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Melody® Indications
• Extend the functional life of
the RV-PA conduit
• Restore & maintain pulmonary
valve competence
• Relieve conduit stenosis
without inducing regurgitation
Policlinico San Donato IRCCS
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FALLOT
PA + VSD
ROSS
TGA+VSD+PS
TRUNCUS
Others
8%
32%
11%
9%
11%
29%
RVOT disfunction: target population
Policlinico San Donato IRCCS
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RV outflow tract obstruction (RVOTO)
– RV systolic pressure ≥ 2/3 of systemic
Moderate to severe regurgitation (PR)
– Impaired exercise capacity (<65% of predicted)
– Significant RV dilatation / dysfunction
Patient Selection
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Patient evaluation
• Clinical/functional (CPEX)
• ECG/Holter
• Echocardiography
• Cardiac MRI
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Policlinico San Donato IRCCS
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Echocardiography
Policlinico San Donato IRCCS
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Echocardiography
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Severe Tricuspid regurgitation
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ooooooooooooooooo
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Policlinico San Donato IRCCS
ooooooooooooooooo
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Policlinico San Donato IRCCS
Magnetic resonance imaging
• RVOT morphology
• Pulmonary trunk/branches anatomy
• RV size and function
• Evaluation of pulmonary
stenosis/regurgitation (regurgitant fraction)
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Magnetic resonance imaging
• RVOT morphology (suitability?)
X ? ? ?
Courtesy dr Schievano Policlinico San Donato IRCCS
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MR + 3D reconstruction
Policlinico San Donato IRCCS
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MR-Angiogram
Policlinico San Donato IRCCS
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Distal conduit stenosis
Policlinico San Donato IRCCS
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Melody
Policlinico San Donato IRCCS
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Policlinico San Donato IRCCS
LPA severe hypoplasia
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Policlinico San Donato IRCCS
LPA severe hypoplasia
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Policlinico San Donato IRCCS
Melody
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Policlinico San Donato IRCCS
CT as an alternative to MR
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RVOT too large????
Policlinico San Donato IRCCS
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RVOT sizing
Policlinico San Donato IRCCS
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Policlinico San Donato IRCCS
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Policlinico San Donato IRCCS
Extensive conduit calcification
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Policlinico San Donato IRCCS
Prestenting + Melody
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Policlinico San Donato IRCCS
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VD, 32 y, TGA+VSD+PS, Rastelli with RV-PA homograft 18
Conduit severe stenosis and calcification
Policlinico San Donato IRCCS
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Prestenting with CP covered stent
Policlinico San Donato IRCCS
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Incomplete stent expansion
Policlinico San Donato IRCCS
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Post-dil with Mullins high pressure balloon
Policlinico San Donato IRCCS
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Final Angio post Melody implantation
Policlinico San Donato IRCCS
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Policlinico San Donato IRCCS
RV-PA conduit / coronaries
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Policlinico San Donato IRCCS
Balloon inflation and simultaneous aortogram
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Policlinico San Donato IRCCS
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Matrix 25 mm conduit: stenosis and regurgitation
Policlinico San Donato IRCCS
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Policlinico San Donato IRCCS
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PA angiogram
Policlinico San Donato IRCCS
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26 Sapien implant
Policlinico San Donato IRCCS
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Final PA angiogram
Policlinico San Donato IRCCS
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Policlinico San Donato IRCCS
Pre-procedure evaluation
• MR is the gold standard for:
* RVOT morphology
* RV volumes/function
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Policlinico San Donato IRCCS
Intraprocedure monitoring
• Angiography is the gold standard
(more sofisticated technology as rotational
angiography may be very helpful)
* Very little role, if any, of echo
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Thank you for your attention!
Mario Carminati
Policlinico San Donato IRCCS