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Coronary compression testing by balloon interrogation during pulmonary valve implantation: room for doubt?

Part of: Interventional Cardiology

Published online by Cambridge University Press:  10 February 2021

Gareth J. Morgan ,
Salvador A. Rodriguez Open the ORCID record for Salvador A. Rodriguez [Opens in a new window] ,
Ryan Leahy  and
Jenny E. Zablah
Gareth J. Morgan*
Affiliation:
The Heart Institute, Children’s Hospital Colorado, Aurora, CO, USA University of Colorado, School of Medicine, Anschutz Medical Campus, Aurora, CO, USA Department of Cardiology, University of Colorado Hospital, Aurora, CO, USA
Salvador A. Rodriguez
Affiliation:
The Heart Institute, Children’s Hospital Colorado, Aurora, CO, USA University of Colorado, School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
Ryan Leahy
Affiliation:
The Heart Institute, Children’s Hospital Colorado, Aurora, CO, USA University of Colorado, School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
Jenny E. Zablah
Affiliation:
The Heart Institute, Children’s Hospital Colorado, Aurora, CO, USA University of Colorado, School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
*
Author for correspondence: Gareth J Morgan, MD, The Heart Institute, Children’s Hospital Colorado, 13123 East 16th Avenue, Box 100, Aurora, CO80045, USA. Tel: +17207773379; Fax: +17207773374. E-mail: drgarethjmorgan@gmail.com
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Abstract

Objective:

To evaluate the reliability of balloon coronary compression testing during percutaneous pulmonary valve implantation.

Background:

Despite the widespread use of the ‘balloon coronary test’ as the preferable method to rule out the risk of coronary compression, this adverse event has been described after pulmonary valve implantation where coronary balloon test suggested no risk or low risk, calling into question the accuracy of the test.

Methods:

We performed a retrospective chart review of 84 patients who underwent pulmonary valve implantation between January 2018 and December 2019 and selected 36 patients whose archived imaging was suitable to perform quantitative analysis of the ‘balloon coronary test’. We focused on the spatial disparity between the right ventricular outflow tract position defined by the inflated testing balloon and the eventual implanted valve position, to classify the test as inaccurate or accurate.

Results:

In total, 36.1% of cases were classified as having an inaccurate coronary balloon test. Among the baseline characteristics, right ventricular outflow tract substrate was identified as a significant predictor of test accuracy. Related to this characteristic, the type of testing balloon used and the size of the eventually implanted valve were found to be associated with test accuracy.

Conclusions:

Based on our findings, balloon coronary testing is not an accurate method of predicting final valve position with respect to fixed structures in the thorax. This may translate to a high false positive rate for the likelihood of coronary compression in pulmonary valve implantation.

Keywords

Percutaneous pulmonary valve replacementCHDcoronary balloon testcoronary compression
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 9 , September 2021 , pp. 1419 - 1425
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Bonhoeffer, P, Boudjemline, Y, Saliba, Z, Merckx, J, Aggoun, Y, Bonnet, D, et al. Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction. Lancet Lond Engl. 2000; 356: 1403–1405. doi: 10.1016/S0140-6736(00)02844-0 CrossRefGoogle Scholar
Bonhoeffer, P, Boudjemline, Y, Qureshi, SA, et al. Percutaneous insertion of the pulmonary valve. J Am Coll Cardiol 2002; 39: 1664–1669. doi: 10.1016/s0735-1097(02)01822-3 CrossRefGoogle ScholarPubMed
Boudjemline, Y, Agnoletti, G, Bonnet, D, Sidi, D, Bonhoeffer, P. Percutaneous pulmonary valve replacement in a large right ventricular outflow tract: an experimental study. J Am Coll Cardiol 2004; 43: 1082–1087. doi: 10.1016/j.jacc.2003.10.037 CrossRefGoogle Scholar
Attmann, T, Jahnke, T, Quaden, R, et al. Advances in experimental percutaneous pulmonary valve replacement. Ann Thorac Surg 2005; 80: 969–975. doi: 10.1016/j.athoracsur.2005.03.041 CrossRefGoogle ScholarPubMed
Khambadkone, S, Coats, L, Taylor, A, et al. Percutaneous pulmonary valve implantation in humans: results in 59 consecutive patients. Circulation 2005; 112: 1189–1197. doi: 10.1161/CIRCULATIONAHA.104.523266 CrossRefGoogle ScholarPubMed
Coats, L, Tsang, V, Khambadkone, S, et al. The potential impact of percutaneous pulmonary valve stent implantation on right ventricular outflow tract re-intervention. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg 2005; 27: 536–543. doi: 10.1016/j.ejcts.2004.12.053 CrossRefGoogle ScholarPubMed
Sridharan, S, Coats, L, Khambadkone, S, Taylor, AM, Bonhoeffer, P. Images in cardiovascular medicine. Transcatheter right ventricular outflow tract intervention: the risk to the coronary circulation. Circulation 2006; 113: e934–e935. doi: 10.1161/CIRCULATIONAHA.105.599514 CrossRefGoogle Scholar
Lurz, P, Coats, L, Khambadkone, S, et al. Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome. Circulation 2008; 117: 1964–1972. doi: 10.1161/CIRCULATIONAHA.107.735779 CrossRefGoogle ScholarPubMed
Lurz, P, Gaudin, R, Taylor, AM, Bonhoeffer, P. Percutaneous pulmonary valve implantation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009; 12: 112–117. doi: 10.1053/j.pcsu.2009.01.011 CrossRefGoogle Scholar
Morray, BH, McElhinney, DB, Cheatham, JP, et al. Risk of coronary artery compression among patients referred for transcatheter pulmonary valve implantation: a multicenter experience. Circ Cardiovasc Interv 2013; 6: 535–542. doi: 10.1161/CIRCINTERVENTIONS.113.000202 CrossRefGoogle ScholarPubMed
Mauri, L, Frigiola, A, Butera, G. Emergency surgery for extrinsic coronary compression after percutaneous pulmonary valve implantation. Cardiol Young 2013; 23: 463–465. doi: 10.1017/S1047951112001187 CrossRefGoogle ScholarPubMed
Eicken, A, Ewert, P, Hager, A, et al. Percutaneous pulmonary valve implantation: two-centre experience with more than 100 patients. Eur Heart J 2011; 32: 1260–1265. doi: 10.1093/eurheartj/ehq520 CrossRefGoogle ScholarPubMed
Kostolny, M, Tsang, V, Nordmeyer, J, et al. Rescue surgery following percutaneous pulmonary valve implantation. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg 2008;33: 607–612. doi: 10.1016/j.ejcts.2007.12.034 CrossRefGoogle ScholarPubMed
Pockett, CR, Moore, JW, El-Said, HG. Three dimensional rotational angiography for assessment of coronary arteries during melody valve implantation: introducing a technique that may improve outcomes. Neth Heart J Mon J Neth Soc Cardiol Neth Heart Found 2017; 25: 82–90. doi: 10.1007/s12471-016-0931-6 Google ScholarPubMed
Goreczny, S, Zablah, J, McLennan, D, Ross, M, Morgan, G. Multi-modality imaging for percutaneous pulmonary valve implantation – getting serious about radiation and contrast reduction. Postępy W Kardiologii Interwencyjnej Adv Interv Cardiol 2019; 15: 110–115. doi: 10.5114/aic.2019.83776 Google ScholarPubMed
Malone, L, Fonseca, B, Fagan, T, et al. Preprocedural risk assessment prior to PPVI with CMR and cardiac CT. Pediatr Cardiol 2017; 38: 746–753. doi: 10.1007/s00246-017-1574-0 CrossRefGoogle ScholarPubMed
Schievano, S, Coats, L, Migliavacca, F, et al. Variations in right ventricular outflow tract morphology following repair of congenital heart disease: implications for percutaneous pulmonary valve implantation. J Cardiovasc Magn Reson Off J Soc Cardiovasc Magn Reson 2007; 9: 687–695. doi: 10.1080/10976640601187596 Google ScholarPubMed
Schievano, S, Capelli, C, Young, C, et al. Four-dimensional computed tomography: a method of assessing right ventricular outflow tract and pulmonary artery deformations throughout the cardiac cycle. Eur Radiol 2011; 21: 36–45. doi: 10.1007/s00330-010-1913-5 CrossRefGoogle ScholarPubMed
Ahmed, M, Thompson, NE, Foerster, SR, Frommelt, MA, Mitchell, ME, Scott, JP. Ventricular fibrillation and myocardial depression following pulmonary valve replacement in tetralogy of Fallot with an intramural coronary artery and coronary artery compression by chest tube. World J Pediatr Congenit Heart Surg 2020; 11: NP77–NP79. doi: 10.1177/2150135117716421 CrossRefGoogle ScholarPubMed
Koppel, CJ, Jongbloed, MRM, Kiès, P, et al. Coronary anomalies in tetralogy of Fallot – a meta-analysis. Int J Cardiol 2020; 306: 78–85. doi: 10.1016/j.ijcard.2020.02.037 CrossRefGoogle ScholarPubMed
Torres, AJ, McElhinney, DB, Anderson, BR, et al. Aortic root distortion and aortic insufficiency during balloon angioplasty of the right ventricular outflow tract prior to transcatheter pulmonary valve replacement. J Intervent Cardiol 2016; 29: 197–207. doi: 10.1111/joic.12270 CrossRefGoogle ScholarPubMed
Tanase, D, Georgiev, S, Eicken, A, Ewert, P. The Sapien valve provides enough grip to be implanted in pulmonary position without a pre-stent. Cardiovasc Diagn Ther 2019; 9 (Suppl 2): S264–S268. doi: 10.21037/cdt.2019.09.08 CrossRefGoogle ScholarPubMed
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