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Percutaneous pulmonary valve implantation in patients after Ross procedure: role of intravascular ultrasound

Part of: Echocardiography

Published online by Cambridge University Press:  21 December 2018

Karol Zbroński Open the ORCID record for Karol Zbroński [Opens in a new window] ,
Lidia Tomkiewicz-Pająk ,
Janusz Kochman  and
Zenon Huczek
Karol Zbroński*
Affiliation:
First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Lidia Tomkiewicz-Pająk
Affiliation:
Department of Cardiac and Cardiovascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
Janusz Kochman
Affiliation:
First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Zenon Huczek
Affiliation:
First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
*
Author for correspondence: K. Zbroński, First Department of Cardiology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland. Tel: +48-22-599-19-58; Fax: +48-22-599-19-57; E-mail: karol.zbronski@gmail.com
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Abstract

Coronary compression exclusion during right ventricle outflow tract stenting is recommended and potential oversight may be fatal. Balloon inflation in right ventricle outflow tract with simultaneous aortography can be inconclusive or falsely negative. We present a case of 27-year-old male post Ross operation qualified for percutaneous pulmonary valve implantation. Neither of the conventional views obtained provided a definite exclusion of coronary compression, therefore an intravascular ultrasound of the left coronary artery before and during balloon inflation in right ventricle outflow tract was performed. Acquired images allowed excluding potential constriction, thus a covered stent and pulmonary valve were implanted and the procedure was concluded. Two hours later, the patient complained of chest pain. Transthoracic echocardiography demonstrated a significant pericardial effusion. Retrospective analysis of the final angiogram revealed a possibility of subtle extravasation at the distal part of the homograft. A hybrid procedure consisting of additional covered stent implantation, pericardial drainage, and second pulmonary valve implantation was performed with an acceptable result. To conclude, in case of doubtful or unconvincing images obtained from aortography or selective angiography during balloon inflation in right ventricle outflow tract, intravascular ultrasound might be a feasible and useful technique. Signs of homograft rupture may be subtle, whereas symptoms of cardiac tamponade delayed. In selected patients percutaneous treatment of homograft rupture is achievable and beneficial.

Keywords

Pulmonary valve implantationcoronary compression exclusionintravascular ultrasound
Type
Brief Report
Information
Cardiology in the Young , Volume 29 , Issue 2 , February 2019 , pp. 256 - 258
Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Zbroński K, Tomkiewicz-Pająk L, Kochman J, Huczek Z. (2018) Percutaneous pulmonary valve implantation in patients after Ross procedure: role of intravascular ultrasound. Cardiology in the Young page 256 of 258. doi: 10.1017/S1047951118002202

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