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?