Transcatheter pulmonary valve replacement in pediatric patients

ABSTRACT

Introduction

Right ventricular outflow tract (RVOT) dysfunction is common among individuals with congenital heart disease (CHD). Surgical intervention often carries prohibitive risks due to the need for sequential pulmonary valve (PV) replacements throughout their life in the majority of cases. Transcatheter pulmonary valve replacement (tPVR) is one of the most exciting recent developments in the treatment of CHD and has evolved to become an attractive alternative to surgery in patients with RVOT dysfunction.

Areas covered

In this review, we examine the pathophysiology of RVOT dysfunction, indications for tPVR, and the procedural aspect. Advancements in clinical application and valve technology will also be covered.

Expert opinion

tPVR is widely accepted as an alternative to surgery to address RVOT dysfunction, but still significant numbers of patients with complex RVOT morphology deemed not suitable for tPVR. As the technology continues to evolve, new percutaneous valves will allow such complex RVOT patient to benefit from tPVR.

KEYWORDS:

• Transcatheter pulmonary valve
• pulmonary regurgitation
• congenital heart disease
• tetralogy of Fallot

Article highlights

• Right ventricular outflow tract dysfunction is not uncommon in patients with CHD.

• It carries significant mortality and morbidity if not treated properly.

• Transcatheter therapy has been proved as a safe and effective alternative to surgeries.

• Understanding timing for intervention is crucial.

• Understanding the procedural aspect including how to manage complication is important.

• The valves technology is evolving and the availability of self-expandable valves will solve a lot of complex RVOT anatomy.

Declaration of interest

ZM Hijazi owns stock options and is a consultant to Venus Medtech & Colibri Heart Valve. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One peer reviewer was an investigator for one of the participating institutions of the COMPASSION S3 trial. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.