[I-AEPCJS-03] Catheter treatment of native RVOT
Pulmonary regurgitation is a common problem after surgical repair of tetralogy of Fallot, especially when transannular patches are used during repair. Traditionally, it has been accepted that pulmonary regurgitation is well tolerated by the patients and so rarely needs treatment. However, over the last 2 decades, it has become fairly clear that some patients are at risk of arrhythmias and symptoms such as breathlessness and effort tolerance. It has also been established that when RVEDVi on MRI exceeds 160-170 ml/m2, then RV remodelling is less likely to occur. It has therefore been accepted that some form of intervention on the pulmonary valve is indicated when RVEDVi exceeds 150 ml/m2.
Since 2000, several different percutaneous valves have been developed and evaluated in the pulmonary position. These include Melody and Sapien valves, which are balloon-expandable. The Melody valve can be dilated up to 22 mm and the Sapien up to 29-30mm. These may then be applicable in about 25% of the patients. However, many native RVOTs may exceed these diameters. To help deal with these larger native RVOTs, self-expandable valves are being evaluated and may have an important role in the future. These include Harmony valve, Alterra combined with a Sapien valve, VenusP-valve, Pulsta valve and Med-Zenith PT valve. The largest of these is VenusP-valve, which is up to 36 mm diameter, whereas the others are smaller. The Harmony and Sapien are currently in use only in USA. The VenusP-valve has received CE approval in April 2022 and the Pulsta valve is undergoing CE study. These self-expanding valves are likely to play a very important role in clinical practice around the world, despite the cost limitations.
Since 2000, several different percutaneous valves have been developed and evaluated in the pulmonary position. These include Melody and Sapien valves, which are balloon-expandable. The Melody valve can be dilated up to 22 mm and the Sapien up to 29-30mm. These may then be applicable in about 25% of the patients. However, many native RVOTs may exceed these diameters. To help deal with these larger native RVOTs, self-expandable valves are being evaluated and may have an important role in the future. These include Harmony valve, Alterra combined with a Sapien valve, VenusP-valve, Pulsta valve and Med-Zenith PT valve. The largest of these is VenusP-valve, which is up to 36 mm diameter, whereas the others are smaller. The Harmony and Sapien are currently in use only in USA. The VenusP-valve has received CE approval in April 2022 and the Pulsta valve is undergoing CE study. These self-expanding valves are likely to play a very important role in clinical practice around the world, despite the cost limitations.