Percutaneous Pulmonary Valve Shows Success in Young Children
Until recently, children born with defective pulmonary valves typically had to undergo multiple open-heart surgeries over the course of a lifetime as replacement valves wore out. The Melody Transcatheter Pulmonary Valve has received FDA approval for clinical use in older children and adults. This device can be delivered percutaneously, eliminating the need for re-operation. However, there is limited experience in implanting this device in young children.
Investigators from Miami Children’s Hospital performed a multicenter retrospective review of all patients weighing less than 30 kg who had this device implanted for dysfunctional right ventricular outflow tract conduits between January 2008 and May 2011. They analyzed data from 25 patients evaluated for the procedure with median age of 8 years and median weight of 21.4 kg.
Valve implantation was successfully performed in 23 patients, with good hemodynamic results in the majority of patients, as measured by Doppler gradient in the conduit. Immediately following implantation, regurgitation was absent or trivial in 21 patients and mild in two.
Adverse events were common, including pulmonary artery perforation associated with pulmonary hemorrhage (n =2), contained conduit tear (n = 5) and contained peripheral venous injury (n = 6). These adverse events were self-limiting in all but one patient. The majority of patients had good procedural and early hemodynamic results.
The investigators concluded that the early results are encouraging and the device restores competence to the pulmonary valve, but more experience and a larger sample size are needed before this procedure can be routinely recommended in young children.
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