Clinical & Experimental Cardiology
Open Access
ISSN: 2155-9880
ISSN: 2155-9880
Artem Gorbatykh
Ministry of Health, Russia
Posters & Accepted Abstracts: J Clin Exp Cardiolog
Aim: To present an experience of transcatheter valve implantation in patient with right outfl ow tract dysfunction without vascular approach. Methods: A 16 year old boy, 46 kg, with repaired complex D-transposition of the great arteries (D-TGA, VSD and LVOTO) was admitted aft er Rastelli procedure with RVOT reconstruction using xenograft , initially modifi ed B-T shunt was performed at the age of 1 month. Aft er 1 year of complete repair, a conduit reimplantation had been performed due to gradually increasing gradient. 3 years later, he underwent LVOT reconstruction with expansion of the tunnel from LV to aorta using pericardial patch. Within next 4 years, he had undergone another two reconstructions of the RVOT with homograft s. Following the 5-year period without hospitalization, the severely increased gradient on the homograft required reintervention and balloon dilatation had been performed through the right jugular vein due to bilateral femoral veins thrombosis. Patient was discharged with satisfactory result: RV pressure was decreased from 90% to 50% from systemic pressure. Aft er 1 year, pressure gradient on RVOT was increased to 80 mmHg. Th e reoperation risk was very high and for the reason of absence of vascular access, the hybrid approach was chosen. Results: Melody valve implantation through the parietal wall of the RV was performed. Initially obstructed area was dilated with 18�?�?40 mm balloon. On angiography there was laminar fl ow through the pulmonary valve, right ventricular pressure was 46/3 mmHg. According to TEE peak pressure gradient on conduit was 27 mmHg. Conclusion: Femoral veins thrombosis does not restrain transcatheter reconstruction of the RVOT. Using of the transventricular hybrid approach for pulmonary valve implantation is an acceptable alternative in absence of vascular access.