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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
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10 years of percutaneous pulmonary valve implantation
Session:
CO11 - Circulação Pulmonar / Congénitos
Speaker:
Petra Loureiro
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.7 Pediatric Cardiology
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Petra Loureiro; José Diogo Ferreira Martins; Lidia De Sousa; Ana Figueiredo Agapito; Maria De Fátima Pinto
Abstract
<p><strong>Introduction:</strong> The congenital heart diseases affecting the right ventricular outflow tract (RVOT) are commonly associated with a significant morbidity, as they require multiple surgical interventions to treat native and residual lesions. A less invasive alternative is percutaneous pulmonary valve implantation (PPVI).</p> <p><strong>Aims</strong>: To assess the safety, the immediate and long-term efficacy of PPVI in patients followed at a single tertiary center over 10 years.</p> <p><strong>Materials and Methods:</strong> We retrospectively analyzed data of all the patients that underwent PPVI between 2008-2018. We performed a statistical analysis of demographic, clinical and anatomical variables.</p> <p><strong>Results:</strong> Thirteen patients with RVOT dysfunction, 76.9% males, with a mean age of 21 years (7.7-39.2 years) and mean weight of 52.4 kg (29-88 kg) underwent PPVI. Of these, 6 (46.1%) had a diagnosis of Tetralogy of Fallot and 12 (92.3%) presented a homograft between the right ventricle (RV) and the pulmonary artery branches. Pre-stenting of the RVOT was performed in all patients. 10 <em>Melody </em>valves and 3 <em>Edwards Sapien XT</em> valves were implanted. The success of the procedure was 92.3% (N = 12). There was one case of pulmonary valve (PV) embolization, that required surgery, after an attempt of transventricular PPVI.</p> <p>On the 12 patients with a successful procedure, the median peak systolic RVOT gradient decreased from 48.9mmHg (18-77mmHg) to 11.2mmHg (2-20mmHg) and the ratio between RV pressure / aortic pressure decreased from 76% (48.6-132%) to 37.9% (23-49%). There were no major intra-procedure complications.</p> <p>In long-term follow-up (mean 7 years (2.9-10 years), 3/12 patients (25%) required a surgical replacement of the PV due to bacterial endocarditis (BE), and there was one case of BE medically treated. The incidence rate of BE was 5.2% person-year.</p> <p>In the remaining 8 patients of the sample, the current pulmonary transvalvular gradient is 26.75mmHg (17-58mmHg), with absence or mild pulmonary valve regurgitation.</p> <p>There was 1 early complication: an aortic fistula to the RVOT, which was surgically treated with PV preservation, and one death (12.5%) of unknown cause. 1/12 patients had stent fractures (Nordmeyer type I).</p> <p>In total, 9/12 patients (75%) are currently free of re-intervention.</p> <p><strong>Conclusion</strong>: In a short and medium-term follow-up PPVI is a safe and effective technique with good hemodynamic results and a low complications rate. BE was the main cause of re-intervention.</p>
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