Novel Self-Expanding Pulmonary Valves and Devices

Abstract

Pulmonary regurgitation after repair of tetralogy of Fallot (ToF) is almost inevitable and in the past has required repeat surgery for replacing the regurgitant pulmonary valve. After 2000, percutaneous pulmonary valve implantation (PPVI) with balloon-expandable valves has replaced the surgical approach in a select group of patients. However, PPVI with the commercially available balloon-expandable valves have limitations because of their size, being applicable to right ventricle"pulmonary artery conduits or bioprosthetic valves. They have not been considered suitable for native dilated right ventricular outflow tracts (RVOT) after a transannular patch repair technique, which form about 70"75% of the patients. Novel self-expanding pulmonary valves have been developed for use in such dilated native outflow tracts. Early experience with these valves, although limited, has been encouraging, suggesting that self-expandable pulmonary valves can be implanted safely, with good short-and mid-term results in patients with native RVOT. This chapter summarises the new transcatheter self-expanding valves available for the management of pulmonary regurgitation after surgical repair of ToF, in patients in whom the shape and size of the RVOT, have previously been considered unsuitable for transcatheter valve implantation