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Hybrid Pulmonary Valve Replacement in an Eight-Year-Old: Status Post Tetralogy of Fallot Repair

By Vishal R. Kaley, MBBS, MD; E. Oliver Aregullin, MD, FAAP; Bennett P. Samuel, MHA, BSN, RN; Giedrius Baliulis, MD; Neal D. Hillman, MD; Marcus P. Haw, MBBS, MS, FRCS, FECTS; Joseph J. Vettukattil, MBBS, MD, DNB, CCST, FRCPCH, FRSM, FRCP

Abstract presented at poster session of the Grand Rapids Citywide Research Day, Grand Rapids, MI, USA (April 2018): P39 – Hybrid procedure for pulmonic valve replacement in an eight-year old status post Tetralogy of Fallot repair.

Keywords: Hybrid procedure; Pulmonary regurgitation; Pulmonary artery banding.

Introduction

Pulmonary Regurgitation (PR) is observed in up to 80% of patients following Tetralogy of Fallot (TOF) repair.1 Free PR leads to progressive dilatation of the Right Ventricular Outflow Tract (RVOT), ventricular dysfunction, reduced exercise capacity, arrhythmias, and sudden death.2 Regular follow-up and timely treatment are required to prevent these complications. Conventionally, these patients are treated by surgical or Transcatheter Pulmonary Valve Replacement (TPVR). Transcatheter intervention is preferred over the surgical approach as it is reported to have better outcomes and fewer complications.3 However, transcatheter implantation is challenging in chronic cases with severely dilated RVOT (e.g. >30 mm) due to limitations in sizes of the currently available prosthetic transcatheter pulmonary valves. Various hybrid approaches such as Pulmonary Artery (PA) banding or PA plication to decrease the size of the dilated RVOT to facilitate TPVR have been described.4,5 We present our experience with the hybrid procedure – PA banding followed by TPVR – to manage an 8-year-old female with dilated RVOT, free PR, left PA stenosis, esophageal varices with protein C and factor VII deficiency status post TOF repair.

To read the full article, please go to the July 2018 Issue of CCT, where it was originally published.

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