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Education in Heart
Congenital heart disease in adult patients
Transcatheter valve replacement in congenital heart disease: the present and the future
  1. Joanna Ghobrial1,2,
  2. Jamil Aboulhosn1
  1. 1 Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Medical Center, Los Angeles, California, USA
  2. 2 Cleveland Clinic Adult Congenital Heart Disease Center, Cleveland Clinic Foundation, Cleveland, OH, USA
  1. Correspondence to Dr Joanna Ghobrial, Cleveland Clinic Adult Congenital Heart Disease Center, Cleveland Clinic Foundation, Cleveland, OH, USA; joannaghobrial{at}gmail.com

https://doi.org/10.1136/heartjnl-2016-310898

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    Learning objectives

    • Familiarise the reader with the various valve lesions encountered in congenital heart disease and the pathophysiology of such lesions.

    • Recognise the commercially available transcatheter valves in the market that can be used in congenital heart disease.

    • Achieve a basic understanding of future directions in this field.

    Introduction

    Survival into adulthood for patients with congenital heart disease (CHD) is expected in those that have access to specialty care. Many of them will need multiple valve surgeries over their lifetime, which increases their risk of morbidity and mortality.1 The advances in interventional cardiology and the introduction of the Melody valve, a balloon expandable pulmonary valve2 in 2000 have radically altered the management options for these patients by reducing the need for redo surgical interventions.3 We herein discuss the existing and future catheter-based valve replacement and repair options for adult CHD.

    Pulmonary valve

    Pulmonary valve disorders in CHD can either be primary or postoperative. Primary pulmonary valve dysfunction may be isolated, as in congenital pulmonary stenosis (PS), or may be a part of a more complex coalescence of lesions as seen in tetralogy of Fallot, wherein pulmonary valvular, subvalvular and/or supravalvular stenosis and a ventricular septal defect (VSD) coexist. Surgical procedures that relieve pulmonic stenosis but result in chronic pulmonary regurgitation (PR) are more often performed over surgical valve or conduit placement in infancy or early childhood. Thereafter, surgical interventions usually consist of pulmonary valve replacement (PVR) with either bioprosthetic valves or valved conduits. Mechanical pulmonic valve replacement has a low incidence of valve deterioration, need for reoperation and valve thrombosis if used with appropriate systemic anticoagulation4; however, they are not widely used due to various limitations including contraindications to systemic anticoagulation, future need for transcatheter interventions of the pulmonary arterial branches, and somatic outgrowth in infants and children. Bioprosthetic valves and conduits …

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    Footnotes

    • Contributors All authors listed have contributed sufficiently to the project.

    • Funding This research received no specific grant from any funding agency in the public,commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Author note References which include a * have been selected as key references for this paper.