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Chronic pulmonary regurgitation (PR) is a frequent condition after intracardiac repair of tetralogy-of-Fallot that affects up to 36% of long-term survivors.1 2 Herein, we present the case of a 64-year-old female patient with severe symptomatic PR. She had undergone tetralogy-of-Fallot repair at the age of 17 including right ventricular (RV) outflow tract (RVOT) enlargement with a transannular patch. At the age of 59, the patient underwent tricuspid valve repair for severe tricuspid regurgitation.
She now presented in New York Heart Association functional class IV due to chronic RV failure with recurrent oedema and ascites refractory to pharmacological treatment. Echocardiography and right heart catheterisation confirmed severe PR (figure 1A) and RV congestion. Due to previous surgical procedures and multiple comorbidities transcatheter valve implantation was considered as the preferable treatment approach in this patient. Prior to valve implantation, prestenting of the RVOT was performed with a 24×35 mm Palmaz® Stent (Cordis Corporation, Miami, FL, USA) to facilitate positioning and anchoring of a trancatheter heart valve (figure 1B). Second, a 26 mm Edwards SAPIEN XT valve was implanted under fluoroscopic and echocardiographic guidance though the right femoral vein within the RVOT stent (figure 1C–E). After valve deployment, pulmonary angiography confirmed only residual regurgitation (figure 1F; video supplement). The position of the device was further evaluated by a CT scan including volume-rendering images which documented the correct position of the Edwards SAPIEN XT valve within the Palmaz® Stent (figure 1G–I; arrow). During early follow-up, the patient experienced functional improvement to New York Heart Association class II–III. She was discharged to a cardiac rehabilitation programme in good clinical condition 6 weeks later.
Transcatheter implantation of Edwards Sapien XT heart valve for treatment of severe pulmonary regurgitation after tetralogy-of-fallot repair.
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Footnotes
Funding This report is funded by the University Heart Center Jena, Germany.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.