Treatment of RV Outflow Tract Dysfunction: New Valve Technologies

Abstract

Approximately 22 % of all congenital heart disease patients have an abnormality of the right ventricular outflow tract. During the course of surgery for this condition, approximately 23 % of the patients will receive some form of a valved RV to PA conduit. These patients are candidates for the Medtronic Melody transcatheter pulmonary valve (TPV) (Medtronic, Minneapolis, MN) or, in some parts of the world, the Edwards SAPIEN pulmonic valve (Edwards Lifesciences Corp., Irvine, CA). However, approximately 77 % of patients will have surgical correction of the RV outflow tract with patch enlargement, with or without pulmonary valvectomy, and many will have a transannular patch placed. Most of these patients will be left with significant pulmonary regurgitation (PR) resulting in RV volume overload and potential RV dysfunction later in life. Developing a transcatheter pulmonary valve to fit this complex anatomy was much more challenging than the design of the Melody TPV for RV-PA conduit dysfunction.