Transcatheter valve insertion in a model of enlarged right ventricular outflow tracts Adeline Basquin, MD, Emmanuelle Pineau, MD, Louise Galmiche, MD,

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Presentation transcript:

Transcatheter valve insertion in a model of enlarged right ventricular outflow tracts Adeline Basquin, MD, Emmanuelle Pineau, MD, Louise Galmiche, MD, Damien Bonnet, MD, PhD, Daniel Sidi, MD, PhD, Younes Boudjemline, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 1, Pages 198-208 (January 2010) DOI: 10.1016/j.jtcvs.2009.07.025 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 C and D, The newly designed stent is shown uncovered (front and lateral views) and compared with the old design on the top panels (A and B). The extremities are directed inward and back toward an intermediate position forming a second wall in parallel with the external one. In comparison, in the previous design, the extremities were directed outward and back toward the middle part. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 198-208DOI: (10.1016/j.jtcvs.2009.07.025) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Surgical views showing the various steps of the enlargement of the RVOT. A, Incision through a left thoracotomy showing the RVOT with the PA at the top. B, Excision of a pulmonary valve leaflet after partial crossclamping of the PA. C, Sewing of the pericardial patch. D, Final aspect of the RVOT. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 198-208DOI: (10.1016/j.jtcvs.2009.07.025) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Angiographic views showing the delivery of the PA filler. In each panel (A–D) an in vitro photograph is provided, showing the opening of the device in a plastic tube. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 198-208DOI: (10.1016/j.jtcvs.2009.07.025) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Angiograms before insertion of the filler showing the variable anatomy of the RVOT obtained with patch enlargement. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 198-208DOI: (10.1016/j.jtcvs.2009.07.025) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Angiograms showing the insertion of the valved stent inside the PA filler. A, Placement of the valved stent. B, Inflation of the inner balloon catheter. C, Inflation of the outer balloon catheter. D, Aspect after full deployment of devices. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 198-208DOI: (10.1016/j.jtcvs.2009.07.025) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Angiograms after dye injection showing the function of implanted devices (equivalent of a lateral view). A, Right ventriculogram showing the perfect sealing of the device and the reduction of PA diameter. B, PA injection showing good function of the implanted valve. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 198-208DOI: (10.1016/j.jtcvs.2009.07.025) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Left, Angiograms showing the RVOT after insertion of the devices in an animal with an undersized filler. Note the significant paravalvular leak represented by the presence of contrast dye around the filler. Right, The aspect of the RVOT at autopsy after opening of the anterior wall. The filler is not embedded in the anterior part of the RVOT, which completely explains the leak seen on angiograms. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 198-208DOI: (10.1016/j.jtcvs.2009.07.025) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 8 Histologic views (trichrome). A and B, Loose connective tissue between the nitinol (black circle on the right) and valved stents (trichrome ×50). C, Magnification of panel A (trichrome ×100). D, Overview of the vascular wall (star) with the nitinol stent (arrowhead), valved stent (arrow), and bovine arterial wall (triangle). The Journal of Thoracic and Cardiovascular Surgery 2010 139, 198-208DOI: (10.1016/j.jtcvs.2009.07.025) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 9 Histologic views (Stevenel Blue). A, Dense connective tissue between the nitinol stent and the arterial wall (×100). B and C, Mild inflammatory infiltrate between the nitinol stent and the arterial wall (×200). D, Valve implant with normal thickness (×50). The Journal of Thoracic and Cardiovascular Surgery 2010 139, 198-208DOI: (10.1016/j.jtcvs.2009.07.025) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions