Advances in Experimental Percutaneous Pulmonary Valve Replacement

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Presentation transcript:

Advances in Experimental Percutaneous Pulmonary Valve Replacement Tim Attmann, MD, Thomas Jahnke, MD, René Quaden, MD, Andreas Boening, MD, PhD, Stefan Muller-Hulsbeck, MD, PhD, Jochen Cremer, MD, PhD, Georg Lutter, MD, PhD The Annals of Thoracic Surgery Volume 80, Issue 3, Pages 969-975 (September 2005) DOI: 10.1016/j.athoracsur.2005.03.041 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Valved segment of a bovine jugular vein inside the nitinol stent: (a) during suturing process and (b) view from above on a bicuspid valve with thin, transparent cusps. The Annals of Thoracic Surgery 2005 80, 969-975DOI: (10.1016/j.athoracsur.2005.03.041) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Endoscopic view from above on a valved stent in the in vitro pulsatile flow system: (a) prompt and wide opening of the cusps during systole and (b) complete closure during diastole. The Annals of Thoracic Surgery 2005 80, 969-975DOI: (10.1016/j.athoracsur.2005.03.041) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Preimplantation angiography of the right ventricular outflow tract and the pulmonary artery. The annulus is 20.3 mm. Note: there is little contrast agent in the right atrium (arrow). The Annals of Thoracic Surgery 2005 80, 969-975DOI: (10.1016/j.athoracsur.2005.03.041) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Three-dimensional computed tomography reconstructions of the heart in volume rendering technique modus after implantation of a valved stent in the pulmonary position. Spin degrees: −22 for the left upper picture, +23 for the left lower picture, +68 for the right upper picture, and +90 for the right lower picture. The Annals of Thoracic Surgery 2005 80, 969-975DOI: (10.1016/j.athoracsur.2005.03.041) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Completion angiography after valved stent deployment. No neovalve insufficiency is detected. The Annals of Thoracic Surgery 2005 80, 969-975DOI: (10.1016/j.athoracsur.2005.03.041) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Typical shape of pressure curves during catheter pullback through the valved stent. The Annals of Thoracic Surgery 2005 80, 969-975DOI: (10.1016/j.athoracsur.2005.03.041) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Fluoroscopy with application device in situ. Note the alteration of the geometry of cardiac structures induced by the extra-stiff guidewire and by the application device. The black arrow indicates the position of the pulmonary annulus before introduction of the guide wire and the application device. The white arrow indicates the new position of the pulmonary annulus. The Annals of Thoracic Surgery 2005 80, 969-975DOI: (10.1016/j.athoracsur.2005.03.041) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 8 (a) Perfect position of the valved stent. The right ventricular outflow tract and pulmonary artery are cut longitudinally. The arrow indicates a native pulmonary valve leaflet. (b) Valved stent after explantation. Note the thin and transparent leaflets. The small defect (arrow) disappeared during water rinse testing. (c) Imprint of the valved stent on the native pulmonary valve and on the intima of the right ventricular outflow tract and pulmonary trunk. Minor endocardial lesions of the right ventricle are indicated by the arrow. The Annals of Thoracic Surgery 2005 80, 969-975DOI: (10.1016/j.athoracsur.2005.03.041) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions