Melody Pulmonary Valve Implantation Through the Periventricular Way

Abstract

Introduction: Percutaneous pulmonary valve implantation (PPVI) initiated a new era in the intervention of congenital heart disease. The Melody valve has the greatest experience around the world with more than 10,000 implants, mostly in the pulmonary position, recommended for patients over 5 years of age and 30kg. There are reports of hybrid implants through a small subxiphoid incision for those patients who do not meet the requirements for a traditional implant. Material and method: Retrospective observational analysis with demographic and procedural evaluation, and medium - term follow - up of two cases of IVP through the periventricular route, in a tertiary care University Hospital. Results: Both patients had multiple sternotomies and had presented severe neurological complications secondary to corrective surgery, which is why they were rejected for surgical valve replacement; weighed less than 30 kg; They met criteria for pulmonary valve replacement and were proposed for periventricular IVP. In a hybrid catheterization laboratory with support from pediatric cardiovascular surgery, a minimal sternotomy (lower third of the sternum) was performed; Extra support guidewire was stabilized in the left pulmonary branch through a hemostatic purse string and Landing Zone was performed with a CP stent. Subsequently, the Melody valve was implanted on an 18 and 22 mm balloon (case 1 and case 2, respectively). Control angiographies were performed without observing pulmonary insufficiency or paravalvular leak. Both were discharged from the hospital in excellent hemodynamic condition at 72 hours, maintaining periodic check - ups. Conclusion: Percutaneous pulmonary valve implantation emerges as an alternative to valve replacement surgery; Periventricular access is a novel technique that allows for effective valve implantation by entering through a small surgical incision, avoiding the complications of major surgery, with excellent results and prompt recovery.