The Use of a Hybrid Approach During Harmony Valve Transcatheter Pulmonary Valve Replacement
Presenter
Kamel Shibbani, M.D., University of Iowa Stead Family Children’s Hospital, Iowa City, IA
Kamel Shibbani, M.D., Bassel Mohammad Nijres, M.D., FSCAI, Mohsin Karimi, M.D. and Osamah Aldoss, M.D., FSCAI, University of Iowa Stead Family Children’s Hospital, Iowa City, IA
Keywords: Adult Congenital Heart Disease (ACHD), Congenital Heart Disease (CHD) and TPVR/Pulmonary Valve
Background
The frequency of use for the Medtronic Harmony pulmonary valve is expected to increase significantly with recent FDA approval. Hybrid procedures involving the plication of the MPA to create an appropriate landing zone have been used, though no such cases have been reported for the Harmony pulmonary valve.
Methods
A hybrid approach combining both surgical and transcatheter based procedures was used to successfully place to a Harmony pulmonary valve in an otherwise unsuitable MPA
Results
A 23-year-old male patient with congenital pulmonary valve stenosis underwent pulmonary balloon valvuloplasty as a neonate. He presented with SOB and exercise restriction. A TTE showed dilated right atrium and right ventricle with severe pulmonary artery regurgitation (PR) MRI showed an indexed end diastolic RV volume of 131/m2 with severe PR (regurgitant fraction 50%) A prescreen CTA analyzed by Medtronic showed his anatomy to be unfavorable for Harmony valve due to extremely dilated MPA. Harmony TPV sizing pre-procedure showed that the TPV 25 would be the most appropriate choice, though the native outflow track was such that even with the TPV 25, the proximal portion of the Harmony valve would have to sit well within the RVOT The patient was therefore scheduled for a Hybrid procedure with planed MPA plication to allow successful transcatheter Harmony valve implant 1 month follow up revealed complete resolution of symptoms with no evidence of PR on echo and no significant gradient
Conclusions
We present a case of a 23-year-old who underwent Harmony pulmonary valve placement as part of a Hybrid procedure where the MPA was plicated to create a more suitable anatomy for implantation. This approach provides a precedent that can be used to increase the Harmony valve use for unfit anatomy by modifying the RVOT and allowing for safe implantation.