DEPARTMENT NAME

Rachel Arnold PA-C Physician Assistant Interventional Cardiology

EXCITING INTERVENTIONS IN THE CARDIAC CATHETERIZATION LAB

DEPARTMENT NAME

Overview of interventional cases performed at Texas Children’s HospitalExciting cases

GOALS

DEPARTMENT NAME

Cath Lab Case Distribution 2014- Jan 2019

23%

25%

49%

3%

Diagnostic

Biopsy

Interventional

Therapeutic

DEPARTMENT NAME

CATH LAB INTERVENTIONS • Open things

• Balloon angioplasty and stenting of vessels

• Valvuloplasty

• Close things• Device closure of VSD, ASD or

PDA• Coil occlusion of collaterals • Device closure Fontan

fenestration

DEPARTMENT NAME

Percutaneous Valves

DEPARTMENT NAME

Indication for Percutaneous Pulmonary Valve

• Class IIa: It is reasonable to consider percutaneous pulmonary valve replacement in a patient with an RV-PA conduit with associated moderate-severe pulmonary regurgitation or stenosis provided the patient meets the inclusion/exclusion criteria for the available valve

DEPARTMENT NAME

CONGENITAL HEART LESIONS REPAIRED WITH RV-PA CONDUITS

• Tetraology of Fallot• Truncus Arterious• Pulmonary Atresia • Others

https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/tetralogy-of-fallot

DEPARTMENT NAME

Truncus with RV-PA conduit

DEPARTMENT NAME

Patient case

• 17 year old male with history of TOF with absent pulmonary valve s/p repair with valved 21mm RV-PA conduit • Referred to cath lab with severe RV-PA conduit obstruction with

mean gradient of 63mmHg and moderately dilated RV with moderate dysfunction

DEPARTMENT NAME

PATIENT CASE

DEPARTMENT NAME

MELODY VALVE • Cow jugular vein hand sewn

onto platinum stent • Placed with a 22 Fr system to

femoral vein • 18mm, 20mm or 22mm valve

http://www.medtronic.com/melody/patient/therapy.html

DEPARTMENT NAME

PATIENT CASE

DEPARTMENT NAME

Patient case results

• Underwent implantation of 22mm Melody Valve • Post procedure echo: mean gradient of 18mmHg, now with mildly

decreased RV function (previously moderate)• Discharged the day after the procedure

DEPARTMENT NAME

Percutaneous Pulmonary valve replacement

• Melody Valve and Edwards Valve• Historically placed in RV-PA conduits for patients with conduit

stenosis or severe regurgitation with dilated RV • Now have placed several in native RVOT. For example TOF with patch

repair instead of a conduit

DEPARTMENT NAME

Patient case jm

• 14 year old male with TOF s/p repair with a 16mm RV-PA conduit

• He had echo moderate to severe pulmonary regurgitation and

moderate stenosis of the RV-PA conduit

• Initial cath: “Due to the left anterior descending coronary artery

coursing between the native RVOT and the RV to PA conduit, the

landing zone for a transcatheter pulmonary valve if placed in the

native RVOT is very short. Decision was made that he needs a shorter

valve, probably a 23 mm Edwards Sapien valve and that a melody

valve would not be appropriate at this time due to its longer length.”

DEPARTMENT NAME

Patient Case #2

DEPARTMENT NAME

Edwards

http://www.edwards.com/eu/Products/TranscatheterValves/Pages/sapien3.aspx?WT.ac=S3campaignprod

DEPARTMENT NAME

Patient Case #2

DEPARTMENT NAME

Case Results

• Placement of 23mm Edwards Sapien valve • Post procedure echo revealed mild conduit stenosis and trivial

regurgitation• Patient did well and went home the day after the procedure

DEPARTMENT NAME

Summary

• Many new valves being developed right now. In all different shapes and sizes. • Several are in clinical trials right now.

http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2345036

DEPARTMENT NAME

• Feltes, F.F., Bacha, E., Beekman, R.H., Cheatham, J.P., Feinstein, J.A., Gomes, A.S., et al. (2011). Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease. Circulation. 123, 2607-2652. doi: 10.1161/CIR.0b013e3821b1f10

• W. L. Gore & Associates; Product Overview. Retrieved from https://www.goremedical.com/products/cardioformeu?locale=mpd_euro

• St. Jude Medical; Products Overview. Retrieved from https://health.sjm.com/amplatzer-septal-occluder

• St. Jude Medical; Product Catalogy. Retrieved from https://health.sjm.com/amplatzer-septal-occluder

• Medtronic; Melody Transcatheter Pulmonary Valve (TPV) Therapy. Retrived from http://www.medtronic.com/melody/patient/therapy.html

• Edwards; Products. Retrived from http://www.edwards.com/eu/Products/TranscatheterValves/Pages/sapien3.aspx?WT.ac=S3campaignprod

• Medtronic; News room. Retrived from http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2345036

• American Heart Association; About congenital heart defects. Retrived from https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/tetralogy-of-fallot

DEPARTMENT NAME

COMMENTS/QUESTIONS?