Catheter implantation of pulmonary valve from the jugular vein in a patient 12 years old with dysfunctioning aortic homograft and azygos vein continuation of the inferior vena cava
Transcatheter pulmonary valve implantation in the heart catheterization laboratory is currently the treatment of choice for patients with severe congenital heart disease in whom their surgical treatment with open-heart surgery includes the placement of a valved aortic homograft graft between the right ventricle and the pulmonary artery. These grafts over the time (usually after 10-15 years), become dysfunctional resulting in poor right ventricular function and heart failure develop defects. As a result, these patients (usually of young age) during their lifetime undergo multiple high-risk surgical procedures for the replacement the graft. With the transcatheter valve implantation, a new high-risk open-heart surgery is avoided. At the same time, a significant improvement in the quality of life of these patients is ensured while there is the option of transcatheter placement an another pulmonary valve of extending for at least 25 years of a normal without heart surgery life.
The patient a young female 12 years old had undergone open-heart surgery for severe aortic valve stenosis at Agia Sofia Children’s Hospital with the Ross technique, which included the placement of a valved aortic homograft between the right ventricle and the pulmonary artery. Due to failure of the material, the graft developed early (6 months postoperatively) severe stenosis (the diameter was reduced at distal part-at pulmonary artery bifurcation from 23mm to 4 mm), resulting in the development of progressively deteriorated heart failure associated with severe dyspnea and fatigue. For this reason and in order to avoid a new increased risk open heart surgery, the young patient underwent successful, implantation of a stent-mounted pulmonary valve in the Cardiac Catheterization Laboratory of IASO Children’s Hospital. Due the presence of interrupted inferior vena cava the standard technique of pulmonary valve implantation from the femoral vein was not possible to be performed. Therefore, the valve was implanted in the stenotic aortic homograft through the jugular vein an elaborate and more demanding from technical point of view venous approach. It should be noted, that is the first- in - man use of this technique in patient with congenital interruption of the inferior vena cava.
The procedure was performed by the specialized and experienced team of the IASO Children's Hospital Pediatric Cardiology Department and Cardiac Catheterization Lab, headed by Dr. Georgios Tsaousis, director of Pediatric Cardiology under the guidance of Vasileios D. Thanopoulos, Associated Professor a leading Greek interventional pediatric cardiologist with great experience in catheter pulmonary valve implantation. The IASO Children’s Hospital Pediatric Cardiac Surgery Department, headed by world renowed Professor Afksendiyos Kalangos, took over the cardiac surgery part of the procedure. The patient was discharged the next day after the procedure in excellent health condition.
It is also important to note that the cost of the procedure was covered on charity basis by the Mayor of Thasos, Mr. Lefteris Kyriakidis, while none of physicians involved in the procedure received a fee, which demonstrates the charitable nature of medical science.
From left: Dr. Georgios Tsaousis, Pediatric Cardiologist, Director of the IASO Children's Hospital Cardiology Department and Cardiac Catheterization Lab, and Professor Vasileios Thanopoulos, Interventional Cardiologist, Scientific Associate of the IASO Children's Hospital Cardiology Department and Cardiac Catheterization Lab