Management of a doubly folded, partially inflated Melody valve after outer balloon rupture: a case report.

This is a report of a rare complication during implantation of a Melody valve in an adult patient in whom the valve failed to expand due to balloon rupture. An 18-year-old patient was admitted with an increased right ventricular pressure and severe pulmonary regurgitation for scheduled cardiac catheterization. Angiography revealed a proximal stenosis of the left pulmonary artery (LPA). First, a prestenting was performed. Three months later he came back for planned percutaneous pulmonary valve implantation (PPVI). Because of the proximity of the right coronary artery (RCA) to the right ventricular outflow tract (RVOT) and thus a relatively short landing zone, the Melody valve had been doubly folded. During the inflation of the outer balloon, it ruptured. At this point, the Melody valve was still fixed to the inner balloon. A second catheter was placed through the Melody valve and successful valve implantation was possible. This procedure was difficult because to push the catheter through the partly inflated Melody valve, the inner balloon had to be slowly and simultaneously deflated. The final angiograms and pressure measurements showed a good functional result and absent pulmonary regurgitation. Open heart surgery could be avoided after incomplete Melody valve dilatation using the contralateral pulmonary artery as a safe rail.

The risk of bacterial endocarditis after percutaneous and surgical biological pulmonary valve implantation.

OBJECTIVE: This single center study compared the risk of bacterial endocarditis (BE) after surgical and percutaneous pulmonary valve implantation. METHODS: Between Jan 1st 2010 and Dec 31st 2015 all patients who received a biological pulmonary valve (surgical/interventional) were identified. The clinical follow-up was analyzed with regard to BE applying the modified Duke criteria and echocardiographic findings. RESULTS: We identified 246 patients who underwent a biological pulmonary valve implantation. The mean age was 15.9 years, (SD 12.7, Median 13.1). There were 166 surgical patients (67.5%), with 55 homografts (22.4%, mean diameter 27.4 mm), 106 Contegra® grafts (43.1%, mean diameter 17.4) and 5 Hancock® valves (2.0, mean diameter 25.6 mm) and 80 percutaneous pulmonary valve implantations (PPVI) (32.5%) with 51 Edwards Sapien® valves (20.7%, mean diameter 25.2 mm) and 29 Melody® valves (11.8%, mean diameter 21.9 mm). Patients with a bovione jugular conduit as the biologiocal substrate had an increased risk for BE and patients with Melody® valves had the highest risk for BE that was 5-8 times higher as compared to other valves. BE episodes were detected in 5/106 Contegras® (4,7%, 1.5 per 100 person-years), and in 6/29 of the Melody® valves (20.7%, 4.8 per 100 person-years). There were no cases of BE in patients treated with Edwards Sapien®, homografts or Hankock® valves. CONCLUSION: Whereas homografts and Edwards Sapien® valves seem to have a very low risk of BE, this risk is increased in Contegra® conduits and in Melody® valves.