Per-Ventricular Insertion of Melody Valve-in-Valve in the Neoaortic Position in a Single-Ventricle Patient

Abstract

Percutaneous therapies for congenital heart disease have been evolving rapidly despite limited investment from industry. The Melody transcatheter pulmonary valve (Medtronic, Inc, Minneapolis, MN USA) replacement therapy represents an important advancement in this arena. It has been approved in the United States for use in the pulmonary position, on a Humanitarian Device Exemption status. Off-label use of the Melody transcatheter pulmonary valve has extended to the mitral, pulmonary, and aortic valves, especially in previously implanted valves with prosthetic valve degeneration. The single-ventricle patient poses additional challenges. However, there exists one report in the English literature of a patient undergoing Melody transcatheter neoaortic valve replacement after the patient developed severe neoaortic regurgitation after Fontan palliation. Here, we describe a patient with hypoplastic left heart syndrome, palliated with a Norwood modified Blalock-Taussig shunt, with a progressively regurgitant quadricusp neoaortic valve who underwent bioprosthetic valve replacement. There was early prosthetic valve degeneration after a year of bioprosthesis implantation. As he was declined for transplantation, he underwent successful perventricular Melody valve-in-valve replacement.

Keywords

Single ventricle Melody valve Per-ventricular valve implantation Valve-in-valve Prosthetic valve degeneration

Get full access to this article

View all access options for this article.

References

Emani

S.M.

, Piekarski

B.L.

, Zurakowski

Concept of an expandable cardiac valve for surgical implantation in infants and children. J Thorac Cardiovasc Surg. 2016; 152: 1514–1523.

Ringewald

J.M.

, Suh

E.J.

Transcatheter pulmonary valve insertion, expanded use (beyond large conduits from the right ventricle to pulmonary artery), and future directions. Cardiol Young. 2014; 24: 1095–1100.

Martin

M.H.

, Gruber

P.J.

, Gray

R.G.

Transcatheter neoaortic valve replacement utilizing the Melody valve in hypoplastic left heart syndrome. Catheter Cardiovasc Interv. 2015; 85: 615–619.

Hasan

B.S.

, McElhinney

D.B.

, Brown

D.W.

Short-term performance of the transcatheter Melody valve in high-pressure hemodynamic environments in the pulmonary and systemic circulations. Circ Cardiovasc Interv. 2011; 4: 615–620.

Yeong

, Bedair

, Baumbach

, Caputo

, Manghat

, Turner

First successful trans-catheter aortic-valve replacement for native aortic stenosis in atrio-pulmonary Fontan. Int J Cardiol. 2016; 222: 963–964.

Moysich

, Kerst

, Akintürk

, Schranz

Transapical valve-in-valve implantation to treat a regurgitant mitral bioprothesis in a child with failing Fontan circulation. J Thorac Cardiovasc Surg. 2015; 150: e23–e25.

Shaddy

R.E.

, Hawkins

J.A.

Immunology and failure of valved allografts in children. Ann Thorac Surg. 2002; 74: 1271–1275.

Meyer

C.G.

, Frick

, Lotfi

Regional left ventricular function after transapical vs. transfemoral transcatheter aortic valve implantation analysed by cardiac magnetic resonance feature tracking. Eur Heart J Cardiovasc Imaging. 2014; 15: 1168–1176.