Noninvasive imaging prior to percutaneous pulmonary valve implantation

The majority of patients with congenital heart disease (CHD) who have undergone open heart surgery during childhood are possible candidates for additional transcatheter or surgical interventions. One fifth of these conditions usually involve the right ventricular outflow tract (RVOT). Percutaneous pulmonary valve replacement (PPVR) has been widely established as an alternative, less invasive option to surgical pulmonary valve replacement (SPVR). The variability of RVOT anatomy and size, the relative course of the coronary arteries, and the anatomy of the pulmonary artery branches are factors that determine the success of the intervention and the complication rates. Careful and reliable pre-interventional imaging warrants the selection of suitable candidates and minimizes the risk of complications. 2D and 3D fluoroscopy have been extensively used during pre- and peri-interventional assessment. Established imaging techniques such as cardiovascular magnetic resonance (CMR) and computed tomography (CT) and newer techniques such as fusion imaging have proved to be efficient and reliable tools during pre-procedural planning in patients assessed for PPVR. Percutaneous pulmonary valve replacement (PPVR) has been widely established as an effective and less invasive alternative option for pulmonary valve (PV) replacement associated with reduced hospital length of stay and quick recovery. Although PPVR is a minimal invasive procedure, it has been associated with complications such as stent fracture, valve embolization, and coronary artery compression. To eliminate possible complications and increase the chances of the procedure's success, a detailed pre-procedural study of the RVOT anatomy and valve size is fundamental. 2D and 3D fluoroscopy approaches have been extensively used during pre- and peri-interventional assessment. Established imaging techniques such as Cardiovascular Magnetic Resonance (CMR) and Computed Tomography (CT) as well as newer techniques such as fusion imaging have proved to be efficient and reliable tools during pre-procedural planning. In this paper, we present the advances in noninvasive imaging that could improve the pre-procedural selection of best candidates for PPVR and increase the procedural success.▪