Three dimensional rotational angiography for assessment of coronary arteries during melody valve implantation: introducing a technique that may improve outcomes

Background Adverse events from Melody valve implantation may be catastrophic. To date a role for three dimensional rotational angiography of the aortic root (3DRAA) during Melody valve implantation has not been established. Objectives To describe the role of 3DRAA in the assessment of Melody valve c...

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Veröffentlicht in:Netherlands heart journal 2017-02, Vol.25 (2), p.82-90
Hauptverfasser: Pockett, C. R., Moore, J. W., El-Said, H. G.
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creator Pockett, C. R.
Moore, J. W.
El-Said, H. G.
description Background Adverse events from Melody valve implantation may be catastrophic. To date a role for three dimensional rotational angiography of the aortic root (3DRAA) during Melody valve implantation has not been established. Objectives To describe the role of 3DRAA in the assessment of Melody valve candidacy and to demonstrate that it may improve outcomes. Methods All patients who underwent cardiac catheterisation for Melody valve implantation and 3DRAA between August 2013 and February 2015 were reviewed. Results 31 patients had 3DRAA with balloon sizing. Ten were deemed not Melody candidates (5 coronary compression, 2 aortic root distortion with cusp flattening, 2 RVOT was too large, and 1 had complex branch stenosis and a short landing zone). Of the 21 patients who were Melody candidates, 12 had conduits, 6 prosthetic valves and 3 native RVOTs. In patients with conduits, the technique of stenting the conduit prior to dilation was used after measuring the distance between the conduit and the coronary arteries on 3DRAA. In the Melody patients, we had 100% procedural success and no serious adverse events (coronary compression, tears, stent fracture or endocarditis). Conclusion As a tool for case selection, 3DRAA may facilitate higher procedural success and decreased risk of serious adverse events. Furthermore, 3D rotational angiography allows stenting of the conduit prior to dilation, which may prevent tears and possibly endocarditis.
doi_str_mv 10.1007/s12471-016-0931-6
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R. ; Moore, J. W. ; El-Said, H. G.</creator><creatorcontrib>Pockett, C. R. ; Moore, J. W. ; El-Said, H. G.</creatorcontrib><description>Background Adverse events from Melody valve implantation may be catastrophic. To date a role for three dimensional rotational angiography of the aortic root (3DRAA) during Melody valve implantation has not been established. Objectives To describe the role of 3DRAA in the assessment of Melody valve candidacy and to demonstrate that it may improve outcomes. Methods All patients who underwent cardiac catheterisation for Melody valve implantation and 3DRAA between August 2013 and February 2015 were reviewed. Results 31 patients had 3DRAA with balloon sizing. Ten were deemed not Melody candidates (5 coronary compression, 2 aortic root distortion with cusp flattening, 2 RVOT was too large, and 1 had complex branch stenosis and a short landing zone). Of the 21 patients who were Melody candidates, 12 had conduits, 6 prosthetic valves and 3 native RVOTs. In patients with conduits, the technique of stenting the conduit prior to dilation was used after measuring the distance between the conduit and the coronary arteries on 3DRAA. In the Melody patients, we had 100% procedural success and no serious adverse events (coronary compression, tears, stent fracture or endocarditis). Conclusion As a tool for case selection, 3DRAA may facilitate higher procedural success and decreased risk of serious adverse events. Furthermore, 3D rotational angiography allows stenting of the conduit prior to dilation, which may prevent tears and possibly endocarditis.</description><identifier>ISSN: 1568-5888</identifier><identifier>EISSN: 1876-6250</identifier><identifier>DOI: 10.1007/s12471-016-0931-6</identifier><identifier>PMID: 27933590</identifier><language>eng</language><publisher>Houten: Bohn Stafleu van Loghum</publisher><subject>Cardiology ; Coronary vessels ; Data collection ; Medical Education ; Medical imaging ; Medicine ; Medicine &amp; Public Health ; Original - Design Study ; Original Article - Design Study Article ; Patients ; Prostheses ; Pulmonary arteries ; Radiation ; Stents ; Veins &amp; arteries</subject><ispartof>Netherlands heart journal, 2017-02, Vol.25 (2), p.82-90</ispartof><rights>The Author(s) 2016</rights><rights>The Author(s) 2016. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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Ten were deemed not Melody candidates (5 coronary compression, 2 aortic root distortion with cusp flattening, 2 RVOT was too large, and 1 had complex branch stenosis and a short landing zone). Of the 21 patients who were Melody candidates, 12 had conduits, 6 prosthetic valves and 3 native RVOTs. In patients with conduits, the technique of stenting the conduit prior to dilation was used after measuring the distance between the conduit and the coronary arteries on 3DRAA. In the Melody patients, we had 100% procedural success and no serious adverse events (coronary compression, tears, stent fracture or endocarditis). Conclusion As a tool for case selection, 3DRAA may facilitate higher procedural success and decreased risk of serious adverse events. 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Methods All patients who underwent cardiac catheterisation for Melody valve implantation and 3DRAA between August 2013 and February 2015 were reviewed. Results 31 patients had 3DRAA with balloon sizing. Ten were deemed not Melody candidates (5 coronary compression, 2 aortic root distortion with cusp flattening, 2 RVOT was too large, and 1 had complex branch stenosis and a short landing zone). Of the 21 patients who were Melody candidates, 12 had conduits, 6 prosthetic valves and 3 native RVOTs. In patients with conduits, the technique of stenting the conduit prior to dilation was used after measuring the distance between the conduit and the coronary arteries on 3DRAA. In the Melody patients, we had 100% procedural success and no serious adverse events (coronary compression, tears, stent fracture or endocarditis). Conclusion As a tool for case selection, 3DRAA may facilitate higher procedural success and decreased risk of serious adverse events. 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source Springer Nature OA Free Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection
subjects Cardiology
Coronary vessels
Data collection
Medical Education
Medical imaging
Medicine
Medicine & Public Health
Original - Design Study
Original Article - Design Study Article
Patients
Prostheses
Pulmonary arteries
Radiation
Stents
Veins & arteries
title Three dimensional rotational angiography for assessment of coronary arteries during melody valve implantation: introducing a technique that may improve outcomes
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