Clinical Application Of Percutaneous Pulmonary Valve Implantation In Patients With Pulmonary Valve Regurgitation

ObjectiveThis study was designed to evaluate the safety and efficacy of PPVI in domestic self-expanding Venus-P valve system in patients with severe pulmonary regurgitation for postoperation of tetralogy of fallot.MethodsA retrospective analysis of 12 patients with severe pulmonary valve episodes of PPVI after treatment of tetralogy of fallot from December 2017 to March 2019.The domestic self-expanding Venus-P valve system was used in all 12 patients.Screening patients with viable PPVI based on clinical symptoms and echocardiography,CT(Computed Tomography,CT),cardiac magnetic resonance(CMR),chest X-ray,electrocardiogram,and cardiac catheterization.Regular follow-up after surgery included:immediate postoperative,1 month,3 months,6 months postoperatively,and 1 year postoperatively.Follow-up included:echocardiography,chest X-ray,electrocardiogram,CT,CMR examination,laboratory examination..The efficacy of PPVI were evaluated by comparing the degree of pulmonary valve regurgitation,the changes of cardiac function indexes and the occurrence of complications before and after operation.ResultsAll 12 patients were successfully implanted with Venus-P valve stent,with a success rate of 100%,no deaths.No stent displacement or shedding occurred,no perivalvular leak occurred and no coronary compression occurred in 12 patients.The clinical symptoms of the patients improved and NYHA cardiac function grading improved significantly.The clinical symptoms of the patients were improved,and the NYHA cardiac function grade was significantly improved compared with the preoperation.The average fluoroscopy time in the procedure of PPVI was(25.54±5.92)min.The diameter of the pulmonary valve annulus measured by balloon was(26.1±4.81)mm during the PPVI operation.The Venus-P valves were used,included:3 diameters of 28 mm,2 diameters of 30 mm,5 diameters of 32 mm,1 diameter of 34 mm,and 1diameter of 36 mm.All patients underwent immediate esophageal ultrasonography:Immediate esophageal ultrasonography showed that no reflux or micro pulmonary valve regurgitation in all patients,and no mild or above pulmonary valve regurgitation occurred.The patient's tricuspid valve is a small amount of pulmonary valve regurgitation.All patients had no complications such as endocardial infection,stent fracture,stent shedding,and coronary compression.Cardiac magnetic resonance imaging was performed before and after the operation.The RVEDVI of 11 patients who completed 6 months follow-up was(144.45±12.29)ml/m~2 before the operation,and the average RVEDVI of 6 months after the operation was(86.09±12.96)ml/m~2,P<0.05 was considered statistically significant.The electrocardiogram showed that the width of QRS wave was narrowed obviously.A routine X-ray examination of the patient showed satisfactory position of the Venus-P valve,no displacement,and stent fracture.Conclusion1.The application of Venus-P valve for PPVI is safe and effective.It is preliminarily indicated that the Venus-P valve is suitable for domestic patients with transvalvular patch.2.With the continuous advancement of interventional techniques,the indications for the use of Venus-P valves for PPVI will continue to expand.3.Venus-P valve system is the first domestic self-expanding valve system,and there is no similar product.At present,the effect of PPVI in the Venus-P valve is a short-term follow-up result.The sample size of the study is small.The mid-and long-term follow-up results and a larger sample size are needed to confirm the safety of the valve system.Effectiveness and durability.