Percutaneous pulmonary valve implantation (PPVI) is used to treat pulmonary valve dysfunction after correction of congenital heart defects.
Coronary compression is a feared complication of PPVI and it is seen in about 5% of patients during test balloon inflation before PPVI is performed.
To avoid this severe complication,
aortic root or selective coronary angiography is routinely performed with simultaneous test high-pressure balloon inflation in the pulmonary valve landing zone prior to pre-stenting a PPVI.
Non-invasive cardiac CT is often suggested for pre-procedural imaging in PPVI,...
Methods and Materials
Retrospective evaluation of patients who underwent cardiac CT prior to PPVI and didn’t experience coronary artery compression during the angiographic procedure.
Using double oblique reconstructed images,
the minimal distances between each coronary artery (right coronary artery - RCA,
left main - LM,
left descending artery - LAD,
left circumflex - LCx) and the stenotic part of the pulmonary trunk/conduit (or the site of the future valve implantation) were measured (Fig.
In cases with both diastolic and systolic phases available the pulmonary trunk diameters were...
Thirty patients were included.
All patients successfully underwent the procedure and none of them experienced coronary compression.
The minimal distance between the RCA,
LAD and LCx to the stenotic part of the pulmonary tract was 13.5±7.8 mm (range from 3,5 to 41 mm),
16.2±9.6 mm (range from 4 to 38,5 mm),
14.2±8.6 mm (range from 3 to 32 mm) and 23.7±11.2 mm (range from 9 to 47 mm),
All coronaries were at least at 3 mm distance from the pulmonary tract.
In patients who underwent PPVI without signs of coronary compression a distance of at least 3 mm between the coronary arteries and the pulmonary trunk/conduit was present.
Cardiac CT is a helpful technique to select suitable patients for PPVI.
The minimum distance between coronary arteries and the pulmonary conduit is also affected by the changes due to different cardiac phases; therefore CT should always be conducted with gated acquisition including both diastolic and systolic phase.
“Percutaneous Pulmonary Valve Implantation.
Present Status and Evolving Future,” J.
“Risk of coronary artery compression among patients referred for transcatheter pulmonary valve implantation a multicenter experience,” Circ.