Branch Pulmonary Artery Jailing With a Bare Metal Stent to Anchor a Transcatheter Pulmonary Valve in Patients With Patched Large Right Ventricular Outflow Tract

Abstract

Although transcatheter pulmonary valve replacement using the Melody valve (Medtronic Inc, Minneapolis, MN) has become widely adopted, it has only been formally studied in patients with right ventricle–to–pulmonary artery conduits <22 mm in diameter.1,2 Such patients compose only a small proportion of individuals with right ventricular outflow tract (RVOT) dysfunction, and there is interest and potential utility to broadening the indications for Melody valve implantation. We report nonstandard use of Melody valve in 3 noncandidate patients and discuss salient technical points. ### Patient 1 A 25-year-old man with early surgical correction of pulmonary atresia intact septum during infancy, presented with severe PR and no gradient across the RVOT and branch pulmonary arteries (PAs). Calibration using a compliant balloon showed RVOT diameter of 25 mm, making the patient unsuitable for the Melody valve, using the conventional technique (Figure 1 and online-only Data Supplement video clips I and II). Figure 1. Cineangiogram still frames demonstrate the jailing technique in patient 1. A , Angiogram on 4-chamber view shows the anatomy of the right ventricular outflow tract (RVOT) and pulmonary artery (PA) tree. B , RV angiogram after placement of open-cell, bare metal stents shows symmetrical perfusion of the 2 PAs and incomplete apposition of the stents to the RVOT. C , Angiogram shows opening of the cells at the level of the jailed PA before Melody insertion. D , Final angiogram shows reduction of pulmonary regurgitation with a small amount of paraprosthetic leak. ### Patient 2 An 18-year-old man with pulmonary atresia and ventricular septal defect underwent palliative Blalock-Taussig shunt in the immediate postnatal period and subsequently, complete repair without pulmonary valved or nonvalved conduit. A false RVOT aneurysm was closed, using an atrial septal defect occluder. The patient presented with native left PA stenosis, severe pulmonary regurgitation (PR), and worsening functional status. There was no gradient …