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      Percutaneous insertion of the pulmonary valve.

      Journal of the American College of Cardiology
      Adolescent, Adult, Bioprosthesis, Cardiac Catheterization, instrumentation, Child, Echocardiography, Doppler, Female, Heart Valve Prosthesis Implantation, Humans, Male, Minimally Invasive Surgical Procedures, Prosthesis Design, Pulmonary Valve Insufficiency, surgery, ultrasonography, Pulmonary Valve Stenosis, Reoperation, Ventricular Outflow Obstruction

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          We report our experience of percutaneous valve insertion in pulmonary position in humans. Over the past 40 years, prosthetic conduits have been developed to surgically establish continuity between the right ventricle and the pulmonary artery. However, stenosis and insufficiency of the conduit due to valvular degeneration or panus ingrowth frequently occur, limiting patients' lifespan. Percutaneous stenting of conduits has recently emerged as a technique for delaying surgical replacement, but it creates a pulmonary regurgitation when crossing the valve. Seven children and one adult with stenosis and/or insufficiency of the pulmonary graft underwent percutaneous implantation of a bovine jugular valve in pulmonary position. Percutaneous pulmonary valve (PV) replacement was successful in all patients. No complications occurred in early follow-up. Angiography, hemodynamic studies and echocardiography after the procedure showed no significant regurgitation of the implanted valve. Implantation was effective in relieving the obstruction in five patients. All patients showed improvement in their clinical status at the latest follow-up (mean 10.1 months). Non-surgical insertion of the PV is possible without any major complications. This new technique may have an important role in the management of conduit obstructions and pulmonary regurgitation.

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