Question

Discuss the following for a patient with repaired tetralogy of Fallot:
Pre-procedural planning for percutaneous pulmonary valve implantation.

Hint:

Accurate pre-procedural planning with imaging and careful patient selection is critical for the success of percutaneous pulmonary valve implantation.

Answer 1

Step 1: Patient Selection:
1. Anatomical Considerations: Patients must have adequate right ventricular size, and the pulmonary artery must be large enough to accommodate the valve.
2. Assessment of Valve Function: Pre-procedural imaging (usually MRI or CT) is essential to evaluate the pulmonary valve annulus and the condition of the right ventricle and pulmonary arteries.
3. Exclusion Criteria: Severe tricuspid valve regurgitation or significant arrhythmias may exclude patients from the percutaneous procedure and indicate the need for surgical intervention.
Step 2: Procedure Preparation:
1. Pre-procedural Imaging: MRI or CT scans are performed to assess the anatomy of the right ventricular outflow tract, pulmonary artery, and annulus for accurate valve sizing.
2. Anesthesia and Sedation: The procedure is usually performed under local anesthesia with sedation, and appropriate vascular access should be secured.
3. Device Selection: Sizing of the percutaneous pulmonary valve is based on pre-procedural imaging and patient anatomy. The right valve size and positioning must be carefully selected.