Spring 2013

Case Study: Transcatheter Pulmonary Implant

When a child born with tetralogy of Fallot absent pulmonary valve syndrome was not quite 2 months old, a cardiothoracic surgeon at UCSF Benioff Children’s Hospital closed his ventricular septal defect by inserting a tube fitted with a human homograft valve between the right ventricle and pulmonary artery. At age 3, the boy underwent another open procedure to replace the first homograft valve.

For the next decade, he lived without limitations in his Bay Area suburb.

But as the boy approached his 14th birthday, a Holter monitor uncovered data that indicated the valve had begun to outlive its usefulness. Though the boy felt fine, his community physicians began speaking to the family about choosing between another open surgery and a Melody transcatheter pulmonary valve implant, a procedure that had been developed in the intervening decade.

Opting for the Less Invasive Procedure

Dr. Phillip Moore

Dr. Phillip Moore

Ultimately, the family decided on the transcatheter procedure, in which the interventional cardiologist uses a balloon catheter to insert a new valve and stent inside the old valve. Once the catheter is in place, the cardiologist expands the stent and valve to create a new, functional opening.

Interventional cardiologist Phillip Moore, M.D., director of the Pediatric Cardiac Catheterization Laboratory at UCSF Benioff Children’s Hospital, and his colleagues at UCSF helped pioneer this procedure on the West Coast and have accumulated considerable experience with it.

Faster Recovery, Less Pain

transcatheter pulmonary implant

Though the transcatheter procedure is still not widely available outside of major academic medical centers, the advantages for patients are apparent. By avoiding open-heart surgery, patients recover in four to five days, as opposed to four to five weeks, with considerably less postsurgical pain. Generally, patients return home the next day and resume full activity three to four days later.

"For some time, our goals for patients with congenital heart defects have been to make longer-lasting valves, and ones that we can implant with less patient risk. The transcatheter procedure demonstrates we've made good progress on the latter, but we still have a way to go on the former," Moore says.

This patient will require ongoing monitoring, but with good follow-up care and a valve replacement every 20 years or so, he can expect a normal life and life expectancy.

For more information, contact Dr. Phillip Moore at (415) 353-4140.


Spring 2013 Table of Contents

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