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Treatment of native right ventricular outflow tract (RVOT) dysfunction with predominant pulmonary regurgitation has become a catheter-based procedure since the introduction of the RVOT reducer devices such as the Alterra prestent (Edwards Lifesciences). These devices have potential complications. One such complication is the migration or embolization of the stent. Herein, we present 2 cases of patients with native RVOT dysfunction who underwent the implantation of the Alterra prestent complicated by proximal migration of the stent, which was managed by placement of a second Alterra prestent in 1 case and repositioning of the prestent in the second case.
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http://dx.doi.org/10.1016/j.jaccas.2024.103107 | DOI Listing |
J Soc Cardiovasc Angiogr Interv
June 2025
Division of Pediatric Cardiology, Department of Pediatrics, The Congenital Heart Collaborative, Case Western Reserve University School of Medicine, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio.
The Alterra Adaptive Prestent is approved for the treatment of patients with severe pulmonary regurgitation who have dilated native or surgically repaired right ventricle outflow tracts. This device provides a landing zone for transcatheter pulmonary valve replacement with a 29-mm SAPIEN 3 transcatheter heart valve. We present a case of transcatheter pulmonary valve replacement using a 26-mm SAPIEN S3 Ultra valve within the Alterra due to concern for coronary compression, with an excellent procedural outcome.
View Article and Find Full Text PDFChildren (Basel)
April 2025
Pediatric Cardiology Unit, AORN "Ospedali dei Colli", Monaldi Hospital, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
Pulmonary disfunction is frequent in repaired congenital heart diseases. Both pulmonary regurgitation and pulmonary stenosis are possible complications over time. In the past, the surgical approach was the only feasible management but exposed the patient to a redo-surgery with its consequent risks.
View Article and Find Full Text PDFJACC Case Rep
March 2025
Department of Pediatrics, Rady Children's Hospital/University of California-San Diego School of Medicine, San Diego, California, USA.
Self-expanding valve platforms are providing new and versatile options for transcatheter pulmonary valve replacement in patients with a large native or patched right ventricular outflow tract. We describe 4 cases of acute reintervention required after successful implantation of an Alterra Adaptive Prestent followed by SAPIEN S3.
View Article and Find Full Text PDFJACC Case Rep
March 2025
Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Treatment of native right ventricular outflow tract (RVOT) dysfunction with predominant pulmonary regurgitation has become a catheter-based procedure since the introduction of the RVOT reducer devices such as the Alterra prestent (Edwards Lifesciences). These devices have potential complications. One such complication is the migration or embolization of the stent.
View Article and Find Full Text PDFPediatr Cardiol
January 2025
School of Medicine, Children's Hospital Colorado, The Heart Institute, University of Colorado Denver|Anschutz Medical Campus, 13123 E 16Th Ave, Box 100, Aurora, CO, 80045-2560, USA.
Though major complications during transcutaneous pulmonary valve replacement (TPVR) are rare, clinically-significant ventricular arrythmia (CSVA) has been reported following self-expanding valve placement. We assess whether alterations in valve frame dimensions and geometry within the right ventricular outflow tract (RVOT) post-implantation in patients who underwent TPVR with Harmony TPV25 or Alterra contribute to CSVA risk. A single center review was performed of patients who underwent TPVR with either Harmony TPV25 or Alterra Pre-stent between August 2019 and April 2023.
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