Congenital heart disease (CHD) is the most common type of birth defect, the estimated number of children born with congenital heart disease in India is more than 200,000 per year. Approximately 20% of CHD patients have structural malformations that disrupt the connection between the heart and the lungs, called the right ventricular outflow tract (RVOT).
Dr. S Radhakrishnan, Director Pediatric Cardiology Department – Fortis Escorts Heart Institute, Okhla, New Delhi, says, “Patients with congenital heart disease affecting the right ventricle outflow tract (RVOT) often require surgery at a young age with a right ventricle-pulmonary artery (RV-PA) conduit or surgical pulmonary valves. In the growing child, the outgrowth of the conduit(s) occurs, causing narrowed and/or leaky conduit or surgical valve. In medical terms, this narrowing of the valve is called pulmonary valve stenosis and leaking of the valve is called pulmonary valve regurgitation.”
Irrespective of the cause of conduit failure, the need for multiple open-heart surgeries for conduit revisions became the rule for these patients. These multiple surgical revisions lead to increased mortality in these patients. Significant pulmonary regurgitation leads to right Heart dilatation, heart rhythm issues, impaired exercise capacity, and an increased risk of sudden death.2
“The affected valve can be treated by balloon dilation (valvuloplasty) as well as through open-heart surgery. However, a new development is the TPVI or the Transcatheter Pulmonary Valve Implantation”, added Dr Radhakrishnan.
For nearly 20 years, investigators have attempted to come up with nonsurgical treatment for failed conduits and valves. First surgery was performed in Paris in 2000 without opening the chest, the surgery was done from the small incision in the leg for the failing Pulmonic Valve using Transcatheter Pulmonary Valve. Since then, rapid advancements in the development of percutaneous catheter-based therapies for cardiac valve repair have occurred.3
This line of treatment is done following surgery on a child for congenital heart disease. This line of treatment has seen the life expectancy of patients improve, as a result of which the demand for TPVI is on the rise. Also, procedure-related morbidity and mortality are low in TPVI.
The aim of this novel catheter intervention was to reduce the total number of open-heart surgeries over a patient’s lifetime. Also, this technology aids in treating young and adult patients less invasively, leading to reduced pain and improved quality of life.
Dr. Sushil Azad Principal Consultant Pediatric Cardiology Department – Fortis Escorts Heart Institute, Okhla, New Delhi, says, “In these subset of patients, multiple surgeries do carry an associated increased risk of complications. With TPVI, the pulmonary valve is replaced with a new valve while your heart is still beating. It does not require patients to have their chest cut open and use heart-lung bypass. The entire procedure lasts for 1-2 hours and within 12 hours of the procedure the patient can walk around and is discharged in 2-3 days. These transcatheter pulmonary valve (TPV) has also demonstrated consistent good valve performance through 10 years with strong valve efficacy”
Transcatheter valve therapy for RVOT conduit dysfunction has been shown to be feasible, safe, and effective, with high procedural success rates and low adverse event rates.