Skip to main content
SpringerLink
Log in

Novel Minimal Radiation Approach for Percutaneous Pulmonary Valve Implantation

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

The aim of the study is to evaluate the impact of multimodality imaging technology during percutaneous pulmonary valve implantation (PPVI). Among percutaneous procedures, PPVI traditionally has one of the highest patient radiation exposures. Different protocol modifications have been implemented to address this problem (i.e., improvements in guidance systems, delivery systems, valve design, post-implantation evaluation). Although the effectiveness of individual modifications has been proven, the effect of an approach which combines these changes has not been reported. We performed a retrospective chart review of 76 patients who underwent PPVI between January 2018 and December 2019. Patients were classified in “Traditional protocol,” using routine biplane angiography and/or 3D rotational angiography (3DRA); and “Multimodality protocol” that included the use of VesselNavigator for guidance, selective 3DRA for coronary evaluation, Long DrySeal Sheath for valve delivery, and Intracardiac Echocardiography for valve evaluation after implantation. Radiation metrics, procedural time, and clinical outcomes were compared between groups. When the traditional protocol group was compared with the multimodality protocol group, a significant reduction was described for total fluoroscopy time (31.6 min vs. 26.2 min), dose of contrast per kilogram (1.8 mL/Kg vs. 0.9 mL/Kg), DAP/kg (26.6 µGy·m2/kg vs. 19.9 µGy·m2/kg), and Air Kerma (194 mGy vs. 99.9 mGy). A reduction for procedure time was noted (140 min vs. 116.5 min), but this was not statistically significant. There was no difference in clinical outcomes or the presence of complications between groups. The combination of novel technology in PPVI caused a significant reduction in radiation metrics without increasing the complication rate in our population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available on request from the corresponding author (JEZ).

References

  1. O’Byrne ML, Glatz AC, Mercer-Rosa L, Gillespie MJ, Dori Y, Goldmuntz E et al (2015) Trends in Pulmonary Valve Replacement In Children and Adults with Tetralogy Of Fallot. Am J Cardiol 115(1):118–124. https://doi.org/10.1016/j.amjcard.2014.09.054

    Article  PubMed  Google Scholar 

  2. Martin MH, Meadows J, McElhinney DB, Goldstein BH, Bergersen L, Qureshi AM et al (2018) Safety and Feasibility of Melody Transcatheter Pulmonary Valve Replacement in the Native Right Ventricular Outflow Tract: A Multicenter Pediatric Heart Network Scholar Study. JACC Cardiovasc Interv 11(16):1642–1650. https://doi.org/10.1016/j.jcin.2018.05.051

    Article  PubMed  Google Scholar 

  3. Meadows JJ, Moore PM, Berman DP, Cheatham JP, Cheatham SL, Porras D et al (2014) Use and performance of the Melody Transcatheter Pulmonary Valve in native and postsurgical, nonconduit right ventricular outflow tracts. Circ Cardiovasc Interv 7(3):374–380. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001225

    Article  PubMed  Google Scholar 

  4. Hoffman JIE, Christianson R (1978) Congenital heart disease in a cohort of 19,502 births with long-term follow-up. Am J Cardiol 42(4):641–647. https://doi.org/10.1016/0002-9149(78)90635-5

    Article  CAS  PubMed  Google Scholar 

  5. van der Linde D, Konings EEM, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJM et al (2011) Birth Prevalence of Congenital Heart Disease Worldwide: A Systematic Review and Meta-Analysis. J Am Coll Cardiol 58(21):2241–2247. https://doi.org/10.1016/j.jacc.2011.08.025

    Article  PubMed  Google Scholar 

  6. Johnson JN, Hornik CP, Li JS, Benjamin DK, Yoshizumi TT, Reiman RE et al (2014) Cumulative radiation exposure and cancer risk estimation in children with heart disease. Circulation 130(2):161–167. https://doi.org/10.1161/CIRCULATIONAHA.113.005425

    Article  PubMed  PubMed Central  Google Scholar 

  7. Goldstein BH, Bergersen L, Armstrong AK, Boe BA, El-Said H, Porras D et al (2020) Adverse Events, Radiation Exposure, and Reinterventions Following Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol 75(4):363–376. https://doi.org/10.1016/j.jacc.2019.11.042

    Article  PubMed  Google Scholar 

  8. Cevallos PC, Armstrong AK, Glatz AC, Goldstein BH, Gudausky TM, Leahy RA et al (2017) Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi-center C3PO-QI study. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv 90(2):269–280. https://doi.org/10.1002/ccd.26911

    Article  Google Scholar 

  9. Patel C, Grossman M, Shabanova V, Asnes J (2019) Reducing Radiation Exposure in Cardiac Catheterizations for Congenital Heart Disease. Pediatr Cardiol 40(3):638–649. https://doi.org/10.1007/s00246-018-2039-9

    Article  PubMed  Google Scholar 

  10. Lamers LJ, Morray BH, Nugent A, Speidel M, Suntharos P, Prieto L. Multicenter Assessment of Radiation Exposure during Pediatric Cardiac Catheterizations Using a Novel Imaging System [Internet]. Vol. 2019, Journal of Interventional Cardiology. Hindawi; 2019 [cited 2020 Jun 12]. p. e7639754. Available from: https://www.hindawi.com/journals/jitc/2019/7639754/. DOI: https://doi.org/10.1155/2019/7639754

  11. Goreczny S, Moszura T, Dryzek P, Lukaszewski M, Krawczuk A, Moll J et al (2017) Three-dimensional image fusion guidance of percutaneous pulmonary valve implantation to reduce radiation exposure and contrast dose: A comparison with traditional two-dimensional and three-dimensional rotational angiographic guidance. Neth Heart J 25(2):91–99. https://doi.org/10.1007/s12471-016-0941-4

    Article  CAS  PubMed  Google Scholar 

  12. Nguyen HH, Balzer DT, Murphy JJ, Nicolas R, Shahanavaz S (2016) Radiation Exposure by Three-Dimensional Rotational Angiography (3DRA) During Trans-catheter Melody Pulmonary Valve Procedures (TMPV) in a Pediatric Cardiac Catheterization Laboratory. Pediatr Cardiol 37(8):1429–1435. https://doi.org/10.1007/s00246-016-1453-0

    Article  PubMed  Google Scholar 

  13. Góreczny S, Dryżek P, Moszura T, Łukaszewski M, Podgórski M, Nordmeyer S et al (2018) Magnetic resonance and computed tomography imaging fusion for live guidance of percutaneous pulmonary valve implantation. Postepy W Kardiologii Interwencyjnej Adv Interv Cardiol 14(4):413–421. https://doi.org/10.5114/aic.2018.79871

    Article  Google Scholar 

  14. Goreczny S, Dryzek P, Morgan GJ, Lukaszewski M, Moll JA, Moszura T (2017) Novel Three-Dimensional Image Fusion Software to Facilitate Guidance of Complex Cardiac Catheterization : 3D image fusion for interventions in CHD. Pediatr Cardiol 38(6):1133–1142. https://doi.org/10.1007/s00246-017-1627-4

    Article  PubMed  Google Scholar 

  15. Fukuda T, Tan W, Sadeghi S, Lin J, Salem M, Levi D et al (2020) Utility of the long DrySeal sheath in facilitating transcatheter pulmonary valve implantation with the Edwards SAPIEN 3 valve. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. https://doi.org/10.1002/ccd.28776

    Article  Google Scholar 

  16. Kenny D, Morgan GJ, Murphy M, AlAlwi K, Giugno L, Zablah J et al (2019) Use of 65 cm large caliber Dryseal sheaths to facilitate delivery of the Edwards SAPIEN valve to dysfunctional right ventricular outflow tracts. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv 94(3):409–413. https://doi.org/10.1002/ccd.28409

    Article  Google Scholar 

  17. Goreczny S, Zablah J, McLennan D, Ross M, Morgan G (2019) Multi-modality imaging for percutaneous pulmonary valve implantation – getting serious about radiation and contrast reduction. Postępy W Kardiologii Interwencyjnej Adv Interv Cardiol 15(1):110–115. https://doi.org/10.5114/aic.2019.83776

    Article  Google Scholar 

  18. Miyake CY, Mah DY, Atallah J, Oikle HP, Melgar ML, Alexander ME et al (2011) Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia. Heart Rhythm 8(4):519–525. https://doi.org/10.1016/j.hrthm.2010.12.022

    Article  PubMed  Google Scholar 

  19. Whiteside W, Pasquali SK, Yu S, Bocks ML, Zampi JD, Armstrong AK (2015) The Utility of Intracardiac Echocardiography Following MelodyTM Transcatheter Pulmonary Valve Implantation. Pediatr Cardiol 36(8):1754–1760. https://doi.org/10.1007/s00246-015-1230-5

    Article  PubMed  Google Scholar 

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

  1. The Heart Institute, Children’s Hospital Colorado, 13123 East 16th Avenue, Box 100, Aurora, CO, USA

    Jenny E. Zablah, Salvador A. Rodriguez, Ryan Leahy & Gareth J. Morgan

  2. School of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA

    Jenny E. Zablah, Salvador A. Rodriguez, Ryan Leahy & Gareth J. Morgan

  3. Department of Cardiology, University of Colorado Hospital, Aurora, CO, USA

    Gareth J. Morgan

Authors
  1. Jenny E. Zablah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Salvador A. Rodriguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryan Leahy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gareth J. Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JEZ, SARF, and GJM. The first draft of the manuscript was written by JEZ, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jenny E. Zablah.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to report.

Ethical Approval

Data collection and analysis were conducted under the permission of the Children's Hospital of Colorado Institutional Review Board (Record IRB Number 18–2138).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (docx 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zablah, J.E., Rodriguez, S.A., Leahy, R. et al. Novel Minimal Radiation Approach for Percutaneous Pulmonary Valve Implantation. Pediatr Cardiol 42, 926–933 (2021). https://doi.org/10.1007/s00246-021-02564-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-021-02564-7

Keywords

Search

Navigation