Patients and methods. Between August 2007 to February 2008 for the first time, we performed minimally invasive trans-ventricular pulmonary valve replacement operations in 13 patients in series. Patient’s ages ranged from 3 to 26 years all of whom complained of pulmonary valve complications. All the cases had a previous operation for the Tetralogy of Fallot repair except one. Median sternotomy with limited exposure of the right ventricle is performed, then the Contegra 200 pulmonary valve (Medtronic, Inc. USA) is transfixed inside a CP stent (NuMed, Inc. USA) using multiple 5/0 prolene sutures. A Cristal balloon catheter (Balt, France) crimps the valve/stent composite. A small purse-string then introduces the valve/stent and the balloon via a placed at the RVOT. The stent/valve composite is then expanded in the pulmonary valve position.
Results. Hospital stay ranged from 4 to 9 days and no mortalities are reported so far. The mean follow up was 6 months (2-12 months range). 53% had no PV insufficiency postoperatively, 31% had mild or trivial insufficiency while 15% had moderate regurgitation. 70% of the cases had mild to moderately depressed RV function with good LV function except for one case that had mildly depressed LV function as well. In the post-operatively follow up period all the cases showed good RV and LV functions except one that his RV remained dilated after 4 months. One case had a tilted valve that was corrected through percutaneous balloon.
Discussion. Trans-ventricular PVR can be performed with high survival and minimal complications.