Abstract
Transcatheter pulmonary valve (TPV) replacement is an effective therapy of right ventricular
outflow tract conduit dysfunction. Acute complications after TPV implantation include
infective endocarditis, stent fracture, and device dislocation. We present a novel,
life-threatening complication: an acute, noninfectious TPV thrombosis. Within 24 hours
after implantation of a Melody system (Medtronic, Inc, Minneapolis, MN), the patient
developed an acute TPV thrombosis characterized by severe TPV stenosis on echocardiography
and contrast filling defects on computed tomography pulmonary angiography images.
Genetic testing revealed heterozygous prothrombin G20210A polymorphism and homozygous
4G/4G polymorphism of the plasminogen-activator-inhibitor. The patient recovered after
surgical valve replacement with a pulmonary homograft.
Résumé
Le remplacement de la valve pulmonaire par cathéter (VPC) est un traitement efficace
contre la dysfonction de la chambre de chasse du ventricule droit. Les complications
à court terme après l’implantation de la VPC sont les suivantes : l’endocardite infectieuse,
la fracture de l’endoprothèse et la dislocation du dispositif. Nous présentons une
nouvelle complication mettant en danger la vie du patient, soit la thrombose non infectieuse
de la VPC. Dans les 24 heures qui suivent l’implantation d’un dispositif Melody (Medtronic
inc., Minneapolis, MN), le patient a subi une thrombose aiguë de la VPC caractérisée
par une sténose grave de la VPC selon les images de l’échocardiographie et des défauts
de remplissage du produit de contraste selon les images de l’angiographie pulmonaire
par tomodensitométrie. Le dépistage génétique a révélé un polymorphisme G20210A de
la prothrombine à l’état hétérozygote et un polymorphisme 4G/4G à l’état homozygote
de l’inhibiteur des activateurs du plasminogène. Le patient s’est rétabli après la
chirurgie de remplacement valvulaire par homogreffe pulmonaire.
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References
- Noninfective transcatheter pulmonary valve thrombosis: a rare cause of post-implantation pulmonary valve obstruction.JACC Cardiovasc Interv. 2017; 10: e119-e122
- Non-infectious thrombosis of the Melody® valve: a tale of two cities.Catheter Cardiovasc Interv. 2016; 88: 600-604
Article info
Publication history
Published online: August 20, 2018
Accepted:
August 14,
2018
Received:
July 8,
2018
Footnotes
See page 1688.e15 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- ErratumCanadian Journal of CardiologyVol. 35Issue 6
- PreviewIn the article, “First Report of an Acute, Obstructive Thrombosis of a Melody Valve Used for Transcatheter Pulmonary Replacement” by Kellermair et al., published in the December 2018 issue (Can J Cardiol 2018;34:1688.e13-15), the authors’ first and last names were transposed for all but the first author. The author list should be corrected as follows:
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