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Percutaneous pulmonary valve implantation with anomalous left anterior descending coronary artery

Published online by Cambridge University Press:  21 May 2018

Dennis VanLoozen  and
Zahid Amin
Dennis VanLoozen
Affiliation:
Department of Pediatric Cardiology, Children’s Hospital of Georgia, Augusta University, Augusta, GA 30912, USA
Zahid Amin*
Affiliation:
Department of Pediatric Cardiology, Children’s Hospital of Georgia, Augusta University, Augusta, GA 30912, USA
*
Author for correspondence: Z. Amin, MD, Department of Pediatric Cardiology, Children’s Hospital of Georgia, Augusta University, 1120 15th Street BA 8300, Augusta, GA 30912, USA. Tel: +706 721 2336; Fax: +706 721 3838; E-mail: zamin@augusta.edu
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Abstract

Percutaneous pulmonary valve placement in patients with an anomalous coronary artery is rare and can be complicated by coronary artery compression. We report successful implantation of a percutaneous pulmonary valve in a patient with an anomalous left anterior descending artery.

Keywords

Percutaneous pulmonary valveanomalous coronary arterytranscatheter paediatric intervention
Type
Images in Congenital Cardiac Disease
Information
Cardiology in the Young , Volume 28 , Issue 7 , July 2018 , pp. 968 - 969
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Copyright
© Cambridge University Press 2018 

Case

A 10-year-old girl with double outlet right ventricle with severe pulmonary valve stenosis status post surgical repair with a right ventricle to pulmonary artery conduit required multiple conduit replacements and developed severe conduit stenosis. She also had an anomalous left anterior descending artery arising from the right coronary artery. Due to increasing right ventricle hypertension and hypertrophy, she underwent percutaneous pulmonary valve placement.

The diagnostic portion of the procedure was performed in the usual manner. Due to the risk of coronary artery compression with percutaneous valve placement,Reference Fraisse and Assaidi 1 great care was taken to ensure sufficient distance of the coronaries from the calcified conduit. Right coronary artery angiography showed an anomalous left anterior descending artery arising from the proximal right coronary artery and travelling posteriorly (Fig 1a and b). The conduit was significantly calcified. A 20 mm×4 cm Z-med II balloon (B. Braun, Bethlehem, Pennsylvania, United States of America) was inflated in the conduit with simultaneous right coronary artery angiography, showing no compression. This was repeated with a 22 mm×2 cm Atlas Gold balloon (Bard PV, Tempe, Arizona, United States of America) (Fig 2). After inflation of the non-compliant balloon demonstrated no coronary artery obstruction, a 23-mm Edwards SAPIEN XT valve (Edwards, Irvine, California, United States of America) was implanted in the usual manner. Repeat angiography showed no coronary compression (Fig 3a and b).

Figure 1 Anomalous left anterior descending artery origin from the proximal right coronary artery; anteroposterior ( a ) and lateral ( b ).

Figure 2 Right coronary artery angiography with inflation of the Atlas Gold balloon showed no obstruction.

Figure 3 Right coronary artery angiography after valve implantation showed no obstruction; anteroposterior ( a ) and lateral ( b ).

Percutaneous pulmonary valve placement in patients with coronary artery anomalies should be approached with caution, but can be safely performed.

Acknowledgements

The authors would like to acknowledge the assistance of their catheterization lab staff in the assistance of care for this patient.

Financial Support

This research received no specific grant from any funding agency or from commercial or not-for-profit sectors.

Conflicts of Interest

None.

Ethical Standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national guidelines on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008, and has been approved by the institutional committees.

References

1. Fraisse, A, Assaidi, A, Mauri L, et al. Coronary artery compression during intention to treat right ventricle outflow with percutaneous pulmonary valve implantation: incidence, diagnosis, and outcome. Catheter Cardiovasc Interv 2014; 83 (7): E260–E268.CrossRefGoogle ScholarPubMed
Figure 0

Figure 1 Anomalous left anterior descending artery origin from the proximal right coronary artery; anteroposterior (a) and lateral (b).

Figure 1

Figure 2 Right coronary artery angiography with inflation of the Atlas Gold balloon showed no obstruction.

Figure 2

Figure 3 Right coronary artery angiography after valve implantation showed no obstruction; anteroposterior (a) and lateral (b).