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Simultaneous Balloon Technique for Adjusting Placement of a Self-Expanding Pulmonary Valve
Christopher Herron1, Karen Iacono1, David Nykanen1
1Division of Pediatric Cardiology, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida, USA.
Objective:
To describe the use of a balloon-assisted technique for placement of a Harmony valve in a patient with tetralogy of Fallot and a dilated right ventricular outflow tract (RVOT).
Key Steps:
Harmony valve malalignment can happen with pyramidal-type outflow tracts. Using a large compliant balloon, we inflated the balloon across the misaligned segment of the partially deployed Harmony valve. Once correctly aligned in the RVOT, we proceeded with standard deployment.
Potential Pitfalls:
Retrieval of the valve back into the delivery catheter can be difficult to impossible and may require use of a Gore 26-F DrySeal sheath to retrieve.
Take-Home Messages:
Complex and dilated RVOTs make deployment of self-expanding valves difficult, with a higher probability of malalignment. We describe a simple "buddy balloon" technique for reorienting the distal valve apparatus to reposition the valve optimally in the RVOT before release.
