Transcatheter Pulmonary Valve Replacement Candidacy: Is Cardiovascular Magnetic Resonance Angiography Enough?

Transcatheter pulmonary valve replacement (TPVR) has become a standard therapy for patients with congenital heart disease and right ventricular outflow tract obstruction or pulmonary regurgitation. 1 McElhinney DB Zhang Y Levi DS Georgiev S Biernacka EK Goldstein BH Shahanavaz S Qureshi AM Cabalka AK Bauser-Heaton H Torres AJ Morray BH Armstrong AK Millan-Iturbe O Peng LF Aboulhosn JA Rużyłło W Berger F Sondergaard L Schranz D Cheatham JP Jones TK Ewert P Schubert S. Reintervention and survival after transcatheter pulmonary valve replacement. J Am Coll Cardiol. 2022; 79: 18-32 Crossref PubMed Scopus (19) Google Scholar Recent guidelines on adult congenital heart disease state that TPVR should be preferred over surgical pulmonary valve replacement in patients with tetralogy of Fallot with no native outflow tracts or patients with right ventricular to pulmonary artery conduits. 2 Baumgartner H De Backer J Babu-Narayan SV Budts W Chessa M Diller GP Lung B Kluin J Lang IM Meijboom F Moons P Mulder BJM Oechslin E Roos-Hesselink JW Schwerzmann M Sondergaard L Zeppenfeld K European Society of Cardiology Scientific Document Group. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021; 42: 563-645 Crossref PubMed Scopus (0) Google Scholar However, in patients with severe pulmonary regurgitation who have a native outflow tract, open heart surgery is still the recommended method of choice. The Harmony transcatheter pulmonary valve (Medtronic, Minneapolis, Minnesota) and the combination of the Edwards SAPIEN 3 transcatheter valve and the Alterra adaptive prestent (Edwards Lifesciences Corporation, California) are newly developed devices for patients with severe pulmonary regurgitation who have native outflow tracts, and are approved by the US Food and Drug Administration. They are promising alternatives to open heart surgery, but nevertheless, as pointed out by Wilson et al 3 Wilson HC Hashemi S Smith C Sallee III D Kim DW Slesnick TC. Comparison of cardiac CT and MRA measurements for determination of candidacy for transcatheter pulmonary valve replacement in native or post-surgical right ventricular outflow tracts. Am J Cardiol. 2023; 206: 98-100 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar in this month's issue, preinterventional assessments include computed tomography (CT), 4 Shahanavaz S Balzer D Babaliaros V Kim D Dimas V Veeram Reddy SR Leipsic J Blanke P Shirali G Parthiban A Gorelick J Zahn EM Alterra adaptive prestent and SAPIEN 3 THV for congenital pulmonic valve dysfunction: an early feasibility study. JACC Cardiovasc Interv. 2020; 13: 2510-2524 Crossref PubMed Scopus (34) Google Scholar ,5 Gillespie MJ Benson LN Bergersen L Bacha EA Cheatham SL Crean AM Eicken A Ewert P Geva T Hellenbrand WE Hor KN Horlick EM Jones TK Mayer J McHenry BT Osten MD Powell AJ Zahn EM Cheatham JP. Patient selection process for the harmony transcatheter pulmonary valve early feasibility study. Am J Cardiol. 2017; 120: 1387-1392 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar although radiation-free cardiovascular magnetic resonance (CMR) angiography is likely to suffice. 3 Wilson HC Hashemi S Smith C Sallee III D Kim DW Slesnick TC. Comparison of cardiac CT and MRA measurements for determination of candidacy for transcatheter pulmonary valve replacement in native or post-surgical right ventricular outflow tracts. Am J Cardiol. 2023; 206: 98-100 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar