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(Circulation. 2006;113:e934-e935.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Transcatheter Right Ventricular Outflow Tract Intervention

The Risk to the Coronary Circulation

Shankar Sridharan, MRCPCH; Louise Coats, MRCP; Sachin Khambadkone, MD; Andrew M. Taylor, MD, MRCP, FRCR; Philipp Bonhoeffer, MD

From the UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.

Correspondence to Dr Shanker Sridharan, Cardiothoracic Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK. E-mail sridhs1{at}gosh.nhs.uk

A 14-year-old male with degeneration of his right ventricular to pulmonary artery homograft conduit was referred to us for percutaneous pulmonary valve implantation (PPVI).¹ Magnetic resonance imaging indicated close proximity of the left anterior descending coronary artery to the homograft (Figure, A). To test whether PPVI would compress the coronary artery, an 18-mm Mullins balloon (NuMed Inc, Hopkinton, NY) was inflated within the homograft, bringing it to its maximum diameter and mimicking stent implantation. Simultaneous selective coronary angiography demonstrated significant compression of the left anterior descending coronary artery (Figure, B). The balloon was deflated, after which normal coronary flow was restored (Figure, C), and thus PPVI was not performed. The patient was referred for surgery.

View larger version (83K): [in this window] [in a new window]   A, Two-dimensional reconstruction of left anterior descending coronary artery (arrows) using a 3-dimensional true fast imaging with stead state precision navigator echo-gated magnetic resonance coronary angiogram sequence. B, Compression of the left anterior descending coronary artery during balloon inflation of the homograft (left anterior oblique projection with 20° of cranial angulation). C, Restoration of normal coronary flow after deflation of the Mullins balloon (left anterior oblique projection with 20° of cranial angulation).

	Sources of Funding

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Dr Coats has received a British Heart Foundation Junior Fellowship Grant. Dr Taylor’s work is funded by an HEFCE grant. Dr Bonhoeffer has received a British Heart Foundation Programme Grant.

Disclosures

Dr Coats has received honoraria from Sanofi Aventis and Medtronic. Dr Taylor serves as a consultant for Medtronic. Professor Bonhoeffer serves as a consultant for Medtronic and NuMed. Drs Sridharan and Khambadkone report no conflicts.

	Reference

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1. Khambadkone S, Coats L, Taylor AM, Boudjemline Y, Derrick G, Tsang V, Cooper J, Muthurangu V, Hegde SR, Razavi RS, Pellerin D, Deanfield J, Bonhoeffer P. Transcatheter pulmonary valve implantation in humans: initial results in 59 consecutive patients. Circulation. 2005; 112: 1189–1197.[Abstract/Free Full Text]
   

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sridharan, S. Articles by Bonhoeffer, P. Search for Related Content PubMed PubMed Citation Articles by Sridharan, S. Articles by Bonhoeffer, P. Related Collections Catheter-based coronary and valvular interventions: other Pediatric and congenital heart disease, including cardiovascular surgery