Pulmonary Regurgitation

The pulmonary valve lies between the right ventricle and the pulmonary artery and allows blood to flow in one direction only, toward the lungs. When this valve does not close completely, part of the blood leaks back into the heart. This condition is called pulmonary regurgitation. Pulmonary regurgitation may be seen particularly in patients who have undergone surgery for congenital heart disease. Over the years, dilatation and impaired function of the right side of the heart may develop.

As the disease progresses, the following may develop:

• Shortness of breath (dyspnoea)
• Tiring easily
• Reduced exercise capacity
• Palpitations
• Swelling in the legs
• Cardiac rhythm disturbances (arrhythmias)

Transcatheter pulmonary valve therapy

Transcatheter pulmonary valve implantation is the replacement of a diseased pulmonary valve, or of a previously implanted bioprosthetic valve, using a catheter-based technique, without the need for surgery. This approach allows many patients to be treated without undergoing repeat open-heart surgery.

How is the procedure performed?

The procedure is performed in the angiography laboratory. Access is usually obtained through the femoral vein in the groin. The new valve is advanced to the heart on a dedicated catheter and is positioned inside the existing valve, or inside the previously implanted bioprosthetic valve. Once the new valve has been deployed, the backward leakage of blood is eliminated or markedly reduced. After the procedure, patients are most often discharged within a few days.

In which patients is it performed?

Transcatheter pulmonary valve therapy is performed particularly in patients who:

• have severe pulmonary regurgitation
• have developed dilatation or impaired function of the right heart
• have shortness of breath and reduced exercise capacity
• have previously undergone surgery for congenital heart disease
• are at risk for repeat open-heart surgery
• are considered suitable by the heart team

What are the advantages of the treatment?

• It can be performed without the need for open-heart surgery.
• The hospital stay is shorter.
• Recovery is faster.
• It reduces the load on the right side of the heart.
• It may improve exercise capacity and quality of life.
• It may delay or remove the need for repeat surgical intervention.

Today, transcatheter pulmonary valve implantation is a modern treatment method that is performed safely in suitable patients and that provides significant benefit, particularly in adults with congenital heart disease.