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A Less-Invasive Pulmonary Valve Repair

June 09, 2010
Alex Compton dtl

Two days after his pulmonary valve replacement, 17-year-old Alex Compton was at his high-school graduation rehearsal.

Open-heart surgery is no stranger to patients like 17-year-old Alex Compton of Elkridge, Md. Born with the congenital heart defect Tetralogy of Fallot, he’s undergone several major operations with long hospitalizations and recoveries. So when he turned 8 years of age, the last thing his parents wanted for him was another invasive surgery, yet one was needed to repair his pulmonary valve. 

“He was in the hospital again for 10 days with chest tubes and monitors hooked up,” says his mother, Carol Compton. 

Time and technology, however, heal some wounds. This past May, Compton had another pulmonary valve replacement in an approach that allowed him to avoid another open-heart operation. Instead of spending a week or more in the hospital, he stayed one night – and two days later he was at his high school graduation rehearsal. 

“Oh my God, he’s doing fantastic,” says his mother, Carol Compton. “He couldn’t be more normal. He’s a normal senior.” 

What was this less-invasive approach? A new catheter procedure called percutaneous pulmonary valve replacement, in which a stent-mounted bioprosthetic valve is mounted onto a balloon-tipped catheter and threaded through the femoral vein of the leg and up to the pulmonary valve, where it is expanded to replace the existing valve. Because of the size of the device, patients need general anesthesia, but they avoid having an incision along the sternum necessary in open-heart surgery and cardiopulmonary bypass. 

“There is no surgery, no cutting of anything, just a puncture in the vein of the leg,” says Hopkins Children’s Rich Ringel, one of only a handful of pediatric interventional cardiologists nationwide who have been trained to perform the procedure. 

Ringel explains that in other patients with left-sided congenital heart disease, the aortic valve is often replaced with the patient’s own pulmonary valve, which in turn is replaced with a cadaveric pulmonary valve. But over time this new pulmonary valve – also referred to as a conduit – scars and narrows, requiring another valve replacement through open-heart surgery. This new catheter approach, Ringel explains, is not designed to replace that surgery but to delay it by extending the life of the original conduit. 

“When the surgeon puts in a conduit, we hope that it will last 15 or 20 years, but too often it lasts only a few years and those patients may require multiple replacements and operations,” Ringel says. “So we insert this valve in the hopes of giving that conduit the years it was designed to get, and to reduce the number of open-heart surgeries patients need over a lifetime.” 

The procedure has proved successful enough in U.S. and European trials for the FDA to approve the valve as a humanitarian use device (Journal of the American College of Cardiology, 2009;54;1722-29). For more information, call 410-614-6745.