Introduction: Percutaneous Pulmonary Valve Implantation (PPVI) was introduced in 2000 by Prof Philip Bonhoeffer to treat stenosis and regurgitation in a prosthetic conduit (artificial tube ) in the right ventricular outflow tract (RVOT). Melody percutaneous valve effectively relieves stenosis (narrowing) and is very capable of treating regurgitant (loose) conduits. This conduits are placed initially in RVOT to treat some complex congenital diseases to allow unobstructed forward flow of blood from right ventricle to pulmonary artery. In this study we included the variety who had surgically implanted prosthetic valves and conduits which degenerates in course of time even calcified, leading to stenosis, regurgitation or both. We started PPVI in Combined Military Hospital (CMH) Bangladesh with Melody™ pulmonary valves on 25th December 2012 as first ever team of South Asia.10 As a resource constraint country it was difficult to introduce such expensive valve (3000 USD), moreover there was no health insurance system existing for civilian population. We aimed to see the outcome of our cases in this background.

 

Methods: A retrospective study on ten cases conducted in Combined Military Hospital Dhaka from December 2012 to December 2019. Inclusion criteria were dysfunctional conduit between right ventricle (RV) and pulmonary artery causing (a) Symptoms of exertional dyspnoea of various grade (NYHA II,III, IV) (b) RVEVD >150ml/m2+regurgitant fraction >40% (c) RVOT peak instantaneous gradient > 30 mm Hg. (d) RV dysfunction (RVEF<40%). Patient fulfilled above criteria were selected and outcome were analyzed.

Results: Mean age was 9.56 years + 2.96 years. Female (66.66%) outnumbered male (33.33%). Mean weight was 28.75 + 8.61 kg. Height varied from 137.5+17.52 cm. Age at the time of surgery was 4.25+ 2.72 years. Six cases (60.00%) had pulmonary atresia and four had tetralogy of Fallot (40.00%). Four cases had Aortic homograft (60.00%), two had pulmonary homograft (20.00%) and two had Bovine valved pericardial conduit (20.00%). Six cases had BT shunt followed by Rastelli operation (60.00%), two had ToF repair followed by redo surgery within one year (20.00%) and two had single surgery (20.00%). Eighteen mmm Ensemble was used in 66.66% cases. Immediate results were excellent with no results stenosis and regurgitation was noticed in 99.99% cases. In one case trivial pulmonary regurgitation was noticed. One patient developed bacterial endocarditis after three years of procedure and was treated.

Conclusion: Aim of PPVI is to prolong the life expectancy of conduits which were placed surgical from right ventricle to pulmonary artery. In our case series, we found that Melody valve is functioning well without any complications like infective endocarditis or stent fracture.