PMC3022147_01
a Right ventricular angiography: large outflow tract, no valve leaflets, mild narrowing at distal anastomosis of a Matrix P valve. b Balloon sizing of the landing zone: simultaneous angiography of the left coronary artery. The balloon does not impinge on the coronary artery. The mild indentation in the balloon measures 20 mm in diameter. c Two large stents are already in place, a third one is about to be implanted to prepare a rigid landing zone for the valve. d Implantation of the SAPIEN pulmonic valve in the pre-stented pulmonary artery
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Fig1
Only at the distal anastomosis, a discrete reduction to 19 mm diameter could be found (Fig. 1a, b). Simultaneously, a coronary injection ruled out any coronary artery near the implantation site (Fig. 1b). Then, two 45 mm CP-Stents (one bare metal, one covered, NuMED Inc., Hopkinton, NY, USA) were subsequently implanted with the same 24 mm balloon into the target region (Fig. 1c). THV, Edwards Lifesciences, Irvine, CA, USA) through a 24 F sheath (outer diameter 28 F) without any problem (Fig. 1d).
Final angiography after implantation of three large stents and a 26 mm SAPIEN pulmonic valve. There is no residual gradient and no pulmonary regurgitation. The valve is expanded completely and symmetrically (small picture in lower left corner)
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Fig2
If smaller valve diameters are appropriate, the Melody valve could be used up to 22 mm diameter (introducer size 22 F outer diameter), for larger diameters up to 26 mm the SAPIEN pulmonic valve (introducer size up to 28 F outer diameter) is available (Fig. 2). 