Pulmonary regurgitation and Percutaneous Pulmonary Valve Implantation (PPVI)

What is pulmonary regurgitation?

The pulmonary valve is one of the four important heart valves which acts like a door to direct blood flow out of the right heart when it contracts and allows this blood to flow effectively into the lungs. When the pulmonary valve fails, some blood flows backwards into the right heart leading to dilation of the right heart and eventually right heart failure. This can lead to worsening fatigue, shortness of breath or leg edema. Many of the causes of PR are congenital (inborn) and some may have re-occurred in adulthood following prior successful repair at childhood. 

What is PPVI?

Percutaneous Pulmonary Valve Implantation (PPVI) is a minimally invasive procedure used to replace a damaged pulmonary valve, which regulates blood flow from the right ventricle of the heart to the lungs.

Why choose PPVI?

1. Less Invasive: Unlike traditional open-heart surgery, PPVI is performed through a small incision, usually in the groin, reducing recovery time and risk.
2. Shorter Recovery: Patients typically experience a quicker recovery and back to usual activities
3. Symptom Relief: Helps alleviate symptoms like shortness of breath, fatigue, and chest pain.

Who Needs PPVI?

PPVI is recommended for patients with:

• Congenital heart defects affecting the pulmonary valve.
• Previously repaired pulmonary valves that have become dysfunctional.
• Right ventricular outflow tract obstructions.

How Does PPVI Work?

1. Preparation: The procedure is performed in a cardiac catheterization laboratory under general anesthesia.
2. Access: A catheter (thin tube) is inserted through a small incision in the groin and guided to the heart.
3. Valve Placement: The new valve,  can be mounted on a balloon, is advanced through the catheter to the pulmonary valve site. Some other valve designs utilize a self expanding technology.
4. Deployment: The balloon is inflated, expanding the new valve into place within the old valve. (Self expanding valves similarly exerts a radial outward force when it is delivered within the old valve and anchors itself in situ)

What to Expect Before, During, and After PPVI

• Before: You will undergo tests such as ECGs, blood tests, echocardiograms and MRI to evaluate your heart. Follow fasting instructions and stop certain medications as advised by your doctor.
• During: The procedure typically lasts 1-2 hours. You will be under general anesthesia and monitored closely.
• After: Expect to stay in the hospital for 2-3 days. You’ll have regular follow-ups to monitor your progress and ensure the new valve functions well.

Risks and Complications

As with any procedure, PPVI carries some risks, including:

• Bleeding or infection at the catheter insertion site.
• Blood clots.
• Valve movement or malfunction.
• Arrhythmias (irregular heartbeats)
• -Blood vessel or cardiac injury

Your medical team will discuss these risks with you and take steps to minimize them.

Follow-Up Care

• Regular check-ups and imaging tests to ensure the new valve is working properly.
• Medications to prevent blood clots and manage other heart conditions.
• Lifestyle changes, including a healthy diet and regular exercise.