Catheter-based interventions on right ventricular outflow tract

The dilemma of when to treat patients who have right ventricular outflow tract (RVOT) dysfunction presenting late after repair of various congenital heart diseases, such as those with repaired tetralogy of Fallot, is one that faces all congenital heart disease clinicians. Surgical pulmonary valve replacement lacks longevity as conduit dysfunction usually occurs within 10-15 years and exposes patients to multiple risky operations over their lifetime. The recent availability of a percutaneous approach to treat RVOT dysfunction, therefore, offers an attractive solution, as it permits earlier intervention without the problems associated with surgery and cardiopulmonary bypass. Initial midterm results are promising and the technique has been proven safe and has provided efficacious relief of pressure and/or volume overload. Following percutaneous pulmonary valve implantation (PPVI), there is a significant remodeling of biventricular volumes with improvement in biventricular systolic function. These results are associated with improvement of symptoms and objective exercise capacity. However, PPVI is not free from possible complications. These have been reduced by improving the implantation technique (learning curve) and the valve design (hammock effect). Due to anatomical (size and morphology) and dynamic reasons, with the current device, only 15 % of patients with RVOT dysfunction are eligible for such a treatment, but future valve design and advances in four-dimensional imaging techniques will most likely broaden its applica bility, thus making PPVI an even better alternative to surgery.