Loma Linda University Medical Center
Assistant Professor, Division of Pediatric Cardiology
Loma Linda, CA
A 14-year-old male with history of transposition of the great vessels underwent an arterial switch procedure with placement of an 11 mm right ventricular to pulmonary artery homograft. His circumflex artery arose from the right coronary artery. The homograft developed stenosis and insufficiency and he subsequently underwent right ventricular outflow track (RVOT) patch with monocusp valve implantation in the pulmonary position. The patient later developed right ventricular dilation with RVOT stenosis/insufficiency and exercise intolerance. He was referred to the cardiac catheterization laboratory for hemodynamic catheterization with possible RVOT stenting and transcatheter pulmonary valve implantation. Right heart catheterization demonstrated moderate homograft stenosis with severe insufficiency. 3D rotational angiography was utilized to reconstruct and better characterize the morphology of the RVOT and to localize the origins of the branch pulmonary arteries. After ensuring that the coronary arteries (specifically the circumflex system) were remote from the RVOT, the outflow track was pre-stented, followed by implementation of a Transcatheter Pulmonic Valve angiography demonstrated no pulmonary insufficiency and normalized right ventricular pressures.