What is the role of percutaneous valve replacement in the treatment of tetralogy of Fallot (TOF)?

Updated: Nov 13, 2018
  • Author: Shabir Bhimji, MD, PhD; Chief Editor: Yasmine S Ali, MD, FACC, FACP, MSCI  more...
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Answer

With innovations in endovascular technology, the potential for percutaneous pulmonary valve replacement is becoming a reality in the near future. For example, the Melody transcatheter pulmonary valve can be implanted percutaneously (see the image below) via the femoral vein, guided by fluoroscopy; early case reports indicate that the technique is feasible and safe. These few case reports reveal that after valve implantation, there is a moderate reduction in pulmonary valve insufficiency and the ventricular size,  as well as marked improvement in exercise tolerance. Thus far, the Melody valve is the only one approved for use through a humanitarian device exemption protocol for patients with a prior pulmonary artery conduit who now have developed pulmonary insufficiency or stenosis. If future studies regarding transcatheter pulmonary valve implantation prove to be durable, this may change how tetralogy of Fallot in adults is managed. [40] [41, 42]

Melody pulmonary valve. Melody pulmonary valve.

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