Percutaneous Right Heart Valve Replacement in Congenital Heart Disease: A Paradigm Shift in Therapy

is the most common birth defect, affecting one in every 125–150 births, with approximately 40,000 children diagnosed with CHD every year in the United States. As a result of dramatic improvements in survival seen over the past several decades, there are now an estimated 1.5–2.0 million adults with CHD in the United States. When grouped together, lesions that require surgical correction of the right ventricular outflow tract (RVOT) are among the most common types of CHD. Typically, RVOT operations are performed early in childhood (as early as the neonatal period) and involve either a patch correction to relieve a stenotic outflow tract (e.g., Tetralogy of Fallot) or placement of a valved conduit or bioprosthetic valve in the pulmonary position. Unfortunately, no current operation offers a lifetime cure, as all artificial valves that have been placed in the RVOT will ultimately fail, either secondary to stenosis, regurgitation or a combination of both. This problem is exaggerated in children where an aggressive host response to bioprosthetic tissue, size constraints of a small thoracic cage, and somatic growth combine to limit the functional lifespan of bioprosthetic valves and conduits to only a few years in some cases. Thus, while surgical mortality for defects involving the RVOT have fallen dramatically over the past 20 years, the cumulative morbidity these patients must endure in the course of their lifetime remains high, APRIL 2013 ADVANCES IN HEART & HEART SURGERY