Abstract：
BACKGROUND: The Alterra adaptive prestent is a novel self-expanding device designed to provide a landing zone for the 29 mm SAPIEN 3 valve to treat pulmonary regurgitation in patients with a right ventricular outflow tract that is too large for a balloon expandable valve alone. The mechanism of fixation for the Alterra prestent is radial force from the self-expanding stent frame, combined with a unique set of flared \"tines\" that protrude from both ends of the stent.
UNASSIGNED: In this report, we describe 6 patients who underwent uncomplicated transcatheter pulmonary valve replacement with an Alterra adaptive prestent and SAPIEN 3 valve and had surveillance chest computed tomography (CT) scans performed 1 day to 21 months after implant. In each patient, the CT scan demonstrated extravascular extension of a portion of the Alterra prestent, without clinical sequelae, but with extension into the ascending aorta in 1 patient and contact with the ascending aorta, left pulmonary vein, or left atrial appendage in 3 others.
CONCLUSIONS: Surveillance CT imaging shows that the Alterra prestent can perforate the pulmonary artery and/or right ventricle. Although no sequelae were seen in these patients, prestent perforation has the potential to be clinically important. Implanters should be aware of this finding and its potential implications. As experience with the Alterra prestent grows, it will be important to further define the risk factors, incidence, and implications of this phenomenon.
UNASSIGNED: In this report, we describe 6 patients who underwent uncomplicated transcatheter pulmonary valve replacement with an Alterra adaptive prestent and SAPIEN 3 valve and had surveillance chest computed tomography (CT) scans performed 1 day to 21 months after implant. In each patient, the CT scan demonstrated extravascular extension of a portion of the Alterra prestent, without clinical sequelae, but with extension into the ascending aorta in 1 patient and contact with the ascending aorta, left pulmonary vein, or left atrial appendage in 3 others.
CONCLUSIONS: Surveillance CT imaging shows that the Alterra prestent can perforate the pulmonary artery and/or right ventricle. Although no sequelae were seen in these patients, prestent perforation has the potential to be clinically important. Implanters should be aware of this finding and its potential implications. As experience with the Alterra prestent grows, it will be important to further define the risk factors, incidence, and implications of this phenomenon.
摘要：
背景：Alterra自适应预支架是一种新型的自膨胀装置，旨在为29mmSAPIEN3瓣膜提供着陆区，以治疗右心室流出道太大的患者的肺反流单独使用球囊扩张瓣膜。Alterra预支架的固定机制是来自自膨胀支架框架的径向力，结合从支架两端突出的一组独特的喇叭形“尖齿”。
■在本报告中，我们描述了6例接受Alterra适应性预支架和SAPIEN3瓣膜的无并发症经导管肺动脉瓣置换术的患者,并在植入后1天至21个月进行了胸部计算机断层扫描(CT)监测.在每个病人中,CT扫描显示Alterra预支架的一部分血管外延伸,没有临床后遗症，但在1例患者中延伸到升主动脉并与升主动脉接触时，左肺静脉,或左心耳3个。
结论：监测CT成像显示Alterra预支架可贯穿肺动脉和/或右心室。尽管在这些患者中没有看到后遗症，支架前穿孔有可能是临床重要的。种植者应该意识到这一发现及其潜在影响。随着Alterra预支架经验的增长，重要的是进一步定义风险因素，发病率,以及这种现象的影响。
■在本报告中，我们描述了6例接受Alterra适应性预支架和SAPIEN3瓣膜的无并发症经导管肺动脉瓣置换术的患者,并在植入后1天至21个月进行了胸部计算机断层扫描(CT)监测.在每个病人中,CT扫描显示Alterra预支架的一部分血管外延伸,没有临床后遗症，但在1例患者中延伸到升主动脉并与升主动脉接触时，左肺静脉,或左心耳3个。
结论：监测CT成像显示Alterra预支架可贯穿肺动脉和/或右心室。尽管在这些患者中没有看到后遗症，支架前穿孔有可能是临床重要的。种植者应该意识到这一发现及其潜在影响。随着Alterra预支架经验的增长，重要的是进一步定义风险因素，发病率,以及这种现象的影响。
