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Fred Wu, MD 🫀 吳明杰 Profile picture
@FredWuMD
May 16, 2021 • 9 tweets • 7 min read • Read on X
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Of interest to the #CHD and #ACHD community, Matthew Gillespie of @HeartCare4Kids, a leader in transcatheter pulmonary valves, gave an update on the state of the art over in the Right Sided Valve Interventions session, and as he rightly points out, it all started with CHD! #ACC21
Who needs pulmonary valve replacement?
👉~40K babies born w/ #CHD each yr
👉~22% have RVOT abnormalities
👉For those w/ RV-PA conduits we've had Melody/Sapien valves
👉For the 85% of RVOT pts w/o conduits with PR, these usu won't work due to dilated/distorted/dynamic RVOTs
#ACC21
Work that started ~2004 with Phil Bonhoeffer culminated in first-in-man implantation of a self-expanding RVOT valve reported in 2010 with several devices now available incl. the Medtronic Harmony devices and the Edwards Alterra combined with their Sapien valve in the US. #ACC21
Because I love you guys, I grabbed the video Dr. Gillespie showed of a Harmony valve being mounted on the 25-Fr delivery system and then being deployed in the RVOT. Is modern medical technology amazing or what?! #ACC21
Where does Harmony stand?
👉Early feasibility trial 2013-2015 w/ 20 pts
👉Pivotal trial 2015-2019 w/ continued access through 2020
👉In total, 106 of 3 avail devices implanted
👉Good 3-yr EFT results; at 5 yrs, 1 death unrelated to valve, 2 explants for tech failure or fx
#ACC21
👉Early feasbibility pts have o/w had good Harmony valve fxn with no paravalvar leak or obstruction on echo
👉Results from 1-yr pivotal trial to be presented at #SCAI2021; manuscript in preparation
👉FDA approval announced; 2 of 3 devices will be commercially available
#ACC21
Other device available in US is Alterra which is 2-step procedure
👉Deploy the Alterra Prestent in the RVOT position
👉Into the landing zone, deploy Sapien S3 balloon expandable valve

👉Early feasibility study and pivotal trial completed; continued access phase underway
#ACC21
In addition, several similar devices available outside US
👉Venus P valve likely approved in Europe this year
👉Pulsta valve approved in Asia, now moving into European trial
👉Med-Zenith valve with 30 pre-trial implants in China, moving into Chinese FDA trial in 2021
#ACC21
Dr. Gillespie's prediction for the future:
Earlier PV interventions ➡️ healthier RVs ➡️ healthier patients
#ACC21

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More from @FredWuMD

Fred Wu, MD 🫀 吳明杰 Profile picture
May 17, 2021
Dr. Lantin giving a Top 10 review of #ACCACPC research in 2020, a truly crazy year! #ACC21
🔟 No mention of 2020 could possibly ignore the effects of the global pandemic on research, patient care, and the way we share knowledge. #COVID19 #ACC21
9⃣ Imaging indices correlate with prognosis.
- Transplant/VAD-free survival correlates with MPI-DTI z-score
- Left atrial strain correlates with PCWP and helps identify graft rejection/failure
#ACC21
Read 22 tweets
Fred Wu, MD 🫀 吳明杰 Profile picture
May 16, 2021
Here are a couple of #ACC21 posters on pregnancy outcomes for women with heart disease, one from @LLUHealth on #CHD with RVOT dysfunction and one from @HopkinsMedicine on valvular heart disease, worth checking out. @doctorpianist @AllisonGHaysMD @kalamityjack #CardioObstetrics
In @abbykhanmd's talk Saturday, she highlighted three commonly used risk models for predicting adverse outcomes in pregnant women with heart disease: the modified WHO criteria, CARPREG II, and ZAHARA. #ACC21
Generally speaking, left-sided obstructive lesions (AS/MS) are known to impart the highest risk, while pulmonary valve disease and aortic regurgitation are regarded as relatively low risk and MR/TR fall somewhere in between. #ACC21
Read 6 tweets
Fred Wu, MD 🫀 吳明杰 Profile picture
May 15, 2021
Starting off the Nuts & Bolts of Pregnancy and Congenital Heart Disease session with a pre-test question... #CardioObstetrics #ACC21 #ACHD
Keep this chart in mind. Pregnancy is a prolonged period of cardiovascular stress with increased cardiac output, plasma volume, and heart rate. Things get really interesting during labor/delivery with acute increases in BP and CO. Image
Various risk scores available: Modified WHO classification, CARPREG II, ZAHARA score. But clinical experience is extremely important since CHD patients are very heterogeneous and may not be well-represented in studies ImageImageImage
Read 15 tweets
Fred Wu, MD 🫀 吳明杰 Profile picture
Aug 29, 2020
Happy #VivienThomasDay! Today marks 110 years since the birth of Dr. Vivien Thomas. Although he never went to medical school, the surgical techniques he developed, such as the BTT shunt, are the foundation on which congenital heart surgery today was built. #CHD #ESCCongress2020
After graduating from high school, Thomas enrolled at Tennessee Agricultural & Industrial State College (now @TSUedu) as a pre-med. Unfortunately, the Great Depression depleted his savings, so he left college and found work as an assistant in Alfred Blalock's lab at @VUmedicine.
Blalock was doing research in traumatic shock and needed Thomas to help perform surgery on lab animals. Thomas learned quickly, and Blalock gave him more and more independence in the lab. Years later, surgical trainees who worked with Thomas would marvel at his surgical skill.
Read 10 tweets
Fred Wu, MD 🫀 吳明杰 Profile picture
Jul 20, 2020
July 19, 1955, marked the last time that Dr. C. Walton Lillehei carried out a heart operation using the controlled cross-circulation technique. The patient was 5-year-old Paul Mathieu who was born with a ventricular septal defect. Here's a bedtime story for you history buffs...
In the early 1950s, few cardiac anomalies could be corrected or palliated. Valve stenosis had been treated with valvotomy. PDA and CoA had been repaired in 1938 and 1944. And kids with tetralogy of Fallot were being palliated with Blalock-Taussig shunts.
In 1951, the University of Minnesota’s Dr. Clarence Dennis made the first unsuccessful attempts to close atrial septal defects using a heart-lung bypass machine of his own design, but neither patient survived.
Read 11 tweets
Fred Wu, MD 🫀 吳明杰 Profile picture
Jan 7, 2019
On the night of January 6, 1968, @StanfordMed surgeon Norman Shumway transplanted the heart of 43-year-old Virginia White into the chest of 54-year-old Mike Kasperak. It was the first adult heart transplant to be performed in the United States. #medhistory #DonateLife Dr. Norman ShumwayMike Kasperak and wifeVirginia White
By 1967, Shumway had already spent over a decade researching heart transplantation. In 1959, he and Richard Lower had performed the world's first successful heart transplant in a dog. Thus it was widely expected that he would be the first to perform a human heart transplant.
On Nov. 20, 1967, Shumway's team announced they were ready to attempt heart transplant in a human. However, just weeks later, on Dec. 3, Christiaan Barnard took the world, and Shumway, by surprise when he reported the world's first human heart transplant.
Read 11 tweets

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