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A leaky valve can lead to arrhythmias, heart failure and even sudden death. A percutaneous pulmonary valve replacement is a less invasive, non-surgical approach developed to control the harmful effects of early repair and multiple operations.
It involves using a bovine valve sutured inside a balloon expandable stent to replace the pulmonary valve.
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A pre-admission clinic appointment will be set up 2-4 weeks before the procedure. This involves obtaining
CXR, consultation with an anesthetist and a visit with the Nurse Coordinator to go over instructions on how to prepare for the procedure. If you have any questions, you can call Sue Jimeno, Nurse Coordinator, at 416 340 4800 ext. 6258.
If there are any changes in the booking of your test, you will be called by the pre-admit department.
If you cannot go to your test, call the doctor's office as soon as you know. If you are unable to reach the doctor, then leave a message at 416 340 4800 ext. 6258.
Take a shower the night before or the morning of your procedure.
Please bring with you a list of your current medications. This includes prescription medications, over-the-counter medications, vitamin or mineral supplements and herbal remedies. The nurse will go over these medications and instruct you on them for the procedure.
If your procedure is in the morning you can have NOTHING to eat or drink from midnight the night before your procedure. Medications can be taken with a sip of water unless you are instructed otherwise by your doctor. The nurse coordinator will give you instructions about your blood thinner or diabetes pills at the time of the pre-admission appointment.
If your procedure is in the afternoon you can have a small breakfast (such as toast and juice) before 6:00 am to 6:30 am. Do not have anything else to eat/drink until after your procedure. Medications can be taken with a sip of water unless you are instructed otherwise by the nurse coordinator. The nurse coordinator will give you instructions about your blood thinner or diabetes pills.
If you take a "blood thinner" (i.e. Coumadin® or Warfarin) or you are not sure, call the doctor that will be doing your test. Ask what you need to do about your "blood thinner".
If you take pills (i.e. Metformin®) or insulin for your diabetes, then call your family doctor or the doctor who is arranging your test. Ask what you will need to do about your medication and breakfast on the day of the test.
If you don't speak English, a friend or family member has to be present in the lab for the procedure. You'll be under anesthesia during this procedure. You will be staying overnight in the Coronary Intensive Care Unit (CICU) and possibly discharged within a day or two.
Although your procedure will be done in the Cardiovascular Investigations Unit, you will initially check in at the Cardiac Short Stay unit on the 5th Floor Munk Building. Please check in at the nursing station. Please have the following ready:
When you check-in, the receptionist will give you a name band to wear. You will be assigned a room to wait until it's time for your procedure. You will be asked to change into a hospital gown. There are lockers for your clothes in your room, but your family should keep your valuables with them.
You will be brought down to the Cardiovascular Investigations Unit on the 2nd floor for your procedure when it's time. You and your family will wait in the holding area where the doctor will speak to you about the procedure and ask for your consent. If you have any unanswered questions, this would be the best time to address them before the procedure.
A catheter is inserted through the femoral artery, which is a large artery near your groin. Hair is first removed from the area.
The procedure will require you to be put to sleep using anesthesia. You will meet the anesthesiologist in the holding area, and an intravenous line will be inserted into your arm.
The percutaneous pulmonary valve replacement is done in the Cardiovascular Investigations Unit. The unit is kept cool to keep the machines working properly, so you may feel cool as well. During the procedure, the nurses will monitor your heart rhythm and blood pressure. Sterile sheets will be put on you to keep the insertion site clean.
The percutaneous pulmonary valve replacement is a specialty procedure that requires a team of doctors, nurses and clinical specialists.
During the first part of the procedure, we make sure that you're hooked up to our monitors to keep a safe eye on your status – and that you're fully asleep. Then a catheter is inserted into a vein while another catheter is directed into the artery in your groin. A long flexible tube is fed up to your heart to deliver the valve. A combination of contrast dye, x-ray and ultrasound will all be used.
When the procedure's over, depending on how awake and alert you are, the anesthesiologist may or may not remove your breathing tube. It could be uncomfortable but the tube will be removed as soon as you're sufficiently awake and breathing fully on your own. You'll receive blood and antibiotics during the procedure as well as pain medication as needed.
Then you'll be taken to the Coronary Intensive Care Unit (CICU) for recovery and for constant monitoring for a day or two. Your doctor will speak to your family in the waiting room after the procedure, and they'll be able to see you once the nurses have settled you into the CICU.
The catheter will remain in your groin for a few hours.
When you return from the lab, you'll be lying flat on your back with your leg straight. You need to stay in this position for 3 to 6 hours before you're allowed to sit up. This allows more time for the area to heal. One hour after the procedure, you'll be allowed to have sips of water if you are able to swallow and keep down fluids. Food will be gradually introduced. A nurse will check the blood pressure and the pulses in your wrists and feet and will also check the area where the catheter was inserted. The catheter will be removed 4-6 hours after the procedure. Once the effect of the blood thinner is out of your system, the catheter can be safely removed.
The physician will speak to you following the percutaneous pulmonary valve replacement. You will have a follow-up appointment in 8-12 weeks following the procedure.
A percutaneous pulmonary valve replacement usually takes 2 to 3 hours.
We do everything that we can to stay on time. Unfortunately, your appointment may be delayed by unforeseen circumstances. We recommend that you come prepared for delays.
You will be contacted with information about your first appointment.
Please bring the following to your appointment. Not all of these items may be needed for your appointment. Our clinic or your referring doctor will let you know what you must bring.
Please arrive 15 minutes before your appointment.
When you arrive, you will sign in with the receptionist. You will need your health card (OHIP card) to sign-in. If you do not have an OHIP card, please bring another form of government-issued photo ID, such as a driver’s license or passport.
You may be given a Measuring Health Equity Questionnaire to fill out. This form contains questions about your background. We collect this information to find out who we serve and what unique needs you may have. The form is voluntary and you can choose ‘prefer not to answer’ to any or all questions. However, the information you choose to give us will help us improve the quality of care for you and others.
First appointments take longer than follow-up appointments. Your first appointment can take 2 hours or more. Follow-up appointments usually take 15 to 30 minutes. We do everything we can to stay on time but sometimes unforeseen circumstances may delay your appointment.
At the end of your first appointment, the nurse or doctor will give you a contact list for your health care team. If you don’t get a contact list, feel free to ask for it.
After every appointment, a member of your health care team will tell you about your next visit. Be sure you understand what is going to happen next. For example, know the time and place of your next visit or if someone will call you with this information.
If you are unsure about what your next steps are, don’t be afraid to ask a member of your team. We are here to help you.
We understand that reaching us by phone can sometimes be difficult. Often our phone lines are busy or are turned over to the message centre so our staff can prepare for clinic visits or help other patients. We make every effort to return your call within 24 hours. Our staff will try to reach you 2 times. If we are not able to reach you directly you may need to call us again.