{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:41:23Z","timestamp":1792662083372,"version":"4.5.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Percutaneous transcatheter pulmonary valve replacement (TPVR) has good clinical and hemodynamic outcomes in treating dysfunctional bioprosthetic valves (BPV) in the pulmonary position. Valve-in-valve therapy can further decrease the inner diameter (ID), potentially resulting in patient-prosthesis mismatch in patients with smaller BPVs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>\n              To evaluate feasibility and outcomes of intentional BPV fracture to enlarge the pulmonary valve orifice with TPVR, 37 patients from 13 centers who underwent TPVR with intended BPV fracture were evaluated. A control cohort (n=70) who underwent valve-in-valve TPVR without attempted fracture was evaluated. BPV was successfully fractured in 28 patients and stretched in 5 while fracture was unsuccessful in 4. A Melody valve was implanted in 25 patients with fractured\/stretched frame and a Sapien (XT 3) valve in 8. Among patients whose BPV was fractured\/stretched, the final ID was a median of 2 mm larger (0\u20136.5 mm) than the valve\u2019s true ID. The narrowest diameter after TPVR in controls was a median of 2 mm smaller (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) than true ID. Right ventricular outflow tract gradient decreased from median 40 to 8 mm\u2009Hg in the fracture group. Cases with fracture\/stretching were matched 1:1 (weight, true ID) to controls. Post-TPVR peak gradient was lower but not significant (8.3\u00b15.2 versus 11.8\u00b19.2 mm\u2009Hg;\n              <jats:italic>P<\/jats:italic>\n              =0.070). There were no fracture-related adverse events.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Preliminary experience shows intentional fracture of BPV frame can be useful for achieving larger ID and better hemodynamics after valve-in-valve TPVR.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.118.006453","type":"journal-article","created":{"date-parts":[[2018,9,14]],"date-time":"2018-09-14T19:53:54Z","timestamp":1536954834000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":58,"title":["Intentional Fracture of Bioprosthetic Valve Frames in Patients Undergoing Valve-in-Valve Transcatheter Pulmonary Valve Replacement"],"prefix":"10.1161","volume":"11","author":[{"given":"Shabana","family":"Shahanavaz","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, MO (S.S., D.T.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy D.","family":"Asnes","sequence":"additional","affiliation":[{"name":"Yale University, New Haven, CT (J.D.A., W.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Grohmann","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Defects and Pediatric Cardiology, Heart Center, University of Freiburg, Germany (J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athar M.","family":"Qureshi","sequence":"additional","affiliation":[{"name":"The Lillie Frank Abercrombie Section of Cardiology, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston (A.M.Q.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Rome","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital of Philadelphia, PA (J.J.R., M.J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Tanase","sequence":"additional","affiliation":[{"name":"Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre, Munich (D.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A.","family":"Crystal","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Morgan Stanley Children\u2019s Hospital, Columbia University Medical Center, New York, NY (M.A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry A.","family":"Latson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Joe DiMaggio Children\u2019s Hospital, Hollywood, FL (L.A.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian H.","family":"Morray","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Seattle Children\u2019s Hospital, University of Washington School of Medicine (B.H.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Hellenbrand","sequence":"additional","affiliation":[{"name":"Yale University, New Haven, CT (J.D.A., W.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Balzer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, MO (S.S., D.T.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Gewillig","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, University Hospitals Leuven, Belgium (M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon C.","family":"Love","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, University of New Mexico, Albuquerque (J.C.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhouch","family":"Berdjis","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Orange County, CA (F.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Gillespie","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital of Philadelphia, PA (J.J.R., M.J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doff B.","family":"McElhinney","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Cardiothoracic Surgery, Lucile Packard Children\u2019s Hospital Heart Center, Stanford University School of Medicine, Palo Alto, CA 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