Severance Hospital reaches 200 cases of transcatheter pulmonary valve replacement

Severance Hospital announced Tuesday that it has performed 200 transcatheter pulmonary valve replacements.

The procedure is a minimally invasive treatment in which a catheter is inserted through a thigh vein — without opening the chest — and guided to the heart, where an artificial valve is placed at the site of the deteriorated pulmonary valve. It reduces the physical burden of repeated open-heart surgeries and shortens recovery time. Severance Hospital became the first in South Korea to perform the procedure in March 2015.

The 200th patient is Jeon, a 38-year-old man. Jeon underwent surgery at another hospital in 1994 at age 6 for tetralogy of Fallot, a congenital heart condition, but did not receive adequate follow-up care afterward.

Over time, pulmonary valve regurgitation progressed and the right ventricle enlarged, eventually leading to arrhythmia — the result of cumulative strain on the right ventricle from prolonged regurgitation. The medical team assessed the degree of regurgitation, the extent of right ventricular enlargement and the onset of arrhythmia, and determined that valve replacement was necessary.

Doctors performed a transcatheter pulmonary valve replacement, inserting an artificial valve through the thigh vein rather than opening the chest.

Patients with congenital heart conditions such as tetralogy of Fallot may experience declining pulmonary valve function as they grow older, even after successful childhood surgery. When pulmonary valve regurgitation or stenosis becomes severe, the valve must be replaced at the appropriate time, and additional surgery may be required if a previously implanted artificial valve deteriorates or complications such as infective endocarditis arise.

Each successive heart surgery becomes more technically demanding, however, due to adhesions around the chest wall and heart left by prior operations. The risks of complications such as bleeding and infection increase, as do the physical burden on the patient and the length of recovery.

Because each patient's cardiac and pulmonary artery anatomy differs — and prior surgeries often alter that anatomy — the procedure demands experience and refined technique. Selecting the appropriate valve and insertion site requires evaluating the heart and pulmonary artery structure beforehand, making close collaboration among pediatric cardiology, cardiovascular surgery, radiology and anesthesiology essential.

Since introducing the procedure in South Korea in 2015, Severance Hospital has steadily built its experience and expanded the scope of transcatheter treatment to include patients whose anatomy has been altered by previous heart surgeries.

That accumulated expertise is also being shared through education. Choi Jae-young, a professor of pediatric cardiology at Severance Hospital and a certified proctor for transcatheter pulmonary valve replacement, has passed on his techniques and clinical experience to medical professionals not only in South Korea but also in Europe and beyond.

"Patients with congenital heart disease may require additional cardiac surgery throughout their lives, even after a successful operation in childhood," Choi said. "Transcatheter pulmonary valve replacement is an important treatment option that allows valve replacement without reopening the chest, reducing the burden of repeated surgeries on patients."

He added that "reaching 200 cases is the result of accumulating procedural experience and technique through treating a wide range of complex patients," and pledged to "continue providing the most appropriate treatment for each patient's cardiac anatomy and condition through multidisciplinary collaboration, while sharing our experience with medical professionals at home and abroad to advance care."