HJAR Jan/Feb 2022

HEALTHCARE JOURNAL OF ARKANSAS  I  JAN / FEB 2022 37 invasive approach. However, TPVR with a Melody or Sapien valve only addresses a fraction of patients needing pulmonary valve replacement. Of the patients who need a pulmonary valve replacement, ap- proximately 80% have not yet undergone surgical replacement of their native valve with a prosthetic conduit, and the design of this generation of valves is generally in- compatible with a native right ventricular outflow tract. Until recently, patients born with this type of heart defect could expect to undergo open-heart surgery at least twice in their lives. …AND THEN, ADDING THE HARMONY Following up on the success of the Mel- ody valve, Medtronic spent another de- cade developing the Harmony valve as the first alternative to open-heart surgery for patients in need of a pulmonary valve re- placement. The FDA approved the therapy this year, and Arkansas Children’s Hos- pital performed the state’s first implants in October with great success. Unlike the rigid design of the previous generation of pulmonary valves, which relied on stiff balloon-expandable stents, the Harmo- ny valve is housed within a more flexible self-expanding frame, constructed of the same nickel-titanium memory wire used in other transcatheter devices for congen- ital heart disease. The flexible design allows the Harmo- ny valve to adapt to a wide variety of pa- tient anatomies, but there are exceptions. Determining whether this valve fits a pa- tient’s particular anatomy is a crucial diag- nostic step, which requires specific exper- tise. The advanced cardiac imaging team at our center utilizes a cardiac computed tomography (CT) protocol to visualize the Michael J. Angtuaco, MD Associate Professor, Pediatric Cardiology Director, Pediatric Catheterization Laboratory Arkansas Children’s Hospital and University of Arkansas for Medical Sciences right ventricular outflow tract and pulmo- nary artery in three dimensions during all phases of the cardiac cycle. These images are then carefully analyzed with 3D soft- ware to perform a “virtual implant” before placing the patient at any risk. As a newly approved device, Harmony valve has not yet become the standard of care for this subset of congenital heart disease patients. However, with the sup- port of Medtronic and expert proctors from around the country, our cardiac cath lab team is quickly gaining experience with this innovative procedure. There is already a great deal of optimism within the world of pediatric and congenital in- terventional cardiology that this device and others like it will become the standard follow-up for an infant’s surgical repair, reducing the number of necessary open- heart surgeries to only one. n Michael J. Angtuaco, MD, is a tenured associate professor of pediatrics in the section of pediatric cardiology at the University of Arkansas for Medical Sciences and Arkansas Children’s Hospital. A native of Little Rock, Angtuaco received an un- dergraduate degree in pre-professional studies and philosophy from the University of Notre Dame in 2001. He returned to Arkansas for medical school and received a medical degree from the University of Arkansas for Medical Sciences in 2005. He then studied pediatrics at Emory University in Atlanta, Georgia, completing a residency in 2008. He again returned home to Little Rock for a fellowship in pediatric cardiology atArkansas Children’s Hospi- tal,which he finished in 2011.He has also completed an advanced fellowship in interventional pediatric cardiology at the University of Colorado Denver and Children’s Hospital Colorado. Angtuaco has been a member of the faculty at the University of Arkansas for Medical Sciences since 2012. He serves as medical director of the Pediatric Catheterization Laboratory at Arkansas Children’s Hospital and is also co-director of the Pediatric Pul- monary Hypertension Clinic.He is a fellowof the Soci- ety for CardiovascularAngiography and Interventions (FSCAI) and the American Academy of Pediatrics (FAAP). His primary research interest is the evalu- ation of outcomes following both surgical and tran- scatheter interventions for congenital heart disease. FIRST, COMPOSING THE MELODY… As our expertise in treating potentially fatal congenital heart disease has expand- ed, the focus has shifted from whether we can fix a heart lesion to how we can ad- dress that lesion with less risk to the pa- tient. The field of interventional pediatric cardiology seeks to help patients avoid surgery through minimally invasive in- travascular procedures using catheters. Over the years, these interventions have evolved from balloon and stent angioplas- ty for vessel narrowing to the use of spe- cially designed occluder devices to address specific congenital heart lesions such as the atrial septal defect and patent ductus arteriosus. Valve replacement is one of the newest frontiers for the specialty. Based on research spanning more than a decade, the Food and Drug Administra- tion (FDA) approved a new nonsurgical therapy to address the problem of pros- thetic pulmonary valve failure in 2010, the Medtronic Melody valve. Transcathe- ter valve therapy has grown exponential- ly since its introduction, with the Melody valve later joined by the Edwards Sapien valve and transcatheter pulmonary valve replacement (TPVR) becoming standard practice for management of congenital heart disease around the world. Arkansas Children’s Hospital implanted the first Melody valve in Arkansas in 2013. Since then, more than 100 children and adults have benefited from TPVR at our center with documented shorter hospital stays and faster recoveries than a heart surgery for the same indication. This innovative therapy has been a game changer and life-altering for the pa- tients who have benefited from this less