Nursing Care for Pediatric Patients Undergoing Transcatheter Pulmonary Valve Replacement

Abstract

Congenital heart disease (CHD) is a major public health problem commonly found in children. One significant abnormality involves the right ventricular outflow tract (RVOT).Patients with this condition often undergo corrective surgery during infancy or childhood. However,as patients grow, deterioration of the pulmonary valve or the right ventricular outflow conduit used for replacement may occur, resulting in the need for multiple repeat surgeries. Repeated open-heart surgeries carry high risks and require a prolonged recovery period. At present,transcatheter pulmonary valve replacement (TPVR) has become an increasingly popular treatment option for pediatric patients with congenital heart disease involving pulmonary valve abnormalities.In some cases, TPVR can serve as an alternative to open-heart surgery, thereby reducing recovery time, lowering surgical risks, and significantly improving patients’ quality of life. However,TPVR is a complex, costly procedure and is not currently reimbursable under the basic healthcare schemes in Thailand, limiting access to treatment. In addition, TPVR carries potential risks of complications such as infection, vascular obstruction, or bleeding during or after the procedure.Therefore, nurses play an essential role in providing holistic care across all stages of treatment,ranging from physical and psychological preparation and support in accessing healthcare coverage,to close monitoring during the procedure, post-procedural care, and discharge education to ensure treatment effectiveness and patient safety.

This article aims to enhance nurses’ knowledge and understanding in caring for pediatric patients undergoing transcatheter pulmonary valve replacement. It highlights nursing roles in the pre-procedural, intra-procedural, and post-procedural phases, and presents a case study as a practical guide for clinical nursing practice. In the pre-procedural phase, nurses are responsible for preparing patients and families both physically and psychologically, providing clear information about the procedure, expected outcomes, treatment benefits, possible risks, and healthcare rights, and necessary physical preparation before the procedure. During cardiac catheterization, nurses are responsible for preparing the catheterization laboratory, ensuring that all medical equipment, instruments, and devices are available and maintained under sterile conditions, and assisting physicians throughout the procedure. Continuous monitoring of vital signs, electrocardiographic findings, oxygen saturation, and hemodynamic status is essential for early detection and prompt management of complications. Nurses also play an important role in coordinating multidisciplinary care to promote patient safety during the intervention.In the post-procedural phase, nurses must provide close observation for complications, monitor recovery, manage the wound, assess vital signs, and educate patients and families on appropriate self-care after discharge.

This article presents a comprehensive, holistic nursing process through a case study of a pediatric female patient with congenital heart disease (pulmonary atresia with ventricular septal defect) previously treated with a right ventricle to pulmonary artery (RV-PA) conduit.The patient underwent transcatheter pulmonary valve replacement (TPVR) due to moderate conduit stenosis that caused increased fatigue. The nursing care model was systematically applied across all phases of treatment. In the pre-procedural phase, nursing interventions primarily focused on providing detailed information and psychological preparation to alleviate the anxiety of both the patient and her parents. During the procedural phase and post-procedural phase, rigorous standard safety monitoring was implemented, confirming successful valve placement and optimal function without complications. A crucial highlight of this case study is the extension of the nurse’s roles into post-discharge care. The nurse provided essential psychosocial support to address the patient’s anxiety regarding physical activity limitations, specifically transitioning away from high-impact sports. By offering tailored counseling and suggesting safe alternative roles, the nurse facilitated the patient’s psychological adaptation and helped maintain vital peer relationships. Concurrently, the nurse strongly promoted long-term health behaviors, emphasizing regular follow-ups, medication adherence, and meticulous dental hygiene to prevent prosthetic valve endocarditis. Ultimately, these integrated nursing interventions ensured the patient’s safe return to daily life with an enhanced overall quality of life.

Transcatheter pulmonary valve replacement is an innovative and effective treatment for pediatric patients with congenital heart disease involving right ventricular outflow tract dysfunction. By providing a less invasive alternative to repeat open-heart surgery, it can improve functional status, enhance quality of life, and postpone future surgical interventions. However,optimal outcomes depend not only on technical procedural success but also on comprehensive multidisciplinary care. Nurses are indispensable members of this team, providing holistic care through patient preparation, procedural support, vigilant monitoring, education, psychosocial support, and long-term follow-up. Their contributions play a pivotal role in promoting patient safety, reducing complications, facilitating successful recovery, and improving long-term quality of life.

Keywords: Cardiac catheterization, Pediatric nursing, Prosthetic heart valve, Transcatheter pulmonary valve replacement