Author + information
- Received July 13, 2009
- Revision received January 27, 2010
- Accepted February 3, 2010
- Published online April 1, 2010.
- Marko Vezmar, MSc, MD⁎,
- Rajiv Chaturvedi, MD, PhD⁎,
- Kyong-Jin Lee, MD⁎,
- Claudia Almeida, MD⁎,
- Cedric Manlhiot, BSc⁎,
- Brian W. McCrindle, MD⁎,
- Eric M. Horlick, MD† and
- Lee N. Benson, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Lee N. Benson, Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
Objectives The aim of this study was to investigate physiological and clinical consequences of percutaneous pulmonary valve implantation (PPVI) in patients with chronic right ventricular outflow tract (RVOT) obstruction and volume overload.
Background The PPVI is a nonsurgical technique to address RVOT conduit dysfunction.
Methods Twenty-eight adolescents (median age 14.9 years; age range 10.9 to 19 years) underwent PPVI due to RVOT stenosis and/or pulmonary regurgitation (PR). Before and after PPVI echocardiographic and magnetic resonance imaging, cardiopulmonary exercise tests were obtained.
Results The RVOT gradient (p < 0.001) and right ventricular (RV) systolic pressure decreased (p < 0.001), acutely. Magnetic resonance imaging (median 6 months) documented reduction in RV end-diastolic (149 ± 49 ml/m2 vs. 114 ± 35 ml/m2, p < 0.005) volume, increases in left ventricular (LV) end-diastolic (p < 0.007) volume and cardiac output (RV: p < 0.04 and LV: p < 0.02), and reduced PR fraction (24 ± 10% to 7 ± 7%, p < 0.0001). Symptoms, aerobic exercise performance (maximal oxygen consumption: p < 0.0001) and ventilatory response to carbon dioxide production (p < 0.003) improved. After 24 months, echocardiography demonstrated the RV/systemic-pressure ratio, and RVOT peak pressure gradient reductions persisted, and PR was absent in 93% (n = 12 of 13) of the cohort. Freedom from surgery was 91%, 83%, and 83%, and freedom from transcatheter reintervention was 91%, 80%, and 80%, at 12, 24, and 36 months, respectively. There were no acute device-related complications, with stent fractures noted in 10.8%.
Conclusions Percutaneous pulmonary valve implantation is feasible and safe in the young with dysfunctional RVOT conduits. An improvement in symptoms, hemodynamic status, and objective findings of exercise performance occurs. Early follow-up demonstrates persistent improvement in ventricular parameters, PR, and objective exercise capacity.
- pulmonary insufficiency
- pulmonary stenosis
- pulmonary valve implant
- right ventricular outflow tract obstruction
- tetralogy of Fallot
- Received July 13, 2009.
- Revision received January 27, 2010.
- Accepted February 3, 2010.
- American College of Cardiology Foundation