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Current approaches to pulmonary regurgitation.
Eur J Cardiothorac Surg. 2008 Sep; 34(3):576-80; discussion 581-2.EJ

Abstract

OBJECTIVE

To evaluate the effects on ventricular function and volumes following right ventricular outflow tract reconstruction (RVOTR) with pulmonary homograft replacement (PVR) and percutaneous pulmonary valve implantation (PPVI) for predominant pulmonary regurgitation. This study was not intended to compare the two approaches.

METHODS

We prospectively examined 25 patients (mean age 21+/-13 years, 96% tetralogy of Fallot, 1/25 with conduit dysfunction) who had PVR with RVOTR for severe pulmonary regurgitation (PR), and 11 patients (mean age 20+/-9 years, 64% tetralogy of Fallot, 9/11 with conduit dysfunction) who underwent PPVI for predominant PR. Mean age at primary repair in both groups was 4.3+/-6.6 years. Magnetic resonance imaging was performed prior to, and 1 year following, interventions.

RESULTS

Before procedure, NYHA classification was similar in both groups 2.1+/-0.5. Following interventions, there was a significant reduction in RV volumes in both groups. In the surgical (PVR) group, RV end-diastolic volume (EDV) decreased from 151+/-49 to 97+/-32 ml/m(2) (p<0.0001) whereas end-systolic volume (ESV) decreased from 80+/-43 to 46+/-23 ml/m(2) (p<0.0001). In the PPVI group, RV EDV decreased from 106+/-27 to 89+/-25 ml/m(2) (p=0.002) and RV ESV from 49+/-20 to 40+/-16 ml/m(2) (p=0.034). Both groups had a significant improvement in RV (63+/-20 to 72+/-16 ml/beat, p=0.003 (PVR group), 53+/-14 to 67+/-16 ml/beat, p=0.030 (PPVI group)) and LV effective stroke volume (61+/-18 to 73+/-16 ml/beat, p=0.001 (PVR group); 59+/-24 to 75+/-16 ml/beat, p=0.009 (PPVI group)).

CONCLUSIONS

Following either PVR with RVOTR or PPVI, there was a significant reduction in RV volumes and an improvement in RV function. Importantly, in both groups, LV effective SV increased, and this may be the parameter to judge the benefit of the procedure. These results also support PPVI as an extra dimension in complex RVOT management.

Authors+Show Affiliations

Great Ormond Street Hospital for Children, London, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18539471

Citation

Frigiola, Alessandra, et al. "Current Approaches to Pulmonary Regurgitation." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 34, no. 3, 2008, pp. 576-80; discussion 581-2.
Frigiola A, Tsang V, Nordmeyer J, et al. Current approaches to pulmonary regurgitation. Eur J Cardiothorac Surg. 2008;34(3):576-80; discussion 581-2.
Frigiola, A., Tsang, V., Nordmeyer, J., Lurz, P., van Doorn, C., Taylor, A. M., Bonhoeffer, P., & de Leval, M. (2008). Current approaches to pulmonary regurgitation. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 34(3), 576-80; discussion 581-2. https://doi.org/10.1016/j.ejcts.2008.04.046
Frigiola A, et al. Current Approaches to Pulmonary Regurgitation. Eur J Cardiothorac Surg. 2008;34(3):576-80; discussion 581-2. PubMed PMID: 18539471.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current approaches to pulmonary regurgitation. AU - Frigiola,Alessandra, AU - Tsang,Victor, AU - Nordmeyer,Johannes, AU - Lurz,Philipp, AU - van Doorn,Carin, AU - Taylor,Andrew M, AU - Bonhoeffer,Philipp, AU - de Leval,Mark, Y1 - 2008/06/09/ PY - 2007/09/05/received PY - 2008/04/29/revised PY - 2008/04/30/accepted PY - 2008/6/10/pubmed PY - 2009/10/20/medline PY - 2008/6/10/entrez SP - 576-80; discussion 581-2 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 34 IS - 3 N2 - OBJECTIVE: To evaluate the effects on ventricular function and volumes following right ventricular outflow tract reconstruction (RVOTR) with pulmonary homograft replacement (PVR) and percutaneous pulmonary valve implantation (PPVI) for predominant pulmonary regurgitation. This study was not intended to compare the two approaches. METHODS: We prospectively examined 25 patients (mean age 21+/-13 years, 96% tetralogy of Fallot, 1/25 with conduit dysfunction) who had PVR with RVOTR for severe pulmonary regurgitation (PR), and 11 patients (mean age 20+/-9 years, 64% tetralogy of Fallot, 9/11 with conduit dysfunction) who underwent PPVI for predominant PR. Mean age at primary repair in both groups was 4.3+/-6.6 years. Magnetic resonance imaging was performed prior to, and 1 year following, interventions. RESULTS: Before procedure, NYHA classification was similar in both groups 2.1+/-0.5. Following interventions, there was a significant reduction in RV volumes in both groups. In the surgical (PVR) group, RV end-diastolic volume (EDV) decreased from 151+/-49 to 97+/-32 ml/m(2) (p<0.0001) whereas end-systolic volume (ESV) decreased from 80+/-43 to 46+/-23 ml/m(2) (p<0.0001). In the PPVI group, RV EDV decreased from 106+/-27 to 89+/-25 ml/m(2) (p=0.002) and RV ESV from 49+/-20 to 40+/-16 ml/m(2) (p=0.034). Both groups had a significant improvement in RV (63+/-20 to 72+/-16 ml/beat, p=0.003 (PVR group), 53+/-14 to 67+/-16 ml/beat, p=0.030 (PPVI group)) and LV effective stroke volume (61+/-18 to 73+/-16 ml/beat, p=0.001 (PVR group); 59+/-24 to 75+/-16 ml/beat, p=0.009 (PPVI group)). CONCLUSIONS: Following either PVR with RVOTR or PPVI, there was a significant reduction in RV volumes and an improvement in RV function. Importantly, in both groups, LV effective SV increased, and this may be the parameter to judge the benefit of the procedure. These results also support PPVI as an extra dimension in complex RVOT management. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/18539471/Current_approaches_to_pulmonary_regurgitation_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2008.04.046 DB - PRIME DP - Unbound Medicine ER -