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Biventricular response after pulmonary valve replacement for right ventricular outflow tract dysfunction: is age a predictor of outcome?
Circulation. 2008 Sep 30; 118(14 Suppl):S182-90.Circ

Abstract

BACKGROUND

The timing of pulmonary valve replacement (PVR) for free pulmonary incompetence in patients with congenital heart disease remains a dilemma for clinicians. We wanted to assess the determinants of improvement after PVR for pulmonary regurgitation over a wide range of patient ages and to use any identified predictors to compare clinical outcomes between patient groups.

METHODS AND RESULTS

Seventy-one patients (mean age 22+/-11 years; range, 8.5 to 64.9; 72% tetralogy of Fallot) underwent PVR for severe pulmonary regurgitation. New York Heart Association class improved after PVR (median of 2 to 1, P<0.0001). MRI and cardiopulmonary exercise testing were performed before and 1 year after intervention. After PVR, there was a significant reduction in right ventricular volumes (end diastolic volume 142+/-43 to 91+/-18, end systolic volume 73+/-33 to 43+/-14 mL/m(2), P<0.0001), whereas left ventricular end diastolic volume increased (66+/-12 to 73+/-13 mL/m(2), P<0.0001). Effective cardiac output significantly increased (right ventricular: 3.0+/-0.8 to 3.3+/-0.8 L/min, P=0.013 and left ventricular: 3.0+/-0.6 to 3.4+/-0.7 L/min, P<0.0001). On cardiopulmonary exercise testing, ventilatory response to carbon dioxide production at anaerobic threshold improved from 35.9+/-5.8 to 34.1+/-6.2 (P=0.008). Normalization of ventilatory response to carbon dioxide production was most likely to occur when PVR was performed at an age younger than 17.5 years (P=0.013).

CONCLUSIONS

A relatively aggressive PVR policy (end diastolic volume <150 mL/m(2)) leads to normalization of right ventricular volumes, improvement in biventricular function, and submaximal exercise capacity. Normalization of ventilatory response to carbon dioxide production is most likely to occur when surgery is performed at an age </=17.5 years. This is also associated with a better left ventricular filling and systolic function after surgery.

Authors+Show Affiliations

Cardiothoracic Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK. alessandra.frigiola@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

18824753

Citation

Frigiola, Alessandra, et al. "Biventricular Response After Pulmonary Valve Replacement for Right Ventricular Outflow Tract Dysfunction: Is Age a Predictor of Outcome?" Circulation, vol. 118, no. 14 Suppl, 2008, pp. S182-90.
Frigiola A, Tsang V, Bull C, et al. Biventricular response after pulmonary valve replacement for right ventricular outflow tract dysfunction: is age a predictor of outcome? Circulation. 2008;118(14 Suppl):S182-90.
Frigiola, A., Tsang, V., Bull, C., Coats, L., Khambadkone, S., Derrick, G., Mist, B., Walker, F., van Doorn, C., Bonhoeffer, P., & Taylor, A. M. (2008). Biventricular response after pulmonary valve replacement for right ventricular outflow tract dysfunction: is age a predictor of outcome? Circulation, 118(14 Suppl), S182-90. https://doi.org/10.1161/CIRCULATIONAHA.107.756825
Frigiola A, et al. Biventricular Response After Pulmonary Valve Replacement for Right Ventricular Outflow Tract Dysfunction: Is Age a Predictor of Outcome. Circulation. 2008 Sep 30;118(14 Suppl):S182-90. PubMed PMID: 18824753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biventricular response after pulmonary valve replacement for right ventricular outflow tract dysfunction: is age a predictor of outcome? AU - Frigiola,Alessandra, AU - Tsang,Victor, AU - Bull,Catherine, AU - Coats,Louise, AU - Khambadkone,Sachin, AU - Derrick,Graham, AU - Mist,Bryan, AU - Walker,Fiona, AU - van Doorn,Carin, AU - Bonhoeffer,Philipp, AU - Taylor,Andrew M, PY - 2008/10/10/pubmed PY - 2008/10/24/medline PY - 2008/10/10/entrez SP - S182 EP - 90 JF - Circulation JO - Circulation VL - 118 IS - 14 Suppl N2 - BACKGROUND: The timing of pulmonary valve replacement (PVR) for free pulmonary incompetence in patients with congenital heart disease remains a dilemma for clinicians. We wanted to assess the determinants of improvement after PVR for pulmonary regurgitation over a wide range of patient ages and to use any identified predictors to compare clinical outcomes between patient groups. METHODS AND RESULTS: Seventy-one patients (mean age 22+/-11 years; range, 8.5 to 64.9; 72% tetralogy of Fallot) underwent PVR for severe pulmonary regurgitation. New York Heart Association class improved after PVR (median of 2 to 1, P<0.0001). MRI and cardiopulmonary exercise testing were performed before and 1 year after intervention. After PVR, there was a significant reduction in right ventricular volumes (end diastolic volume 142+/-43 to 91+/-18, end systolic volume 73+/-33 to 43+/-14 mL/m(2), P<0.0001), whereas left ventricular end diastolic volume increased (66+/-12 to 73+/-13 mL/m(2), P<0.0001). Effective cardiac output significantly increased (right ventricular: 3.0+/-0.8 to 3.3+/-0.8 L/min, P=0.013 and left ventricular: 3.0+/-0.6 to 3.4+/-0.7 L/min, P<0.0001). On cardiopulmonary exercise testing, ventilatory response to carbon dioxide production at anaerobic threshold improved from 35.9+/-5.8 to 34.1+/-6.2 (P=0.008). Normalization of ventilatory response to carbon dioxide production was most likely to occur when PVR was performed at an age younger than 17.5 years (P=0.013). CONCLUSIONS: A relatively aggressive PVR policy (end diastolic volume <150 mL/m(2)) leads to normalization of right ventricular volumes, improvement in biventricular function, and submaximal exercise capacity. Normalization of ventilatory response to carbon dioxide production is most likely to occur when surgery is performed at an age </=17.5 years. This is also associated with a better left ventricular filling and systolic function after surgery. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/18824753/Biventricular_response_after_pulmonary_valve_replacement_for_right_ventricular_outflow_tract_dysfunction:_is_age_a_predictor_of_outcome L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.107.756825?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -