Tags

Type your tag names separated by a space and hit enter

Percutaneous pulmonary valve implantation in the young 2-year follow-up.
JACC Cardiovasc Interv. 2010 Apr; 3(4):439-48.JC

Abstract

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/m(2) vs. 114 +/- 35 ml/m(2), 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.

Authors+Show Affiliations

Department of Pediatrics, The Hospital for Sick Children, The Labatt Family Heart Centre, University of Toronto School of Medicine, Toronto, Canada.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)

Journal Article

Language

eng

PubMed ID

20398873

Citation

Vezmar, Marko, et al. "Percutaneous Pulmonary Valve Implantation in the Young 2-year Follow-up." JACC. Cardiovascular Interventions, vol. 3, no. 4, 2010, pp. 439-48.
Vezmar M, Chaturvedi R, Lee KJ, et al. Percutaneous pulmonary valve implantation in the young 2-year follow-up. JACC Cardiovasc Interv. 2010;3(4):439-48.
Vezmar, M., Chaturvedi, R., Lee, K. J., Almeida, C., Manlhiot, C., McCrindle, B. W., Horlick, E. M., & Benson, L. N. (2010). Percutaneous pulmonary valve implantation in the young 2-year follow-up. JACC. Cardiovascular Interventions, 3(4), 439-48. https://doi.org/10.1016/j.jcin.2010.02.003
Vezmar M, et al. Percutaneous Pulmonary Valve Implantation in the Young 2-year Follow-up. JACC Cardiovasc Interv. 2010;3(4):439-48. PubMed PMID: 20398873.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous pulmonary valve implantation in the young 2-year follow-up. AU - Vezmar,Marko, AU - Chaturvedi,Rajiv, AU - Lee,Kyong-Jin, AU - Almeida,Claudia, AU - Manlhiot,Cedric, AU - McCrindle,Brian W, AU - Horlick,Eric M, AU - Benson,Lee N, PY - 2009/07/13/received PY - 2010/01/27/revised PY - 2010/02/03/accepted PY - 2010/4/20/entrez PY - 2010/4/20/pubmed PY - 2010/7/10/medline SP - 439 EP - 48 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 3 IS - 4 N2 - 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/m(2) vs. 114 +/- 35 ml/m(2), 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. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/20398873/Percutaneous_pulmonary_valve_implantation_in_the_young_2_year_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(10)00136-6 DB - PRIME DP - Unbound Medicine ER -