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Right ventricular remodelling after transcatheter pulmonary valve implantation.
Catheter Cardiovasc Interv. 2017 Sep 01; 90(3):407-417.CC

Abstract

OBJECTIVES

To define the optimal timing for percutaneous pulmonary valve implantation (PPVI) in patients with severe pulmonary regurgitation (PR) after Fallot's Tetralogy (ToF) correction.

BACKGROUND

PPVI among the aforementioned patients is mainly driven by symptoms or by severe right ventricular (RV) dilatation/dysfunction. The optimal timing for PPVI is still disputed.

METHODS

Twenty patients [age 13.9 ± 9.2 years, (range 4.3-44.9), male 70%] with severe PR (≥3 grade) secondary to previous correction of ToF, underwent Melody valve (Medtronic, Minneapolis, MN) implantation, after a pre-stent placement. Full echocardiographic assessment (traditional and deformation analysis) and cardiovascular magnetic resonance evaluation were performed before and at 3 months after the intervention. 'Favorable remodelling' was considered the upper quartile of RV size decrease (>20% in 3 months).

RESULTS

After PPVI, indexed RV effective stroke volume increased from 38.4 ± 9.5 to 51.4 ± 10.7 mL/m2 , (P = 0.005), while RV end-diastolic volume and strain indices decreased (123.1 ± 24.1-101.5 ± 18.3 mL/m2 , P = 0.005 and -23.5 ± 2.5 to -21 ± 2.5%, P = 0.002, respectively). After inserting pre-PPVI clinical, RV volumetric and deformation parameters in a multiple regression model, only time after last surgical correction causing PR remained as significant regressor of RV remodelling [R2 = 0.60, beta = 0.387, 95%CI(0.07-0.7), P = 0.019]. Volume reduction and functional improvement were more pronounced in patients treated with PPVI earlier than 7 years after last RV outflow tract (RVOT) correction, reaching close-to-normal values.

CONCLUSIONS

Early PPVI (<7 years after last RVOT operation) is associated with a more favorable RV reverse remodelling toward normal range and should be considered, before symptoms or RV damage become apparent. © 2017 Wiley Periodicals, Inc.

Authors+Show Affiliations

Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium.Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium.Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium.Department of Radiology, University Hospital Leuven, Leuven, 3000, Belgium.Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium.Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28296032

Citation

Pagourelias, Efstathios D., et al. "Right Ventricular Remodelling After Transcatheter Pulmonary Valve Implantation." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 90, no. 3, 2017, pp. 407-417.
Pagourelias ED, Daraban AM, Mada RO, et al. Right ventricular remodelling after transcatheter pulmonary valve implantation. Catheter Cardiovasc Interv. 2017;90(3):407-417.
Pagourelias, E. D., Daraban, A. M., Mada, R. O., Duchenne, J., Mirea, O., Cools, B., Heying, R., Boshoff, D., Bogaert, J., Budts, W., Gewillig, M., & Voigt, J. U. (2017). Right ventricular remodelling after transcatheter pulmonary valve implantation. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 90(3), 407-417. https://doi.org/10.1002/ccd.26966
Pagourelias ED, et al. Right Ventricular Remodelling After Transcatheter Pulmonary Valve Implantation. Catheter Cardiovasc Interv. 2017 Sep 1;90(3):407-417. PubMed PMID: 28296032.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Right ventricular remodelling after transcatheter pulmonary valve implantation. AU - Pagourelias,Efstathios D, AU - Daraban,Ana M, AU - Mada,Razvan O, AU - Duchenne,Jürgen, AU - Mirea,Oana, AU - Cools,Bjorn, AU - Heying,Ruth, AU - Boshoff,Derize, AU - Bogaert,Jan, AU - Budts,Werner, AU - Gewillig,Marc, AU - Voigt,Jens-Uwe, Y1 - 2017/03/15/ PY - 2016/06/12/received PY - 2016/12/13/revised PY - 2017/01/16/accepted PY - 2017/3/16/pubmed PY - 2018/5/22/medline PY - 2017/3/16/entrez KW - congenital heart disease adults KW - imaging TEE/TTE KW - imaging cardiac magnetic resonance imaging KW - right ventricular function KW - transcatheter valve implantation SP - 407 EP - 417 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 90 IS - 3 N2 - OBJECTIVES: To define the optimal timing for percutaneous pulmonary valve implantation (PPVI) in patients with severe pulmonary regurgitation (PR) after Fallot's Tetralogy (ToF) correction. BACKGROUND: PPVI among the aforementioned patients is mainly driven by symptoms or by severe right ventricular (RV) dilatation/dysfunction. The optimal timing for PPVI is still disputed. METHODS: Twenty patients [age 13.9 ± 9.2 years, (range 4.3-44.9), male 70%] with severe PR (≥3 grade) secondary to previous correction of ToF, underwent Melody valve (Medtronic, Minneapolis, MN) implantation, after a pre-stent placement. Full echocardiographic assessment (traditional and deformation analysis) and cardiovascular magnetic resonance evaluation were performed before and at 3 months after the intervention. 'Favorable remodelling' was considered the upper quartile of RV size decrease (>20% in 3 months). RESULTS: After PPVI, indexed RV effective stroke volume increased from 38.4 ± 9.5 to 51.4 ± 10.7 mL/m2 , (P = 0.005), while RV end-diastolic volume and strain indices decreased (123.1 ± 24.1-101.5 ± 18.3 mL/m2 , P = 0.005 and -23.5 ± 2.5 to -21 ± 2.5%, P = 0.002, respectively). After inserting pre-PPVI clinical, RV volumetric and deformation parameters in a multiple regression model, only time after last surgical correction causing PR remained as significant regressor of RV remodelling [R2 = 0.60, beta = 0.387, 95%CI(0.07-0.7), P = 0.019]. Volume reduction and functional improvement were more pronounced in patients treated with PPVI earlier than 7 years after last RV outflow tract (RVOT) correction, reaching close-to-normal values. CONCLUSIONS: Early PPVI (<7 years after last RVOT operation) is associated with a more favorable RV reverse remodelling toward normal range and should be considered, before symptoms or RV damage become apparent. © 2017 Wiley Periodicals, Inc. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/28296032/Right_ventricular_remodelling_after_transcatheter_pulmonary_valve_implantation_ L2 - https://doi.org/10.1002/ccd.26966 DB - PRIME DP - Unbound Medicine ER -