Percutaneous pulmonary valve implantation in the young: 2-year follow-up

Marko Vezmar, Rajiv Chaturvedi, Kyong Jin Lee, Claudia Almeida, Cedric Manlhiot, Brian W. McCrindle, Eric M. Horlick, Lee N. Benson

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)439-448
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume3
Issue number4
DOIs
StatePublished - Mar 2010

Keywords

  • pulmonary insufficiency
  • pulmonary stenosis
  • pulmonary valve implant
  • right ventricular outflow tract obstruction
  • tetralogy of Fallot

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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