European Heart Journal Advance Access originally published online on June 26, 2007
European Heart Journal 2007 28(15):1886-1893; doi:10.1093/eurheartj/ehm181
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physiological consequences of percutaneous pulmonary valve implantation: the different behaviour of volume- and pressure-overloaded ventricles
1 UCL Institute of Child Health, London, UK
2 Cardiothoracic Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
3 The Heart Hospital, London, UK
Received 29 November 2006; revised 22 February 2007; accepted 13 April 2007; online publish-ahead-of-print 26 June 2007.
* Corresponding author. Tel: +44 2078138106; fax: +44 2078138262. E-mail address: bonhop{at}gosh.nhs.uk
See page 1793 for the editorial comment on this article (doi:10.1093/eurheartj/ehm261)
Aims: To investigate the early clinical and physiological consequences of relieving chronic right ventricular (RV) volume overload with percutaneous pulmonary valve implantation (PPVI).
Methods and results: We selected 17 patients (age 21.2 ± 8.7 years), from a total of 125 who underwent PPVI, because they had important pulmonary regurgitation (PR) [regurgitant fraction > 25% on magnetic resonance (MR)] and an echocardiographic gradient < 50 mmHg across the RV outflow tract. Cardiopulmonary exercise testing, tissue Doppler and MR were performed before and within 3 months of PPVI. Following PPVI, PR (40.7 ± 7.3 to 4.1 ± 6.1%, P < 0.001) and RV end-diastolic volume fell (115.4 ± 33.1 to 98.9 ± 32.0 mL/m2, P = 0.001); effective RV stroke volume increased (34.3 ± 7.8 to 44.4 ± 9.3 mL/m2, P < 0.001). Left ventricular end-diastolic volume (66.6 ± 18.0 to 73.4 ± 16.5 mL/m2, P = 0.014), stroke volume (38.4 ± 11.1 to 46.4 ± 10.2 mL/m2, P = 0.001) and ejection fraction (57.8 ± 8.1 to 63.5 ± 5.2 mL/m2, P = 0.001) increased. Pulmonary artery diastolic pressure (8.9 ± 4.5 to 12.5 ± 5.2 mmHg, P = 0.041) and mitral E/Ea increased (from 9.0 ± 2.0 to 11.6 ± 3.1, P = 0.003). Patients felt better, but standard measures of exercise capacity were unchanged.
Conclusion: PPVI relieves PR and restores compensatory cardiac performance. The lack of improvement in exercise parameters suggests that, in contrast to pressure overload, the contractile reserve of chronically volume-overloaded myocardium is limited.
Key Words: Conduit dysfunction • Volume overload • Ventricular function • Physiology • Percutaneous valve
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in EHJ:
- Deciphering the mystery of the leaky pulmonary valve in a new era of interventional cardiology
- Luc Mertens
EHJ 2007 28: 1793-1794.[Extract] [FREE Full Text]
This article has been cited by other articles:
|
|
 |
|
  E. M. Zahn, W. E. Hellenbrand, J. E. Lock, and D. B. McElhinney Implantation of the melody transcatheter pulmonary valve in patients with a dysfunctional right ventricular outflow tract conduit early results from the u.s. Clinical trial. J. Am. Coll. Cardiol., October 27, 2009; 54(18): 1722 - 1729. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. K. Friedberg and L. Mertens Tissue velocities, strain, and strain rate for echocardiographic assessment of ventricular function in congenital heart disease Eur J Echocardiogr, July 1, 2009; 10(5): 585 - 593. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Lurz, J. Nordmeyer, V. Muthurangu, S. Khambadkone, G. Derrick, R. Yates, M. Sury, P. Bonhoeffer, and A. M. Taylor Comparison of Bare Metal Stenting and Percutaneous Pulmonary Valve Implantation for Treatment of Right Ventricular Outflow Tract Obstruction: Use of an X-Ray/Magnetic Resonance Hybrid Laboratory for Acute Physiological Assessment Circulation, June 16, 2009; 119(23): 2995 - 3001. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Lurz, J Nordmeyer, L Coats, A M Taylor, P Bonhoeffer, and I Schulze-Neick Immediate clinical and haemodynamic benefits of restoration of pulmonary valvar competence in patients with pulmonary hypertension Heart, April 1, 2009; 95(8): 646 - 650. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Mertens Deciphering the mystery of the leaky pulmonary valve in a new era of interventional cardiology Eur. Heart J., August 1, 2007; 28(15): 1793 - 1794. [Full Text] [PDF]
|
|