European Heart Journal Advance Access originally published online on June 4, 2009
European Heart Journal 2009 30(17):2147-2154; doi:10.1093/eurheartj/ehp204
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Quantitative assessment of homograft function 1 year after insertion into the pulmonary position: impact of in situ homograft geometry on valve competence
1 Cardiovascular Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK
2 The Heart Hospital, UCLH, London, UK
3 CHU de Nantes, L'institut du Thorax, Nantes, France
4 Policlinico San Donato Milanese, IRCCS, Milano, Italy
Received 28 January 2009; revised 27 March 2009; accepted 30 April 2009; online publish-ahead-of-print 4 June 2009.
* Corresponding author. Tel: +44 207 405 9200, Fax: +44 207 813 8263, Email: a.taylor{at}ich.ucl.ac.uk
See page 2076 for the editorial comment on this article (doi:10.1093/eurheartj/ehp283)
Aims: To prospectively evaluate homograft function with cardiac magnetic resonance (CMR) imaging 1 year after insertion into the pulmonary position, and to assess the impact of in situ homograft geometry, surgical factors, and ‘intrinsic’ homograft properties on early valve incompetence.
Methods and results: A total of 60 patients (mean age 21 ± 10 years; 35 females) with congenital heart disease underwent pulmonary valve replacement with homograft insertion and were prospectively enrolled into a study protocol that included serial echocardiography and CMR 1 year after surgery. None of the patients had homograft stenosis but 10 (17%) had significant homograft incompetence (i.e. pulmonary regurgitation fraction >20% on CMR). A higher incidence of ‘eccentric’ pulmonary forward flow pattern (P < 0.001, Fisher's exact test), more acute ‘homograft distortion angle’ (P < 0.001), larger relative ‘annular’ size (P < 0.01), and greater pre-homograft right ventricular outflow tract (RVOT) diameters (P = 0.01) at CMR was seen in those with worse homograft function. In a backward multivariate linear regression model, ‘eccentric’ pulmonary forward flow pattern (rpart = 0.36, P < 0.001), ‘homograft distortion angle’ (rpart = 0.31, P = 0.001), and pre-homograft RVOT diameter (rpart = 0.19, P = 0.03) were independently associated with the degree of pulmonary regurgitation (in %) at 1 year.
Conclusion: Using CMR, in this prospective cohort study, we have shown that significant valve incompetence is present in one-sixth of patients after homograft insertion into the pulmonary position, and that alterations in the in situ homograft geometry were associated with the likelihood of developing valve incompetence. These findings imply that mechanical factors may have an important impact on homograft performance.
Key Words: Congenital heart disease • Surgical pulmonary valve replacement • Conduit function • Magnetic resonance imaging
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EHJ 2009 30: 2076-2078.[Extract] [Full Text]
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  L. Grosse-Wortmann and A. Redington Doing the right thing at the right time: is there more to pulmonary valve replacement than meets the eye? Eur. Heart J., September 1, 2009; 30(17): 2076 - 2078. [Full Text] [PDF]
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