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European Heart Journal Advance Access published online on June 26, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm181
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Physiological consequences of percutaneous pulmonary valve implantation: the different behaviour of volume- and pressure-overloaded ventricles

Louise Coats1,2, Sachin Khambadkone1,2, Graham Derrick1,2, Marina Hughes1,2, Rod Jones1,2, Bryan Mist3, Denis Pellerin3, Jan Marek1,2, John E. Deanfield1,2, Philipp Bonhoeffer1,2,* and Andrew M. Taylor1,2

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

* Corresponding author. Tel: +44 2078138106; fax: +44 2078138262. E-mail address: bonhop{at}gosh.nhs.uk

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


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