Analysis of right ventricle function with strain imaging before and after pulmonary valve replacement

Gürsu, Hazım Alper; Varan, Birgül; Sade, Elif; Erdoğan, İlkay; Özkan, Murat

doi:10.5603/cj.a2016.0007

Cited by 7 publications

(31 citation statements)

References 11 publications

(22 reference statements)

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“…These guidelines are in agreement with the clinical indications generally accepted in the literature for symptomatic patients, with the support of the clinical non-invasive and invasive investigations. [6,8,10,14–19,22–25] The criteria for indications for PV implantation in asymptomatic patients, and particularly the choice of the best timing, are less clearly defined. [52] General agreement exists on the indication for PV implantation in asymptomatic patients in the presence of any of the following criteria, as judged by echocardiography and/or magnetic resonance imaging: (a) PV regurgitation >20%; (b) indexed end-diastolic right ventricular volume >120–150 ml m –2 BSA; or (c) indexed end-systolic right ventricular volume >80–90 ml m –2 BSA.…”

Section: Discussionmentioning

confidence: 99%

“…[2] However, on longer-term follow-up and subsequent review, the presence of severe PV regurgitation was reported to be associated with exercise intolerance, heart failure, ventricular arrhythmias with syncopal episodes and sudden death. [3–11] These symptoms are related to right ventricular volume and/or pressure overload, inducing dilatation and dysfunction, and ultimately right ventricular failure;[5,9,10,12] sometimes the clinical conditions are further complicated by subsequent impairment of the left ventricular function. [9]…”

Section: Introductionmentioning

confidence: 99%

“…[8,10,12–17] Patients with severe PV regurgitation can therefore benefit from this procedure to restore right ventricular volume and improve its function, preventing progression towards right ventricular failure.…”

Section: Introductionmentioning

confidence: 99%

“…While general agreement exists on the need for a PV implantation in the presence of severe PV regurgitation after surgical treatment for congenital heart defects, extensive debates accompany the following issues: timing of PV implantation, particularly in asymptomatic patients;[6–8,10,14–25]choice of the approach, between percutaneous interventional [6,26–33] versus surgical [8,10,12–19,34–38] PV implantation;choice of the most suitable valve;[3,34–48] androle of the surgical right ventricular remodelling. [49–51]…”

Section: Introductionmentioning

confidence: 99%

“…choice of the approach, between percutaneous interventional [6,26–33] versus surgical [8,10,12–19,34–38] PV implantation;…”

Section: Introductionmentioning

confidence: 99%

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Trifecta St. Jude medical® aortic valve in pulmonary position

Corno

Dawson

Bolger

et al. 2017

Nano Reviews & Experiments

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Introduction: To evaluate an aortic pericardial valve for pulmonary valve (PV) regurgitation after repair of congenital heart defects. Methods: From July 2012 to June 2016 71 patients, mean age 24 ± 13 years (four to years) underwent PV implantation of aortic pericardial valve, mean interval after previous repair = 21 ± 10 years (two to 47 years). Previous surgery at mean age 3.2 ± 7.2 years (one day to 49 years): tetralogy of Fallot repair in 83% (59/71), pulmonary valvotomy in 11% (8/71), relief of right ventricular outflow tract (RVOT) obstruction in 6% (4/71). Pre-operative echocardiography and MRI showed severe PV regurgitation in 97% (69/71), moderate in 3% (2/71) with associated RVOT obstruction. MRI and knowledge-based reconstruction 3D volumetry (KBR-3D-volumetry) showed mean PV regurgitation = 42 ± 9% (20–58%), mean indexed RV end-diastolic volume = 169 ± 33 (130–265) ml m–2 BSA and mean ejection fraction (EF) = 46 ± 8% (33–61%). Cardio-pulmonary exercise showed mean peak O2/uptake = 24 ± 8 ml kg–1 min–1 (14–45 ml kg–1 min–1), predicted max O2/uptake 66 ± 17% (26–97%). Pre-operative NYHA class was I in 17% (12/71) patients, II in 70% (50/71) and III in 13% (9/71). Results: Mean cardio-pulmonary bypass duration was 95 ± 30ʹ (38–190ʹ), mean aortic cross-clamp in 23% (16/71) 46 ± 31ʹ (8–95ʹ), with 77% (55/71) implantations without aortic cross-clamp. Size of implanted PV: 21 mm in seven patients, 23 mm in 33, 25 mm in 23, and 27 mm in eight. The z-score of the implanted PV was −0.16 ± 0.80 (−1.6 to 2.5), effective orifice area indexed (for BSA) of native PV was 1.5 ± 0.2 (1.2 to –2.1) vs. implanted PV 1.2 ± 0.3 (0.76 to –2.5) (p = ns). In 76% (54/71) patients surgical RV modelling was associated. Mean duration of mechanical ventilation was 6 ± 5 h (0–26 h), mean ICU stay 21 ± 11 h (12–64 h), mean hospital stay 6 ± 3 days (three to 19 days). In mean follow-up = 25 ± 14 months (six to 53 months) there were no early/late deaths, no need for cardiac intervention/re-operation, no valve-related complications, thrombosis or endocarditis. Last echocardiography showed absent PV regurgitation in 87.3% (62/71) patients, trivial/mild degree in 11.3% (8/71), moderate degree in 1.45% (1/71), mean max peak velocity through RVOT 1.6 ± 0.4 (1.0–2.4) m s–1. Mean indexed RV end-diastolic volume at MRI/KBR-3D-volumetry was 96 ± 20 (63–151) ml m–2 BSA, lower than pre-operatively (p < 0.001), and mean EF = 55 ± 4% (49–61%), higher than pre-operatively (p < 0.05). Almost all patients (99% = 70/71) remain in NYHA class I, 1.45% = 1/71 in class II. Conclusion: (a) Aortic pericardial valve is implantable in PV position with an easy and reproducible surgical technique; (b) valve size adequate for patient BSA can be implanted with simultaneous RV remodelling; (c) medium-term outcomes are good with maintained PV function, RV dimensions significantly reduced and EF significantly improved; (d) adequate valve size will allow later percutaneous valve-in-valve implantation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…choice of the approach, between percutaneous interventional [6,26–33] versus surgical [8,10,12–19,34–38] PV implantation;…”

Section: Introductionmentioning

confidence: 99%

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Trifecta St. Jude medical® aortic valve in pulmonary position

Corno

Dawson

Bolger

et al. 2017

Nano Reviews & Experiments

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Imaging in repaired tetralogy of Fallot with a focus on recent advances in echocardiography

Larios

Friedberg²

2017

Current Opinion in Cardiology

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Evaluation of right ventricle systolic function after tetralogy of Fallot repair: A systematic review comparing cardiac magnetic resonance and global longitudinal strain

Oliveira¹,

Oliveira

Guimarães

et al. 2022

Echocardiography

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Background Most patients who undergo tetralogy of Fallot (TOF) repair experience late right ventricle (RV) dysfunction due to pulmonary valve regurgitation (PVR). Cardiac magnetic resonance (CMR) is the gold standard method for evaluating RV during follow‐up. Global longitudinal strain (GLS) has been introduced as a novel method for the assessment of RV dysfunction. We aimed to compare the feasibility of GLS and CMR for assessing RV function after TOF repair. Methods We systematically reviewed the English literature using PubMed, SciELO and Google Scholar for articles published between January 1, 2015, and December 31, 2020. Articles evaluating RV function comparing by GLS and CMR after TOF repair were included. Results Nine studies including 465 patients were analyzed. Most patients were men (280; 60%), the male:female ratio was 1.5:1, and the age range was .8 to 57.7 years. The mean follow‐up time was 6 to 32 months. The correlation between RV GLS and RV ejection fraction (EF) by CMR was negative for the articles and varied from moderate to strong (r = ‐.45, r = ‐.60, r = ‐.76). Conclusion Right ventricle GLS can be considered for routine follow‐up of TOF repair patients, even though CMR remains the noninvasive gold standard method. Using a single parameter may not allow comparison of the accuracy of 3D RV EF by using CMR and GLS. Further studies with a larger number of patients undergoing TOF repair are required to evaluate the correlation between these examinations.

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Analysis of right ventricle function with strain imaging before and after pulmonary valve replacement

Abstract: (Cardiol J 2016; 23, 2: 195-201)

Cited by 7 publications

References 11 publications

Trifecta St. Jude medical® aortic valve in pulmonary position

Trifecta St. Jude medical® aortic valve in pulmonary position

Imaging in repaired tetralogy of Fallot with a focus on recent advances in echocardiography

Evaluation of right ventricle systolic function after tetralogy of Fallot repair: A systematic review comparing cardiac magnetic resonance and global longitudinal strain

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