Multimodality Imaging of the Neglected Valve: Role of Echocardiography, Cardiac Magnetic Resonance and Cardiac Computed Tomography in Pulmonary Stenosis and Regurgitation

Costantini, Pietro; Perone, Francesco; Siani, Agnese; Groenhoff, Léon; Muscogiuri, Giuseppe; Sironi, Sandro; Marra, Paolo; Carriero, Serena; Pavon, Anna Giulia; Guglielmo, Marco

doi:10.3390/jimaging8100278

Cited by 12 publications

(8 citation statements)

References 60 publications

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“…In this regard, cardiac MRI has demonstrated to be a reliable tool for the assessment of RV global longitudinal and radial strains in a population of patients with repaired Tetralogy of Fallot and may overcome some of the limitations of transthoracic echocardiography [ 24 ]. Moreover, it is reported that long-standing RV pressure overload may lead to myocardial fibrosis assessed on cardiac MRI, and this finding can possibly jeopardize the benefits of pressure overload relief [ 25 ]. However, in our cohort, we did not find significant differences in terms of RV functional recovery after BPV between younger and older children.…”

Section: Discussionmentioning

confidence: 99%

Acute Changes in Right Ventricular Function in Pediatric Patients with Pulmonary Valve Stenosis Undergoing Percutaneous Valvuloplasty: A Speckle-Tracking Study

Sirico

Spigariol

Mahmoud

et al. 2023

JCM

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Introduction: Pulmonary valve stenosis determines multiple effects on the right ventricular dimension and function. Percutaneous balloon valvuloplasty is the treatment of choice in severe pulmonary valve stenosis in patients of all ages. However, little is known regarding right ventricular function immediate changes after percutaneous balloon dilation. Pediatric patients with isolated pulmonary valve stenosis represent a pure clinical model of chronic RV pressure overload not affected by other confounders or comorbidities. Aim of the study: This study seeks to explore right ventricle (RV) mechanics in pediatric patients early after percutaneous balloon pulmonary valvuloplasty (BPV) for valvar pulmonary stenosis (PS). Materials and Methods: Forty-three pediatric patients (19 males), mean age 3.2 ± 4.9 years old, with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited. All patients underwent standard transthoracic echocardiography (TTE), and speckle-tracking echocardiography (STE) with an analysis of right ventricle free-wall longitudinal strain (RVFWLS) one day before and one day after the procedure. For each patient, we collected invasive parameters during the interventional procedure before and after BPV. Results: After the procedure, there was an immediate significant reduction in both peak-to-peak transpulmonary gradient (peak-to-peak PG) and ratio between the right ventricle and aortic systolic pressure (RV/AoP) with a drop of ∆29.3 ± 14.67 mmHg and ∆0.43 ± 0.03, respectively. Post-procedural echocardiography showed peak and mean transvalvar pressure gradient drop (∆50 ± 32.23 and ∆31 ± 17.97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, affecting 29% of our patients post-BPV (p = 0.007). The analysis of right ventricular mechanics showed a significant improvement of fractional area change (FAC) immediately after BPV (40.11% vs. 44.42%, p = 0.01). On the other hand, right ventricular longitudinal systolic function parameters, TAPSE and global RVFWLS, did not improve significantly after intervention. The segmental analysis of the RVFWLS showed a significant regional increase in the myocardial deformation of the apical segments. Conclusions: Percutaneous BPV represents an efficient and safe procedure to relieve severe pulmonary valve stenosis. The analysis of the right ventricular function on echocardiography demonstrated an immediate global systolic function improvement, while longitudinal systolic function was persistently impaired 24 h after intervention, possibly due to the necessity of a longer recovery time.

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Section: Discussionmentioning

confidence: 99%

Acute Changes in Right Ventricular Function in Pediatric Patients with Pulmonary Valve Stenosis Undergoing Percutaneous Valvuloplasty: A Speckle-Tracking Study

Sirico

Spigariol

Mahmoud

et al. 2023

JCM

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“…Moreover, it gives detailed information about prosthetic valves, and it is also essential for surgical and transcatheter intervention planning. 20 To correctly visualize the pulmonary valve and its surrounding structures, the right heart chambers must be appropriately opacified using optimal imaging methodology and ECG-gated acquisitions: in particular, the split-bolus injection offers adequate attenuation for right heart chambers avoiding streak artifacts from high-attenuation contrast medium. 21 …”

Section: Diagnosismentioning

confidence: 99%

Pulmonary Valve Stenosis: From Diagnosis to Current Management Techniques and Future Prospects

Marchini¹,

Meossi²,

Passarini³

et al. 2023

VHRM

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Pulmonary stenosis (PS) is mainly a congenital defect that accounts for 7–12% of congenital heart diseases (CHD). It can be isolated or, more frequently, associated with other congenital defects (25–30%) involving anomalies of the pulmonary vascular tree. For the diagnosis of PS an integrated approach with echocardiography, cardiac computed tomography and cardiac magnetic resonance (CMR) is of paramount importance for the planning of the interventional treatment. In recent years, transcatheter approaches for the treatment of PS have increased however, meaning surgery is a possible option for complicated cases with anatomy not suitable for percutaneous treatment. The present review aims to summarize current knowledge regarding diagnosis and treatment of PS.

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“…Both echocardiography and cardiac magnetic resonance (CMR) imaging are used to assess PR, with CMR flow quantification considered the benchmark standard. 23 , 24 Cross-sectional imaging is most reliable for the quantification of ventricular volumes and function in the tripartite RV. Cardiac magnetic resonance and CCT are both used to quantify ventricular volumes and function.…”

Section: Multimodality Definitions Of Pulmonary Valve Bioprosthetic V...mentioning

confidence: 99%

Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits, and Bioprosthetic Valves

Han,

Garcia,

Aboulhosn

et al. 2023

World J Pediatr Congenit Heart Surg

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This consensus document for the performance of cardiovascular computed tomography (CCT) to guide intervention in the right ventricular outflow tract (RVOT) in patients with congenital heart disease (CHD) was developed collaboratively by pediatric and adult interventionalists, surgeons, and cardiac imagers with expertise specific to this patient subset. The document summarizes definitions of RVOT dysfunction as assessed by multimodality imaging techniques and reviews existing consensus statements and guideline documents pertaining to indications for intervention. In the context of this background information, recommendations for CCT scan acquisition and a standardized approach for reporting prior to surgical or transcatheter pulmonary valve replacement are proposed and presented. It is the first Imaging for Intervention collaboration for CHD patients and encompasses imaging and reporting recommendations prior to both surgical and percutaneous pulmonary valve replacement.

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Multimodality Imaging of the Neglected Valve: Role of Echocardiography, Cardiac Magnetic Resonance and Cardiac Computed Tomography in Pulmonary Stenosis and Regurgitation

Cited by 12 publications

References 60 publications

Acute Changes in Right Ventricular Function in Pediatric Patients with Pulmonary Valve Stenosis Undergoing Percutaneous Valvuloplasty: A Speckle-Tracking Study

Acute Changes in Right Ventricular Function in Pediatric Patients with Pulmonary Valve Stenosis Undergoing Percutaneous Valvuloplasty: A Speckle-Tracking Study

Pulmonary Valve Stenosis: From Diagnosis to Current Management Techniques and Future Prospects

Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits, and Bioprosthetic Valves

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